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1.
World J Urol ; 2020 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-32052128

RESUMO

PURPOSE: To report the outcomes of AUS in women with neurological SUI resulting from intrinsic sphincter deficiency after a follow-up from 3 to 20 years. METHODS: The charts of female with moderate to severe neurological SUI who underwent open or laparoscopic AUS implantation between November 1994 and July 2014 were reviewed retrospectively. All patients were operated by a single experienced surgeon. Primary endpoint was a postoperative continence categorized as complete continence (no pads used), improved incontinence or unchanged incontinence. RESULTS: Twenty-three women (mean age 54 years, range 19-77) underwent open or laparoscopic AUS implantation. At the last follow-up, 7 (30.4%) initial artificial urinary sphincters remained in situ and 9 (39.1%) patients had at least one revision or reimplantation. Sixteen patients were fully continent (69.6%), four (17.4%) had improved incontinence and three (13.0%) had unchanged incontinence. After a median follow-up of 11.6 years (3-22), 8 (34.8%) explanations in 7 patients and 16 (69.6%) revisions in 11 patients occurred. The average time without explanation or revision was 10.9 and 8.5 years, respectively. Survival rates without AUS explanation were 94.4%, 76.5%, 72.8%, 50% and without revision were 83.3%, 64.7%, 45.5% and 16.7% at 5, 10, 15 and 20 years, respectively. CONCLUSION: Although all methods are imperfect at best, AUS remain toward our experience a good way to achieve long-term continence in female patients suffering from neurological SUI with preserved manual dexterity.

2.
BJOG ; 127(1): 88-97, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31544327

RESUMO

OBJECTIVE: To assess the short-term incidence of serious complications of surgery for urinary incontinence or pelvic organ prolapse. DESIGN: Prospective longitudinal cohort study using a surgical registry. SETTING: Thirteen public hospitals in France. POPULATION: A cohort of 1873 women undergoing surgery between February 2017 and August 2018. METHODS: Preliminary analysis of serious complications after a mean follow-up of 7 months (0-18 months), according to type of surgery. Surgeons reported procedures and complications, which were verified by the hospitals' information systems. MAIN OUTCOME MEASURES: Serious complication requiring discontinuation of the procedure or subsequent surgical intervention, life-threatening complication requiring resuscitation, or death. RESULTS: Fifty-two women (2.8%, 95% CI 2.1-3.6%) experienced a serious complication either during surgery, requiring the discontinuation of the procedure, or during the first months of follow-up, necessitating a subsequent reoperation. One woman also required resuscitation; no women died. Of 811 midurethral slings (MUSs), 11 were removed in part or totally (1.4%, 0.7-2.3%), as were two of 391 transvaginal meshes (0.5%, 0.1-1.6%), and four of 611 laparoscopically placed mesh implants (0.7%, 0.2-1.5%). The incidence of serious complications 6 months after the surgical procedure was estimated to be around 3.5% (2.0-5.0%) after MUS alone, 7.0% (2.8-11.3%) after MUS with prolapse surgery, 1.7% (0.0-3.8%) after vaginal native tissue repair, 2.8% (0.9-4.6%) after transvaginal mesh, and 1.0% (0.1-1.9%) after laparoscopy with mesh. CONCLUSIONS: Early serious complications are relatively rare. Monitoring must be continued and expanded to assess the long-term risk associated with mesh use and to identify its risk factors. TWEETABLE ABSTRACT: Short-term serious complications are rare after surgery for urinary incontinence or pelvic organ prolapse, even with mesh.


Assuntos
Diafragma da Pelve/cirurgia , Prolapso de Órgão Pélvico/cirurgia , Telas Cirúrgicas/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Colposcopia/efeitos adversos , Colposcopia/mortalidade , Colposcopia/estatística & dados numéricos , Feminino , França/epidemiologia , Humanos , Incidência , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/mortalidade , Pessoa de Meia-Idade , Prolapso de Órgão Pélvico/mortalidade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/mortalidade , Estudos Prospectivos , Sistema de Registros , Slings Suburetrais/efeitos adversos , Slings Suburetrais/estatística & dados numéricos , Telas Cirúrgicas/estatística & dados numéricos , Centros Cirúrgicos/estatística & dados numéricos , Adulto Jovem
3.
Prog Urol ; 29(11): 560-566, 2019 Sep.
Artigo em Francês | MEDLINE | ID: mdl-31471265

