L’incontinence urinaire d’effort est un symptome, secondaire a une hypermobilite cervico-uretrale... more L’incontinence urinaire d’effort est un symptome, secondaire a une hypermobilite cervico-uretrale (HU) et/ou a une insuffisance sphincterienne (IS). De tres nombreuses techniques chirurgicales ont ete decrites pour le traitement de l’IUE. Dans l’HU, les soutenements, les suspensions ou les frondes qui utilisent des materiaux autologues ou synthetiques ont pour but de positionner le col vesical dans l’enceinte manometrique abdominale. Ils repondent a la theorie de defaut de transmission des pressions abdominales a l’uretre (1), et a l’ecrasement du col vesical et de l’uretre sur les structures de suspension (2). Une nouvelle technique, le Tension-free Vaginal Tape, consiste a soutenir la partie moyenne de l’uretre et non plus le col vesical. Elle resulte de la theorie integrale des mecanismes de cloture uretrale chez la femme (3, 4). Dans le cas de l’IS isolee avec uretre fixe, l’approche chirurgicale est polymorphe avec trois techniques chirurgicales validees : les frondes sous-uretrales, les injections para-uretrales, et le sphincter urinaire artificiel. Les deux premieres techniques sont passives et tendent a retablir la continence en creant une dysurie par obstruction uretrale. Le sphincter urinaire artificiel vise a retablir un cycle continence-miction quasi physiologique en obtenant une continence complete entre des mictions qui s’effectuent sans obstacle au niveau de l’uretre. Les techniques chirurgicales les plus utilisees actuellement pour le traitement de l’IUE, se resument aux colposuspensions, aux frondes, au TVT, aux injections para-uretrales et au sphincter urinaire artificiel. Les troubles de la statique pelvienne sont souvent associes a l’IUE. Ils concernent les etages anterieur (cystocele), moyen (colpocele, hysterocele et ptose du dome vaginal), et posterieur (rectocele et elytrocele). Les modalites chirurgicales sont multiples. Toutes visent a retablir une anatomie normale.
Progres en urologie : journal de l'Association francaise d'urologie et de la Societe francaise d'urologie, 2004
OBJECTIVE The functional consequences and complications of surgical treatment offemale stress uri... more OBJECTIVE The functional consequences and complications of surgical treatment offemale stress urinary incontinence (SUI) are not systematically reported in clinical trials. The authors present a practical review of the results of the surgical techniques most frequently used for the treatment of SUI. MATERIALS AND METHODS An exhaustive literature search concerning the various surgical techniques for female SUI, their results, and their complications, was performed using MEDLINE (1966-2003) and the PUBMED search engine. Some papers presented by expert teams at international congresses were also included. In view of the diversity and weakness of the published results, a specific classification of the consequences of this surgery was adopted, comprising treatment failures, immediate (0 to 48 hours), early (before 6 weeks) and late (after 6 weeks) surgical complications, and impact on quality of life. RESULTS The best long-term success rate was observed for bladder neck slings. Prolene s...
OBJECTIVE To compare the results in patients operated by partial nephrectomy (PN) and radical nep... more OBJECTIVE To compare the results in patients operated by partial nephrectomy (PN) and radical nephrectomy (RN) for renal cancers < 4 cm, between 4 and 7 cm and > 7 cm. MATERIALS AND METHODS Retrospective study including 107 patients operated for renal cancer between 1998 and 2004. Demographic characteristics, TNM stage, tumour diameter and type of surgery (PN vs RN) were recorded. The patients' current status was determined and a survival curve was constructed by the Kaplan-Meier method. RESULTS 35.2% patients were operated by PN and 64.8% were operated by RN. The mean follow-up was 45 months. No significant difference in recurrence-free survival rate was observed between patients operated by PN and RN for tumours < 4 cm (93.3% vs 92.3%, respectively, p = 0.243), or for tumours between 4 and 7 cm (100% vs 89.3%, respectively, p = 0.564) or for tumours > 7 cm (100% vs 85.5%, respectively, p = 0.218). CONCLUSION Partial nephrectomy is the standard treatment for tumours...