RESUMO

BACKGROUND: Patients with detrusor-sphincter dysynergia (DSD) who are unable to perform self-catheterisation can benefit from an endoscopic treatment. We chose regular urethral stent changes as an alternative to sphincterotomy in this kind of patients. The purpose of this study is to show that temporary urethral stents changes represent a treatment option with a reasonable morbidity for patients with DSD. METHODS: We retrospectively reviewed patients in our center who had been treated with urethral stents from April 2005 to September 2017. The stent changes were performed every 12 to 18 months depending on urethrovesical fibroscopy findings. The primary endpoint was treatment continuation. RESULTS: A total of 44 patients were enrolled in our study and the average follow-up duration was 46 months [18.5-53.25]. Primary treatment failure was seen in 14 (32%) patients mainly due to problems related to equipment (n=3) and urinary retention (n=2). Four patients died before their first stent change. The treatment was successful in 30 (68%) patients, of whom 10 (33%) subsequently adopted a voiding mode change. We lost sight of 5 patients (11%) during follow-up. The main complications were urinary retention (29%), urinary tract infections (27%) and stent migration (18%). Fifteen (34%) experienced grade III-IV complications. CONCLUSIONS: Regular urethral stent changes represent an alternative treatment option for patients with DSD but with a significant morbidity. LEVEL OF EVIDENCE: 4.

4.
Prog Urol ; 28(7): 382-386, 2018 Jun.
Artigo em Francês | MEDLINE | ID: mdl-29526581

RESUMO

INTRODUCTION: The intravesical instillation of dimethyl sulfoxide (iDMSO), performed without anesthestic, is a therapeutic option for the painful bladder syndrome/interstial cystitis (PBS/IC). Some patients are against those iDMSO because of bad tolerance. Our study evaluates the tolerance and the outcome of the iDMSO under general anesthetic (GA) after the failure of the iDMSO without anesthetic. PATIENTS AND METHODS: From May 2013 to April 2016, 11 patients with a PBS, 9 women (81.8 %), have been treated by iDMSO without anesthetic, without improvement because of bad tolerance and no possibility to have a one hour contact between the bladder and the DMSO. The 11 patients were evaluated by mictional calendar and Sant O'Leary score. All the patients had a hydrodistension and a per os treatment without improvement. OUTCOMES: Six new iDMSO were performed under general anesthetic in ambulatory surgery with good tolerance for the 11 patients. The frequency and the nocturia before iDMSO without anesthetic and after iDMSO under general anesthetic were 32.2minutes [15; 60] and 6.3 per night [3; 10] and 126.9minutes [25; 240] and 3 per night [2; 6], so a variation respectively of 96.4minutes [0; 180] and of 3.75 per night [2; 6]. The symptom score and the problem index were 17.5 [13; 20] and 15.5 [13; 16] before and 13.5 [4; 20] and 12 [1; 16] after iDMSO under general anesthetic; a variation of 3.2 [0; 9] and 4 [0; 12]. CONCLUSION: The iDMSO under general anesthetic seems to improve objectively and subjectively the patients who are not improved by the instillations without anesthetic because of bad tolerance. LEVEL OF EVIDENCE: 4.


Assuntos
Anestesia Geral/métodos , Crioprotetores/administração & dosagem , Cistite Intersticial/tratamento farmacológico , Dimetil Sulfóxido/administração & dosagem , Administração Intravesical , Adulto , Crioprotetores/efeitos adversos , Dimetil Sulfóxido/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
5.
Prog Urol ; 26(16): 1159-1162, 2016 Dec.
Artigo em Francês | MEDLINE | ID: mdl-27793540

RESUMO

OBJECTIVE: The mid urethral sling (MUS) has become as the gold standard treatment for stress urinary incontinence (SUI) in female. The aim of this study was to assess the outcome of the SUI Transobturator Tape after 10 years follow-up. METHODS: Retrospective study of 73 patients who underwent a mid urethral sling-transoburator tape (MUS-TOT) between November 2002 and November 2004. These patients were followed up by phone call and by mail, 10 years after the surgery. The indication of the MUS-TOT was a stress urinary incontinence, yet 26 patients (35.6 %) had a mixed urinary incontinence. RESULTS: Out of 73 patients, 5 patients were excluded. Sixty-eight patients were contacted. The rate of responders was 72 %. Thirty-four patients (69.3 %) described episodes of urinary incontinence (52.9 % SUI, 47.1 % urgency). Fifteen patients (30.7 %) were continent. Among the patients who had incontinence, 26 (76.5 %) needed protections during the day and 18 (52.9 %) had to change them at least once. Twelve patients (35.3 %) needed protections at night and 3 (8.8 %) had to change it at least once. Thirty-nine patients (79.6 %) were satisfied. Twenty-nine patients filled up the Ditrovie questionnaire (42.6 %). The mean score of Ditrovie questionnaire after 10 years was 1.6±0.7, with a real improvement in comparison with the preoperative score (P<0.05). CONCLUSION: Ten years after MUS-TOT treatment, the continence rate was low, even though the patients included in this study had high satisfaction rate. Several limitations should be taken into consideration in this study. LEVEL OF EVIDENCE: 4.


Assuntos
Slings Suburetrais , Feminino , Humanos , Satisfação Pessoal , Estudos Retrospectivos , Incontinência Urinária por Estresse , Incontinência Urinária de Urgência
11.
Prog Urol ; 25(12): 705-10, 2015 Oct.
Artigo em Francês | MEDLINE | ID: mdl-26381320

RESUMO

OBJECTIVES: Urethral stenosis has a recurrent character. The urethroplasty is often proposed for repeat stenosis. This study seeks to explore the interest of clean intermittent self-catheterization in the evolution of urethral stenosis after urethrotomy. METHODS: Single-center retrospective study from 2008 to 2013, concerning patients who received urethrotomy to treat urethral stenosis which was confirmed by endoscopy and a flow chart. Some accomplished self-catheterization in addition to urethrotomy to prevent recurrence. The monitoring was provided during consultation by a subjective assessment (patient and surgeon) and a flow chart. The restenosis were confirmed by endoscopy and flow chart. RESULTS: Ninety-three patients treated with urethrotomy alone (50 patients) or associated with self-catheterization (43) was included. Urethral stenosis were mostly iatrogenic (75%), short <10mm (84%), single (74%) and primary (50.5%). Mean follow-up was 99.3±72.8 weeks. Eighteen patients (19%) had symptomatic recurrence suspected by flow chart with a mean Qmax at recurrence was 6.25±2.8mL/s (P<0.001), 8 in urethrotomy group and 10 in the urethrotomy+self-catheterization group. Recurrence rates were comparable in the 2 groups, urethrotomy (16%) urethrotomy+self-catheterization (23%) (P=0.46). The mean time to recurrence was 81.1±87 weeks and was different in the 2 groups: 76.8±76.3 weeks in urethrotomy group, 83.3±93.9 in urethrotomy+self-catheterization group (P=0.014). An analysis recurrence for the primitive urethral stenosis showed that the recurrence rate was not statistically different: 18% for urethrotomy+self-catheterization group vs 14% for urethrotomy group. An analysis of recurrent relapses for urethral stenosis showed a rate of 26%, comparable in the 2 groups (P=1). CONCLUSION: After urethrotomy, urethral stenosis recurs in 1 patient over 5, after 18 months especially if they were complicated (multiple, recurrent, extended). Self-catheterization do not provide benefit in terms of recurrence (for the general population and for primitive urethral stenosis) compared to only urethrotomy but seem to extend the time without recurrence (76.8 weeks vs 83.3 weeks). LEVEL OF EVIDENCE: 5.


Assuntos
Cateterismo Uretral Intermitente , Autocuidado , Estreitamento Uretral/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Humanos , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Estreitamento Uretral/complicações , Adulto Jovem
12.
Prog Urol ; 25(17): 1219-24, 2015 Dec.
Artigo em Francês | MEDLINE | ID: mdl-26318394