Bladder compliance is defined by the ratio of the increase of intravesical pressures to the incre... more Bladder compliance is defined by the ratio of the increase of intravesical pressures to the increase of volume (_V/_P). The pathophysiology of disorders of compliance in neurogenic bladder is still poorly elucidated. It can be evaluated in terms of three elements: 1) The natural history of the appearance of these disorders in neurogenic bladders. Clinical experience shows the existence of prognostic factors that determine the development of these disorders, such as the voiding mode adopted (self-catheterization/hetero-catheterization versus indwelling catheter), the level of the spinal cord lesion (suprasacral versus sacral, incomplete versus complete, and cauda equina lesions), and the presence of meningomyelocele. 2). Data derived from conservative management of these disorders in neurogenic bladders: urethral dilatation, various sphincterotomies, bladder disafferentation, alpha-blockers, vanilloids (resiniferatoxin and capsaicin), intra-detrusor botulinum toxin and intrathecal ba...
Urologic Oncology: Seminars and Original Investigations, 2021
BACKGROUND Accuracy of multiparametric MRI (mpMRI) for the detection of significant prostate canc... more BACKGROUND Accuracy of multiparametric MRI (mpMRI) for the detection of significant prostate cancer (CaP) varies in the literature as only few studies use radical prostatectomy specimens as their gold standard. On another hand, MRI-targeted prostate biopsy is emerging as an alternative to the traditional randomized biopsy, with a higher detection rate of high-grade cancers. However, data on MRI guided in bore biopsy is lacking. MATERIAL AND METHODS We reviewed every patient that had his mpMRI, MRI guided in bore biopsy and radical prostatectomy performed in our hospital between November 2015 and December 2020. The diagnostic performances of both mpMRI and MRI targeted biopsy in sampling PIRADS index lesions were studied, using radical prostatectomy specimens as the gold standard. Sensitivity, specificity, positive predictive value and negative predictive value of mpMRI for detecting T3 stage, extra-capsular extension, seminal vesicles involvement and lymph node disease were also evaluated. RESULTS Sixty-two met our inclusion criteria. For PIRADS≥3 lesions, sensitivity and positive predictive value for detecting clinically significant CaP were of 83.5% and 94.7%. A total of 32.2% prostate cancers on targeted biopsy were upgraded on final pathology, with an upgrading to ISUP≥2 in 3.2% and to ISUP≥3 in 14.5%. A total of 20.9% of cancers were downgraded but without any downgrading to ISUP 1. When final pathology is taken as a gold standard, sensitivity of mpMRI was 31.8% for T3 staging prediction, 30.0% for extra-capsular extension, 28.7% for seminal vesicles involvement and 66.7% for lymph node disease prediction. Specificity was 89.3%, 93.1%, 95.3%, and 92.7%, respectively. CONCLUSION mpMRI has an acceptable accuracy for the prediction of significant CaP and index lesion detection but is unreliable for CaP staging. Comparison between pathology and biopsy results revealed that the in-bore biopsy technique has an upgrading and downgrading rate comparable in the literature to fusion biopsy, but higher than the combined biopsy approach.
We assessed the efficacy of sacral neuromodulation as an alternative therapeutic option in women ... more We assessed the efficacy of sacral neuromodulation as an alternative therapeutic option in women with an artificial urinary sphincter (AUS) who had de novo irritative urinary symptoms (urgency/frequency) refractory to conventional treatment. Between 1984 and 2002 we implanted an AUS in 350 women and detrusor overactivity developed in 14. Six of the 14 patients responding positively to a percutaneous nerve evaluation test (greater than 50% subjective/objective improvement) were implanted with an S3 neuromodulator within 42.8 weeks (range 21 to 106) of AUS implantation. Followup included analysis of the voiding diary, a pad test and urodynamic assessment. After 30.5 months followup (range 14 to 40) 1 patient was dry, 4 were improved and treatment failed in 1. At 12 months mean voiding frequency daily had decreased from 17 (range 12 to 23) to 8 (range 4 to 12) and the mean number of leakages episodes daily had decreased from 14.7 (range 8.5 to 17) to 6 (range 4 to 10). Mean voided volume had increased from 121.7 (range 90 to 170) to 180 ml (range 120 to 225), mean first desire to void volume had increased from 117 (range 88 to 190) to 183 ml (range 130 to 275) and mean functional bladder capacity had increased from 325 (range 200 to 530) to 372 ml (range 250 to 580). Uninhibited bladder contractions had resolved in 4 of 5 patients. In women who already have an AUS with urge incontinence sacral neuromodulation can help resolve symptoms. Because this therapy does not compromise the potential for future treatment, it appears to be an alternative option in these patients. It can postpone or avoid more mutilating surgery and self-catheterization.
To estimate the prevalence of lower urinary tract symptoms (LUTS), including overactive bladder (... more To estimate the prevalence of lower urinary tract symptoms (LUTS), including overactive bladder (OAB), and urinary incontinence (UI), in Egypt and the impact on patients' quality of life. A population-based, cross-sectional survey (EPIC) was conducted with a random sample of adults aged ≥18 years. Prevalence estimates were based on 2002 International Continence Society definitions. A total of 3600 adult men and women participated in the survey; 86% of them experienced ≥1 LUTS: storage symptoms were more frequently reported (75%) than voiding (52%) or postmicturition (42%) symptoms. The most prevalent storage symptom was nocturia (defined as ≥1 time per night) in 70% of the population. UI was reported by 21% (mixed UI [MUI]: 9%; stress UI [SUI]: 4%; urgency UI [UUI]: 5%; other UI: 3%), and 30% met criteria for OAB. Despite the high prevalence of LUTS, few individuals with UUI, MUI, SUI, or OAB took prescription medicine (12%) or consulted a healthcare professional about their sym...
The treatment of neurogenic detrusor-sphincter dyssynergia is primarily medical (drugs and cathet... more The treatment of neurogenic detrusor-sphincter dyssynergia is primarily medical (drugs and catheterization). Some patients may not be eligible for or fail to respond to these treatment options and endoscopic sphincterotomy or permanent prosthesis may be indicated. In this article, the authors review the indications, results and contraindications of these various treatments.
Neurogenic sphincter incompetence, in the absence of detrusor dysfunction, results in stress urin... more Neurogenic sphincter incompetence, in the absence of detrusor dysfunction, results in stress urinary incontinence. Management is exclusively surgical. The available artificial sphincters ensure continence, provided intermittent self-catheterization is performed when necessary for neurogenic bladder. Artificial urinary sphincter is the reference treatment, historically and based on published cohort studies. However, it is associated with a higher morbidity in this population than in the non-neurological population. Although the surgical implantation technique is not modified in females as a result of the neurological disorder it is modified in males, as periprostatic implantation may be necessary, requiring specific training in this technique and rigorous patient selection. Other more recent prosthetic treatments are being developed, but are still at the stage of evaluation: periurethral fascia sling, periurethral injections and periurethral balloon implantation. These techniques eliminate the need to manipulate a pump to open the sphincter for self-catheterization. They appear to be promising, but their long-term results are unknown. In conclusion, operative indications for SUI due to neurogenic sphincter incompetence must be based on a multidisciplinary diagnostic assessment and explicit patient information.
To determinate the efficacy of botulinum toxin to treat refractory urinary incontinence due to bl... more To determinate the efficacy of botulinum toxin to treat refractory urinary incontinence due to bladder hyperreflexia. The international medical literature was reviewed from the Medline and Pubmed database. The usual first line treatment of detrusor hyperreflexia is parasympathicolytic drugs and self cathterization. In case of lack of efficacy or severe side effects, a surgical procedure (enterocystoplasty) can be performed. 300 units of Botox injected into the detrusor permit a significant increase of bladder capacity and a significant decrease of maximal detrusor pressure for at last 6 months. But we did not find any double blind controlled studies in this indication and no fundamental studies focused on the mechanism of action of botulinum toxin on the bladder muscle. It is now impossible to conclude on the long term efficacy and toxicity. Botulinum toxin injected into the detrusor muscle seems to be an efficient treatment of bladder hyperreflexia for 6 months in patients resistant to parasympathicolytic drugs. Long term efficacy and mechanism of action is actually not known.
It is difficult to prove the neurourological origen of a voiding disorder, pain or postoperative ... more It is difficult to prove the neurourological origen of a voiding disorder, pain or postoperative functional disorders after stress urinary incontinence and pelvic repair surgery and their incidence is difficult to evaluate. The purpose of this chapter is to review the data of the literature concerning complications of this type of surgery, possibly related to a neurological injury, regardless of the site. The most frequently encountered postoperative problem is acute urinary retention. Prevention of acute urinary retention must be based on preoperative assessment looking for risk factors and the quality of postoperative resumption of voiding after removal of the bladder catheter Medium-term and long-term de novo dysuria and/or urgency must be analysed according to a neurourological approach, looking for obstruction (that must be removed) and complications related to the implanted prosthetic material or to the operative technique. The most difficult symptom to assess is postoperative pelvic pain &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;induced&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; by surgery. It can be accentuated by a previously undiagnosed concomitant spinal or regional lesion (hip) and the diagnostic assessment must be based on a multidisciplinary approach. This review emphasizes the low level of proof of data of the literature in this field and supports the impression that prospective data from homogeneous cohorts must be recorded in registries, for example, despite the difficulty of long-term evaluation (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 5 years). In the future, patients in whom prosthetic material is implanted should probably be encouraged to more readily cooperate in this field to ensure continuing improvement of the quality of surgical care.