RESUMO

OBJECTIVE: There is currently no guideline regarding the management of neurogenic detrusor overactivity (NDO) refractory to intra-detrusor botulinum toxin injections. The primary objective of the present study was to find a consensus definition of failure of botulinum toxin intra-detrusor injections for NDO. The secondary objective was to report current trends in the managment of NDO refractory to botulinum toxin. METHODS: A survey was created, based on data drawn from current literature, and sent via e-mail to all the experts form the Group for research in neurourology in french language (GENULF) and from the comittee of neurourology of the French urological association (AFU). The experts who did not answer to the first e-mail were contacted again twice. Main results from the survey are presented and expressed as numbers and proportions. RESULTS: Out of the 42 experts contacted, 21 responded to the survey. Nineteen participants considered that the definition of failure should be a combination of clinical and urodynamics criteria. Among the urodynamics criteria, the persistence of a maximum detrusor pressure>40 cm H2O was the most supported by the experts (18/21, 85%). According to the vast majority of participants (19/21, 90.5%), the impact of injections on urinary incontinence should be included in the definition of failure. Regarding the management, most experts considered that the first line treatment in case of failure of a first intra-detrusor injection of Botox(®) 200 U should be a repeat injection of Botox(®) at a higher dosage (300 U) (15/20, 75%), regardless of the presence or not of urodynamics risk factors of upper tract damage (16/20, 80%). CONCLUSION: This work has provided a first overview of the definition of failure of intra-detrusor injections of botulinum toxin in the management of NDO. For 90.5% of the experts involved, the definition of failure should be clinical and urodynamic and most participants (75%) considered that, in case of failure of a first injection of Botox(®) 200 U, repeat injection of Botox(®) 300 U should be the first line treatment.


Assuntos
Toxinas Botulínicas Tipo A/uso terapêutico , Bexiga Urinária Hiperativa/tratamento farmacológico , Administração Intravesical , Feminino , Humanos , Masculino , Inquéritos e Questionários , Falha de Tratamento
13.
Prog Urol ; 25(7): 404-12, 2015 Jun.
Artigo em Francês | MEDLINE | ID: mdl-25841758

RESUMO

OBJECTIVE: To establish a guide dedicated to general practitioner for the diagnosis, the follow-up, and the treatment of lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH). METHOD: Guidelines already published for urologists were modified to make them relevant for general practitioners. The role of specialist's referral was defined. The whole content of the document was submitted to the formal consensus process in which urologists and general medicine teachers were involved. RESULTS: Initial assessment has several aims: making sure that LUTS are related to BPH, assessing bother related to LUTS, and checking for a possible complication. Initial assessment should include: medical history, physical examination with digital rectal examination, and urinalysis. Some other explorations such as frequency volume chart, serum PSA or creatinine, and ultrasonography of the urinary tract were found optional, meaning they are necessary only in specific situations. Referring to urologist is justified when LUTS might not be related to BPH (particularly when urgencies are predominant), or when a severe bladder outlet obstruction is suspected (severe symptoms, palpable bladder, post-voiding residual volume>100ml), or when a complication is assessed. Follow-up without treatment is justified for patients with no bothersome symptoms related to not complicated BPH. Several drugs are available for the treatment of bothersome symptoms related to BPH. Alpha-blockers and plants extracts might be offered as monotherapy. Five alpha reductase inhibitors might be offered to patients with LUTS related to a significant prostate hypertrophy (>40 ml) ; they might be given for a minimum duration of one year, alone or in association with alpha-blocker. The association of antimuscarinic and alpha-blocker might be used in patients with persistent storage LUTS in spite of alpha-blocker treatment. Phosphodiesterase 5 inhibitors might be offered to patients with erectile dysfunction associated with LUTS related to BPH. In case of complicated BPH, or when medical treatment is not efficacious or not tolerated, a surgical option should be discussed. CONCLUSION: The male lower urinary tract symptom committee of the French Urological Association and general practitioner present the first guide for the management of LUTS related to BPH dedicated to general practitioner. LEVEL OF EVIDENCE: 5.


Assuntos
Medicina Geral , Sintomas do Trato Urinário Inferior/diagnóstico , Sintomas do Trato Urinário Inferior/terapia , Hiperplasia Prostática/diagnóstico , Hiperplasia Prostática/terapia , Humanos , Sintomas do Trato Urinário Inferior/etiologia , Masculino , Guias de Prática Clínica como Assunto , Hiperplasia Prostática/complicações
14.
Prog Urol ; 25(5): 282-7, 2015 Apr.
Artigo em Francês | MEDLINE | ID: mdl-25724863