Benign prostatic hyperplasia, which is usually treated conservatively (except in the presence of ... more Benign prostatic hyperplasia, which is usually treated conservatively (except in the presence of complications) in non-neurological patients, needs to be managed even more cautiously in patients with neurogenic bladder. The treatment decision must include analysis of the previous voiding mode. The development of detrusor-sphincter dyssynergia in an elderly man with a neurological disease must raise the suspicion of prostatic obstruction. The difficulty of establishing a diagnosis of obstruction, that cannot always be confirmed by clinical tools, urodynamic assessment or the search for renal complications, may lead to temporary prostatic stenting as a diagnostic procedure. Certain situations are more specifically encountered in patients with neurogenic bladder: spinal cord injury patients with reflex voiding, patients with stroke and its sequelae, ageing men and diabetic patients.
Annales de Réadaptation et de Médecine Physique, 2003
Objectif. -L'objectif de cet article est de déterminer la place de la toxine botulique dans l'ars... more Objectif. -L'objectif de cet article est de déterminer la place de la toxine botulique dans l'arsenal thérapeutique des hyperactivités du détrusor neurologique.
Collection de L’Académie Européenne de Médecine de Réadaptation, 2006
... Sur le plan clinique, leur effica-cité dans la DVSS n&amp;#x27;a pas été démontrée. Page ... more ... Sur le plan clinique, leur effica-cité dans la DVSS n&amp;#x27;a pas été démontrée. Page 3. Les benzodiazépines potentialisent l&amp;#x27;action de l&amp;#x27;acide gamma-aminobutirique (GABA) en pré-et postsynaptiques aux niveaux médullaire et cérébral (28). ...
Progrès en urologie : journal de l'Association française d'urologie et de la Société française d'urologie, 2007
To compare the results in patients operated by partial nephrectomy (PN) and radical nephrectomy (... more To compare the results in patients operated by partial nephrectomy (PN) and radical nephrectomy (RN) for renal cancers < 4 cm, between 4 and 7 cm and > 7 cm. Retrospective study including 107 patients operated for renal cancer between 1998 and 2004. Demographic characteristics, TNM stage, tumour diameter and type of surgery (PN vs RN) were recorded. The patients' current status was determined and a survival curve was constructed by the Kaplan-Meier method. 35.2% patients were operated by PN and 64.8% were operated by RN. The mean follow-up was 45 months. No significant difference in recurrence-free survival rate was observed between patients operated by PN and RN for tumours < 4 cm (93.3% vs 92.3%, respectively, p = 0.243), or for tumours between 4 and 7 cm (100% vs 89.3%, respectively, p = 0.564) or for tumours > 7 cm (100% vs 85.5%, respectively, p = 0.218). Partial nephrectomy is the standard treatment for tumours < 4 cm, but this study suggests that it is just...
Progrès en urologie : journal de l'Association française d'urologie et de la Société française d'urologie, 2005
The descending perineum syndrome, described in 1970 by Alan Parks, remains difficult to interpret... more The descending perineum syndrome, described in 1970 by Alan Parks, remains difficult to interpret clinically and pathophysiologically. A general review of descending perineum was conducted, based on review of the literature published between 1966 and 2004, and retrospective analysis of 1,023 colpocystograms. The symptoms observed are usually secondary to associated lesions. Radiological signs of descending perineum are not always associated with clinical symptoms. Colpocystogram shows perineal descent and associated disorders of anterior and middle pelvic tone, while defecography provides a better explanation for dyschezia which is generally due to an associated posterior disorder (rectocele with rectal intussusception). The management of descending perineum is based on medical treatment and retraining. No consensus has been reached concerning surgical management. Surgery is generally used to treat associated lesions. In the case of complete collapse of perineum, an abdominal approa...
L’incontinence urinaire d’effort est un symptome, secondaire a une hypermobilite cervico-uretrale... more L’incontinence urinaire d’effort est un symptome, secondaire a une hypermobilite cervico-uretrale (HU) et/ou a une insuffisance sphincterienne (IS). De tres nombreuses techniques chirurgicales ont ete decrites pour le traitement de l’IUE. Dans l’HU, les soutenements, les suspensions ou les frondes qui utilisent des materiaux autologues ou synthetiques ont pour but de positionner le col vesical dans l’enceinte manometrique abdominale. Ils repondent a la theorie de defaut de transmission des pressions abdominales a l’uretre (1), et a l’ecrasement du col vesical et de l’uretre sur les structures de suspension (2). Une nouvelle technique, le Tension-free Vaginal Tape, consiste a soutenir la partie moyenne de l’uretre et non plus le col vesical. Elle resulte de la theorie integrale des mecanismes de cloture uretrale chez la femme (3, 4). Dans le cas de l’IS isolee avec uretre fixe, l’approche chirurgicale est polymorphe avec trois techniques chirurgicales validees : les frondes sous-uretrales, les injections para-uretrales, et le sphincter urinaire artificiel. Les deux premieres techniques sont passives et tendent a retablir la continence en creant une dysurie par obstruction uretrale. Le sphincter urinaire artificiel vise a retablir un cycle continence-miction quasi physiologique en obtenant une continence complete entre des mictions qui s’effectuent sans obstacle au niveau de l’uretre. Les techniques chirurgicales les plus utilisees actuellement pour le traitement de l’IUE, se resument aux colposuspensions, aux frondes, au TVT, aux injections para-uretrales et au sphincter urinaire artificiel. Les troubles de la statique pelvienne sont souvent associes a l’IUE. Ils concernent les etages anterieur (cystocele), moyen (colpocele, hysterocele et ptose du dome vaginal), et posterieur (rectocele et elytrocele). Les modalites chirurgicales sont multiples. Toutes visent a retablir une anatomie normale.
Progres en urologie : journal de l'Association francaise d'urologie et de la Societe francaise d'urologie, 2004
OBJECTIVE The functional consequences and complications of surgical treatment offemale stress uri... more OBJECTIVE The functional consequences and complications of surgical treatment offemale stress urinary incontinence (SUI) are not systematically reported in clinical trials. The authors present a practical review of the results of the surgical techniques most frequently used for the treatment of SUI. MATERIALS AND METHODS An exhaustive literature search concerning the various surgical techniques for female SUI, their results, and their complications, was performed using MEDLINE (1966-2003) and the PUBMED search engine. Some papers presented by expert teams at international congresses were also included. In view of the diversity and weakness of the published results, a specific classification of the consequences of this surgery was adopted, comprising treatment failures, immediate (0 to 48 hours), early (before 6 weeks) and late (after 6 weeks) surgical complications, and impact on quality of life. RESULTS The best long-term success rate was observed for bladder neck slings. Prolene s...
OBJECTIVE To compare the results in patients operated by partial nephrectomy (PN) and radical nep... more OBJECTIVE To compare the results in patients operated by partial nephrectomy (PN) and radical nephrectomy (RN) for renal cancers < 4 cm, between 4 and 7 cm and > 7 cm. MATERIALS AND METHODS Retrospective study including 107 patients operated for renal cancer between 1998 and 2004. Demographic characteristics, TNM stage, tumour diameter and type of surgery (PN vs RN) were recorded. The patients' current status was determined and a survival curve was constructed by the Kaplan-Meier method. RESULTS 35.2% patients were operated by PN and 64.8% were operated by RN. The mean follow-up was 45 months. No significant difference in recurrence-free survival rate was observed between patients operated by PN and RN for tumours < 4 cm (93.3% vs 92.3%, respectively, p = 0.243), or for tumours between 4 and 7 cm (100% vs 89.3%, respectively, p = 0.564) or for tumours > 7 cm (100% vs 85.5%, respectively, p = 0.218). CONCLUSION Partial nephrectomy is the standard treatment for tumours...