RESUMO

INTRODUCTION AND OBJECTIVE: The objective of this study was to assess the oncological results of a population of patients which undergo surveillance after diagnosis of stage I testicular seminoma (2, 5 and 8 years overall, specific and recurrence free survival). We also research recurrence risk factors. PATIENTS AND METHODS: We have looked at the data of all patients treated in our center since 1993 for a grade I testicular seminoma. We focused on age at diagnosis, biological (tumoral markers) and pathological (tumor size, rete testis, lymphovascular, tunica albuginea or spermatic cord invasion) data. During surveillance, we noted the number, the localization and the interval until recurrence and death. We calculated 2, 5 and 8 years overall, specific and recurrence-free survival and searched recurrence risk factors. RESULTS: Sixty-nine patients (mean age: 37) were followed during a mean time of 97 months. Sixty-three per cent of the tumours were less than 4 cm (50 lesions). Lymphovascular, rete testis, spermatic cord and tunica albuginea invasion were present in respectively 21%, 33%, 4% and 29% of the cases. LDH and HCG were above normal rate in respectively 44 and 27% of the cases. Eighteen patients (23%) relapsed at a mean time of 12 months. Recurrence-free survival was respectively 81%, 77% and 77% at 2, 5 and 8 years. Tumor size<4 cm (P = 0.002), rete testis invasion (P = 0.03) and stage ≥ pT2 (P = 0.012) were associated with recurrence in univariate analysis. Using multivariate analysis, only tumor size >4 cm was a recurrence risk factor (risk multiplied by 3). At the end of the study, 77 patients are alive (97.5%). Overall and specific survival was 97.5% at 2, 5 and 8 years. CONCLUSION: We show here the interest of surveillance in case of stage 1 testicular seminoma. The overall and specific survivals are the same as after chemotherapy or radiotherapy. Furthermore, we confirm the role of tumor size to stratify recurrence risk.


Assuntos
Recidiva Local de Neoplasia/diagnóstico , Recidiva Local de Neoplasia/terapia , Seminoma/diagnóstico , Seminoma/terapia , Neoplasias Testiculares/diagnóstico , Neoplasias Testiculares/terapia , Adulto , Quimioterapia Adjuvante , Intervalo Livre de Doença , Seguimentos , França , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/mortalidade , Estadiamento de Neoplasias , Orquiectomia/métodos , Vigilância da População , Radioterapia Adjuvante , Estudos Retrospectivos , Fatores de Risco , Seminoma/mortalidade , Seminoma/patologia , Neoplasias Testiculares/mortalidade , Neoplasias Testiculares/patologia , Resultado do Tratamento
15.
Prog Urol ; 25(6): 342-7, 2015 May.
Artigo em Francês | MEDLINE | ID: mdl-25726693

RESUMO

OBJECTIVES: To assess morbidity and functional consequences of laparoscopic cystectomy with ileal conduit urinary diversion: in neurologic patients. MATERIALS: We reviewed the records of forty-two patients (ten men and thirty-two women) who underwent surgery between August 2007 and October 2013. The median age of the patient was 54 years old (range between 21-79 years). A laparoscopic cystectomy was performed followed by a short laparotomy to perform the ileal conduit urinary diversion. Records were reviewed to retrieve the indications and describe the postoperative and functional course. Patients and GPs were interviewed during phone calls to appreciate the quality of life by the PGII scale in order to assess the functional outcome. RESULTS: The operation was performed on 42 patients, of whom 18 had multiple sclerosis, nine a post-traumatic neurogenic bladder. Among the total population, 10 patients (23.81%) required a transfusion of at least one packed red blood cells (1-7). The overall rate of early complications was 35.71%. Belated complications were seen in 52.38% of the population. The median duration of hospital stay was 16 days (range between 9-70 days). The median follow up was 34 months (range between 1-76 months). For patients, the PGII scale rating had a median value of 6 (2-7). All referring physicians described a better functional status. CONCLUSION: The laparoscopic cystectomy can make postoperative course smoother for the neurological patients. However, the surgeon must weigh individually the benefit of performing the operation.


Assuntos
Cistectomia/métodos , Laparoscopia , Qualidade de Vida , Bexiga Urinaria Neurogênica/cirurgia , Derivação Urinária , Adulto , Idoso , Cistectomia/efeitos adversos , Feminino , Humanos , Íleo/cirurgia , Laparoscopia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Bexiga Urinaria Neurogênica/complicações , Derivação Urinária/efeitos adversos , Adulto Jovem
16.
Prog Urol ; 25(8): 461-73, 2015 Jun.
Artigo em Francês | MEDLINE | ID: mdl-25662706

RESUMO

AIM: Systematically review literature on the efficacy and tolerability of botulinum toxin A (onabotulinumtoxineA, BOTOX(®), Allergan, CA, USA) in refractory idiopathic overactive bladder (iOAB) METHODS: Pubmed search on the efficacy, toxicity and adverse events of onabotulinumtoxinA in clinical trials only with level 1 and 2 evidence. RESULTS: Eleven controlled randomised trials have been selected, of which 3 phase III trials. The studies published data of 1008 patients with refractory iOAB treated with onabotulinumtoxineA. In the phase II and III trials, doses from 50 U to 300 U have been evaluated; more than half of the patients (n = 676) with 100 U. In the 2 main phase III trials, onabotulinumtoxinA has demonstrated to be more efficient compared to placebo on continence, symptoms and quality of live (QoL). Urodynamic results, reported in the phase II trials, demonstrated higher changes compared to placebo only from dose 100 U on, although not always significant. Adverse events (urinary retention, dysuria, urinary tract infection) were easily treated and did not influence patient's QoL. CONCLUSION: Intradetrusor injections of onabotulinumtoxinA (BOTOX(®)), a minimally-invasive procedure, seem to be efficient and well tolerated in the treatment of refractory iOAB.


Assuntos
Inibidores da Liberação da Acetilcolina/uso terapêutico , Toxinas Botulínicas Tipo A/uso terapêutico , Bexiga Urinária Hiperativa/tratamento farmacológico , Algoritmos , Humanos
17.
Prog Urol ; 24(11): e1-7, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25214455

RESUMO

OBJECTIVE: Provide guidelines for practical usage of botulinum toxin type A (BoNTA) for refractory idiopathic overactive bladder management. PATIENTS AND METHODS: Guidelines using formalized consensus guidelines method. These guidelines have been validated by a group of 13 experts quoting proposals, subsequently reviewed by an independent group of experts. RESULTS: In the case of patients with urinary tract infection, it must be treated and injection postponed. Before proposing an injection, it is recommended to ensure the feasibility and acceptability of self-catheterisation by patient. The injection can be performed after local anesthesia of the bladder and urethra (lidocaine), supplemented where necessary by nitrous oxide inhalation and sometimes under general anesthesia. Injection is performed in the operating room or endoscopy suite. The bladder should not be too filled (increased risk of perforation). Treatment should be applied in 10 to 20 injections of 0.5 to 1 mL homogeneously distributed in the bladder at a distance from the urethral orifices. It is not recommended to leave a urinary catheter in place except in cases of severe hematuria. The patient should be monitored until resumption of micturition. After the first injection, an appointment must be scheduled within 3 months (micturition diary, uroflowmetry, measurement of residual urine and urine culture). Performance of self-catheterisation should be questioned in the case of a symptomatic post-void residual and/or a residue>200 mL. A new injection may be considered when the clinical benefit of the previous injection diminishes (between 6 and 9 months). A period of three months must elapse between each injection. CONCLUSIONS: Implementation of these guidelines may promote best practice usage of BoNTA with optimal risk/benefit ratio.


Assuntos
Toxinas Botulínicas Tipo A/uso terapêutico , Bexiga Urinária Hiperativa/tratamento farmacológico , Humanos , Fármacos Neuromusculares , Guias de Prática Clínica como Assunto
18.
J Gynecol Obstet Biol Reprod (Paris) ; 43(8): 572-80, 2014 Oct.
Artigo em Francês | MEDLINE | ID: mdl-25087018

RESUMO

INTRODUCTION: Botulinum toxin-A detrusor injections are now approved for use (extension of marketing authorization) in the management of refractory idiopathic overactive bladder. The goal of the current study was to study the value and efficacy of this therapy. PATIENTS AND METHODS: A literature review was performed on Medline, Embase and Cochrane databases, using the following keywords: botulinum toxin; overactive bladder syndrome; urinary incontinence; detrusor injection. RESULTS: The recommended first step dose is 50 units of BOTOX(©) (dose selected for tolerance assessment). However, the cure rates for urge incontinence are greater with 100 units. Before proposing an injection, it is recommended to ensure the feasibility and acceptability of self-catheterisation by the patient, because of the risk of urinary retention (6%). The administration of BOTOX(©) comprises an intra-detrusor injection using a cystoscope, performed under local anesthesia. Clinical improvement is generally observed in the first two weeks after the injection. Patients should be considered for reinjection when the clinical effect of the previous injection has diminished, approximately 6-9 months after the first injection. An injection of 100 units may be considered when the clinical benefit of the 50-unit injection is not satisfactory concerning incontinence symptoms. CONCLUSION: Botulinum toxin detrusor injections may be offered to women who develop refractory OAB.