Bladder compliance is defined by the ratio of the increase of intravesical pressures to the incre... more Bladder compliance is defined by the ratio of the increase of intravesical pressures to the increase of volume (_V/_P). The pathophysiology of disorders of compliance in neurogenic bladder is still poorly elucidated. It can be evaluated in terms of three elements: 1) The natural history of the appearance of these disorders in neurogenic bladders. Clinical experience shows the existence of prognostic factors that determine the development of these disorders, such as the voiding mode adopted (self-catheterization/hetero-catheterization versus indwelling catheter), the level of the spinal cord lesion (suprasacral versus sacral, incomplete versus complete, and cauda equina lesions), and the presence of meningomyelocele. 2). Data derived from conservative management of these disorders in neurogenic bladders: urethral dilatation, various sphincterotomies, bladder disafferentation, alpha-blockers, vanilloids (resiniferatoxin and capsaicin), intra-detrusor botulinum toxin and intrathecal ba...
Urologic Oncology: Seminars and Original Investigations, 2021
BACKGROUND Accuracy of multiparametric MRI (mpMRI) for the detection of significant prostate canc... more BACKGROUND Accuracy of multiparametric MRI (mpMRI) for the detection of significant prostate cancer (CaP) varies in the literature as only few studies use radical prostatectomy specimens as their gold standard. On another hand, MRI-targeted prostate biopsy is emerging as an alternative to the traditional randomized biopsy, with a higher detection rate of high-grade cancers. However, data on MRI guided in bore biopsy is lacking. MATERIAL AND METHODS We reviewed every patient that had his mpMRI, MRI guided in bore biopsy and radical prostatectomy performed in our hospital between November 2015 and December 2020. The diagnostic performances of both mpMRI and MRI targeted biopsy in sampling PIRADS index lesions were studied, using radical prostatectomy specimens as the gold standard. Sensitivity, specificity, positive predictive value and negative predictive value of mpMRI for detecting T3 stage, extra-capsular extension, seminal vesicles involvement and lymph node disease were also evaluated. RESULTS Sixty-two met our inclusion criteria. For PIRADS≥3 lesions, sensitivity and positive predictive value for detecting clinically significant CaP were of 83.5% and 94.7%. A total of 32.2% prostate cancers on targeted biopsy were upgraded on final pathology, with an upgrading to ISUP≥2 in 3.2% and to ISUP≥3 in 14.5%. A total of 20.9% of cancers were downgraded but without any downgrading to ISUP 1. When final pathology is taken as a gold standard, sensitivity of mpMRI was 31.8% for T3 staging prediction, 30.0% for extra-capsular extension, 28.7% for seminal vesicles involvement and 66.7% for lymph node disease prediction. Specificity was 89.3%, 93.1%, 95.3%, and 92.7%, respectively. CONCLUSION mpMRI has an acceptable accuracy for the prediction of significant CaP and index lesion detection but is unreliable for CaP staging. Comparison between pathology and biopsy results revealed that the in-bore biopsy technique has an upgrading and downgrading rate comparable in the literature to fusion biopsy, but higher than the combined biopsy approach.
We assessed the efficacy of sacral neuromodulation as an alternative therapeutic option in women ... more We assessed the efficacy of sacral neuromodulation as an alternative therapeutic option in women with an artificial urinary sphincter (AUS) who had de novo irritative urinary symptoms (urgency/frequency) refractory to conventional treatment. Between 1984 and 2002 we implanted an AUS in 350 women and detrusor overactivity developed in 14. Six of the 14 patients responding positively to a percutaneous nerve evaluation test (greater than 50% subjective/objective improvement) were implanted with an S3 neuromodulator within 42.8 weeks (range 21 to 106) of AUS implantation. Followup included analysis of the voiding diary, a pad test and urodynamic assessment. After 30.5 months followup (range 14 to 40) 1 patient was dry, 4 were improved and treatment failed in 1. At 12 months mean voiding frequency daily had decreased from 17 (range 12 to 23) to 8 (range 4 to 12) and the mean number of leakages episodes daily had decreased from 14.7 (range 8.5 to 17) to 6 (range 4 to 10). Mean voided volume had increased from 121.7 (range 90 to 170) to 180 ml (range 120 to 225), mean first desire to void volume had increased from 117 (range 88 to 190) to 183 ml (range 130 to 275) and mean functional bladder capacity had increased from 325 (range 200 to 530) to 372 ml (range 250 to 580). Uninhibited bladder contractions had resolved in 4 of 5 patients. In women who already have an AUS with urge incontinence sacral neuromodulation can help resolve symptoms. Because this therapy does not compromise the potential for future treatment, it appears to be an alternative option in these patients. It can postpone or avoid more mutilating surgery and self-catheterization.