Assuntos
Toxinas Botulínicas Tipo A/administração & dosagem , Fármacos Neuromusculares/administração & dosagem , Bexiga Urinária Hiperativa/tratamento farmacológico , Adulto , Toxinas Botulínicas Tipo A/farmacologia , Feminino , Humanos , Fármacos Neuromusculares/farmacologia
19.
Prog Urol ; 24(12): 771-6, 2014 Oct.
Artigo em Francês | MEDLINE | ID: mdl-25158327

RESUMO

PURPOSE: To report our experience with Flexible Ureteroscopy-laser (FU-L) in the treatment of renal and/or ureteric stones. PATIENTS AND METHODS: We conducted a retrospective study of 191 kidney and/or ureteric stones treated in the urology department of New Civil Hospital (Strasbourg) over a period of 2 years. Two hundred and nineteen FU-L were performed. We were interested in the indications of FU-L, its complications, treatment outcomes and predictors of obtaining a stone-free outcome. Postoperative complications were reported according to the Clavien-Dindo classification. RESULTS: The indications were first line in 62.3% of cases, failures of shock wave lithotripsy in 26.2% of cases and failure of alkalinization of urine in 5.2% of cases. As intraoperative complications, we had one case of ureteropelvic avulsion and one case of bronchospasm leading to stop ureteroscopy. Postoperative complications occurred after 38 FU-L (17.3%). All grades combined these postoperative complications were infectious in 50% of cases. They were grade I, II, III, IV and V respectively in 5.9; 7.3; 2.7; 1.3 et 0% of cases. Their occurrence was not significantly correlated to the size of the stones or the unilateral or bilateral nature of the FU-L. The overall rate of stone-free was 71.7%. The factors determining significantly a stone-free outcome were the size of kidney stone and experience of the operator. CONCLUSION: In our center, the FU-L is increasingly used as first-line option due to its low morbidity and excellent results especially for the treatment of kidney stones less than 20mm and ureteric stones. It is a quality alternative to PCNL in kidney stones over 20mm.


Assuntos
Cálculos Renais/terapia , Litotripsia a Laser , Cálculos Ureterais/terapia , Ureteroscopia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
20.
Prog Urol ; 24(2): 127-31, 2014 Feb.
Artigo em Francês | MEDLINE | ID: mdl-24485083

RESUMO

OBJECTIVE: To evaluate the outcome of postoperative male stress urinary incontinence surgery using the I-STOP TOMS(®) sub-urethral sling. MATERIAL AND METHOD: Between April 2007 and August 2012, 29 patients had been treated by sub-urethral sling. Stress urinary incontinence was classified as mild, moderate or severe according to the number of pads per day. Patients were also assessed thanks to IQOL, MHU and Ditrovie self-administered questionnaires. RESULTS: Before surgery, 16 patients (55.2%) had mild incontinence, 12 (41.4%) had moderate incontinence and one (3.4%) had severe incontinence. Preoperative median MHU was 9 (5-12); median IQOL was 73 (58-88); and median Ditrovie was 2.7 (2.1-3.3). Three months after surgery, median MHU was 7 (4-9); median IQOL was 85 (75-99); and median Ditrovie was 2.1 (1.6-2.4). Pre- and postoperative questionnaires scores show a significant improvement for IQOL (P=0.014) and Ditrovie (P<0.001). After 3 months, six patients were dry (20.7%), 19 patients had mild incontinence (65.5%) and four had moderate incontinence (13.8%); in résumé 17 patients (58.6%) showed a significant improvement in the number of pads (20.7% dry, 37.9% improved). After a mean follow-up of 24 ± 19.9 months, five patients were dry (17.2%), 20 patients (69%) had mild incontinence and four had moderate incontinence (13.8%). CONCLUSION: I-STOP TOMS(®) sub-urethral sling improved the level of postoperative stress urinary incontinence. However, the continence rate was weak.


Assuntos
Prostatectomia/efeitos adversos , Slings Suburetrais , Incontinência Urinária por Estresse/etiologia , Incontinência Urinária por Estresse/cirurgia , Idoso , Humanos , Masculino , Desenho de Prótese , Estudos Retrospectivos , Resultado do Tratamento
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