To estimate the prevalence of lower urinary tract symptoms (LUTS), including overactive bladder (... more To estimate the prevalence of lower urinary tract symptoms (LUTS), including overactive bladder (OAB), and urinary incontinence (UI), in Egypt and the impact on patients' quality of life. A population-based, cross-sectional survey (EPIC) was conducted with a random sample of adults aged ≥18 years. Prevalence estimates were based on 2002 International Continence Society definitions. A total of 3600 adult men and women participated in the survey; 86% of them experienced ≥1 LUTS: storage symptoms were more frequently reported (75%) than voiding (52%) or postmicturition (42%) symptoms. The most prevalent storage symptom was nocturia (defined as ≥1 time per night) in 70% of the population. UI was reported by 21% (mixed UI [MUI]: 9%; stress UI [SUI]: 4%; urgency UI [UUI]: 5%; other UI: 3%), and 30% met criteria for OAB. Despite the high prevalence of LUTS, few individuals with UUI, MUI, SUI, or OAB took prescription medicine (12%) or consulted a healthcare professional about their sym...
The treatment of neurogenic detrusor-sphincter dyssynergia is primarily medical (drugs and cathet... more The treatment of neurogenic detrusor-sphincter dyssynergia is primarily medical (drugs and catheterization). Some patients may not be eligible for or fail to respond to these treatment options and endoscopic sphincterotomy or permanent prosthesis may be indicated. In this article, the authors review the indications, results and contraindications of these various treatments.
Neurogenic sphincter incompetence, in the absence of detrusor dysfunction, results in stress urin... more Neurogenic sphincter incompetence, in the absence of detrusor dysfunction, results in stress urinary incontinence. Management is exclusively surgical. The available artificial sphincters ensure continence, provided intermittent self-catheterization is performed when necessary for neurogenic bladder. Artificial urinary sphincter is the reference treatment, historically and based on published cohort studies. However, it is associated with a higher morbidity in this population than in the non-neurological population. Although the surgical implantation technique is not modified in females as a result of the neurological disorder it is modified in males, as periprostatic implantation may be necessary, requiring specific training in this technique and rigorous patient selection. Other more recent prosthetic treatments are being developed, but are still at the stage of evaluation: periurethral fascia sling, periurethral injections and periurethral balloon implantation. These techniques eliminate the need to manipulate a pump to open the sphincter for self-catheterization. They appear to be promising, but their long-term results are unknown. In conclusion, operative indications for SUI due to neurogenic sphincter incompetence must be based on a multidisciplinary diagnostic assessment and explicit patient information.
To determinate the efficacy of botulinum toxin to treat refractory urinary incontinence due to bl... more To determinate the efficacy of botulinum toxin to treat refractory urinary incontinence due to bladder hyperreflexia. The international medical literature was reviewed from the Medline and Pubmed database. The usual first line treatment of detrusor hyperreflexia is parasympathicolytic drugs and self cathterization. In case of lack of efficacy or severe side effects, a surgical procedure (enterocystoplasty) can be performed. 300 units of Botox injected into the detrusor permit a significant increase of bladder capacity and a significant decrease of maximal detrusor pressure for at last 6 months. But we did not find any double blind controlled studies in this indication and no fundamental studies focused on the mechanism of action of botulinum toxin on the bladder muscle. It is now impossible to conclude on the long term efficacy and toxicity. Botulinum toxin injected into the detrusor muscle seems to be an efficient treatment of bladder hyperreflexia for 6 months in patients resistant to parasympathicolytic drugs. Long term efficacy and mechanism of action is actually not known.
It is difficult to prove the neurourological origen of a voiding disorder, pain or postoperative ... more It is difficult to prove the neurourological origen of a voiding disorder, pain or postoperative functional disorders after stress urinary incontinence and pelvic repair surgery and their incidence is difficult to evaluate. The purpose of this chapter is to review the data of the literature concerning complications of this type of surgery, possibly related to a neurological injury, regardless of the site. The most frequently encountered postoperative problem is acute urinary retention. Prevention of acute urinary retention must be based on preoperative assessment looking for risk factors and the quality of postoperative resumption of voiding after removal of the bladder catheter Medium-term and long-term de novo dysuria and/or urgency must be analysed according to a neurourological approach, looking for obstruction (that must be removed) and complications related to the implanted prosthetic material or to the operative technique. The most difficult symptom to assess is postoperative pelvic pain &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;induced&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; by surgery. It can be accentuated by a previously undiagnosed concomitant spinal or regional lesion (hip) and the diagnostic assessment must be based on a multidisciplinary approach. This review emphasizes the low level of proof of data of the literature in this field and supports the impression that prospective data from homogeneous cohorts must be recorded in registries, for example, despite the difficulty of long-term evaluation (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 5 years). In the future, patients in whom prosthetic material is implanted should probably be encouraged to more readily cooperate in this field to ensure continuing improvement of the quality of surgical care.
Benign prostatic hyperplasia, which is usually treated conservatively (except in the presence of ... more Benign prostatic hyperplasia, which is usually treated conservatively (except in the presence of complications) in non-neurological patients, needs to be managed even more cautiously in patients with neurogenic bladder. The treatment decision must include analysis of the previous voiding mode. The development of detrusor-sphincter dyssynergia in an elderly man with a neurological disease must raise the suspicion of prostatic obstruction. The difficulty of establishing a diagnosis of obstruction, that cannot always be confirmed by clinical tools, urodynamic assessment or the search for renal complications, may lead to temporary prostatic stenting as a diagnostic procedure. Certain situations are more specifically encountered in patients with neurogenic bladder: spinal cord injury patients with reflex voiding, patients with stroke and its sequelae, ageing men and diabetic patients.
Annales de Réadaptation et de Médecine Physique, 2003
Objectif. -L'objectif de cet article est de déterminer la place de la toxine botulique dans l'ars... more Objectif. -L'objectif de cet article est de déterminer la place de la toxine botulique dans l'arsenal thérapeutique des hyperactivités du détrusor neurologique.
Collection de L’Académie Européenne de Médecine de Réadaptation, 2006
... Sur le plan clinique, leur effica-cité dans la DVSS n&amp;#x27;a pas été démontrée. Page ... more ... Sur le plan clinique, leur effica-cité dans la DVSS n&amp;#x27;a pas été démontrée. Page 3. Les benzodiazépines potentialisent l&amp;#x27;action de l&amp;#x27;acide gamma-aminobutirique (GABA) en pré-et postsynaptiques aux niveaux médullaire et cérébral (28). ...
Progrès en urologie : journal de l'Association française d'urologie et de la Société française d'urologie, 2007
To compare the results in patients operated by partial nephrectomy (PN) and radical nephrectomy (... more To compare the results in patients operated by partial nephrectomy (PN) and radical nephrectomy (RN) for renal cancers < 4 cm, between 4 and 7 cm and > 7 cm. Retrospective study including 107 patients operated for renal cancer between 1998 and 2004. Demographic characteristics, TNM stage, tumour diameter and type of surgery (PN vs RN) were recorded. The patients' current status was determined and a survival curve was constructed by the Kaplan-Meier method. 35.2% patients were operated by PN and 64.8% were operated by RN. The mean follow-up was 45 months. No significant difference in recurrence-free survival rate was observed between patients operated by PN and RN for tumours < 4 cm (93.3% vs 92.3%, respectively, p = 0.243), or for tumours between 4 and 7 cm (100% vs 89.3%, respectively, p = 0.564) or for tumours > 7 cm (100% vs 85.5%, respectively, p = 0.218). Partial nephrectomy is the standard treatment for tumours < 4 cm, but this study suggests that it is just...
Progrès en urologie : journal de l'Association française d'urologie et de la Société française d'urologie, 2005
The descending perineum syndrome, described in 1970 by Alan Parks, remains difficult to interpret... more The descending perineum syndrome, described in 1970 by Alan Parks, remains difficult to interpret clinically and pathophysiologically. A general review of descending perineum was conducted, based on review of the literature published between 1966 and 2004, and retrospective analysis of 1,023 colpocystograms. The symptoms observed are usually secondary to associated lesions. Radiological signs of descending perineum are not always associated with clinical symptoms. Colpocystogram shows perineal descent and associated disorders of anterior and middle pelvic tone, while defecography provides a better explanation for dyschezia which is generally due to an associated posterior disorder (rectocele with rectal intussusception). The management of descending perineum is based on medical treatment and retraining. No consensus has been reached concerning surgical management. Surgery is generally used to treat associated lesions. In the case of complete collapse of perineum, an abdominal approa...
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