A. Vidart

Evaluating Single-incision Slings in Female Stress Urinary Incontinence: The Usefulness of the CONSORT Statement Criteria

OBJECTIVE To evaluate the usefulness and applicability of the Consolidated Standards of Reporting Trials (CONSORT) for journal articles reporting randomized, controlled trials evaluating single-incision slings in the treatment of female stress urinary incontinence. METHODS Original articles reporting randomized, controlled trials assessing single-incision slings in the treatment of female stress urinary incontinence were searched for in the PubMed and Embase databases in 2011. Reporting quality was studied by 2 hospital pharmacists and 2 urologic surgeons. Primary outcome was the score out of 20 in the abstract CONSORT checklist. Secondary outcomes were the scores in the standard CONSORT checklist and the extension CONSORT additional items for trials assessing nonpharmacologic treatments. RESULTS Among 135 articles retrieved, 8 met the inclusion criteria and were assessed. Abstract scores ranged from 4.7-14.1. Standard scores were >10.0 out of 20 for most articles; the extension scores did not exceed 5.0 out of 10. Four reported trials were not identified as randomized in the title. The interventions were incompletely reported. Four articles reported whether blinding was achieved but lack of blinding was never discussed as a potential source of bias. Few articles reported the operators and centers characteristics and their impact on statistical analysis. The combination of the 3 checklists was considered a useful guideline to enhance and assess the reporting quality of a surgical trial. CONCLUSION Our results support the further use of CONSORT criteria as a basic standardized tool in all stages of clinical evaluation for any prosthetic device in female pelvic surgery.

Chapitre G - Les conséquences neuro-urologiques de la chirurgie gynécologique (endométriose, hystérectomie simple, colpo-hystérectomie élargie), de la chirurgie colo-rectale et de la radiothérapie pelvienne

Resume En dehors des atteintes de l’innervation vesicale primitive, un certain nombre de pathologies locales, de traitements comme la radiotherapie, peuvent entrainer des troubles fonctionnels du bas appareil urinaire. Quelques uns de ces troubles peuvent etre traites suivant les principes utilises dans la prise en charge des vessies neurologiques. Le but de cette revue est de rapporter les consequences fonctionnelles de l’endometriose pelvienne, de la radiotherapie, de la chirurgie colo-rectale et de la chirurgie de l’incontinence urinaire en soulignant les situations dans lesquelles un mecanisme neurogene peut etre suspecte.

Traitement palliatif de l'hyperplasie bénigne prostatique symptomatique par prothèse endo-uréthrale permanente (Ultraflex ® , Boston Scientific) chez les patients à haut risque chirurgical

Resume Objet Evaluer les resultats a moyen et long terme du traitement de l’hyperplasie benigne prostatique (HBP) symptomatique par la mise en place d’une prothese endo-urethrale permanente trans-prostatique chez des patients a haut risque chirurgical. Materiels et methodes Etude retrospective monocentrique portant sur 19 patients consecutifs d’âge moyen 79.5 ans (61-96) ayant eu la mise en place d’une prothese urethrale permanente en nitinol (Boston Scientific Corp.) de decembre 1995 a juillet 2006 pour obstacle prostatique. Les patients avaient tous une contre-indication majeure (ASA III ou IV) a une prise en charge chirurgicale conventionnelle immediate. La pose se faisait sous anesthesie locale par gel de xylocaine ® endo-urethral. Quatorze patients presentaient une retention aigue d’urine et 4 une insuffisance renale chronique obstructive. Un patient ayant une sonde a demeure, avait des prostatites aigues a repetition. L’evaluation fonctionnelle etait jugee sur la reprise d’une miction, la mesure du residu vesical post mictionnel, le taux de creatininemie et la recherche d’infection urinaire symptomatique. L’evaluation anatomique etait realisee par une urethro-cystographie retrograde et mictionnelle et une endoscopie urethrale. Resultats Ces 19 patients ont ete suivis 20 mois en moyenne (1-62). Aucun incident per-operatoire n’etait note. La reprise de la miction avait lieu chez 18 patients en post operatoire immediat. Un patient necessitait un drainage plus prolonge des urines avant une reprise de miction. Aucun cas de migration de prothese n’etait releve. La creatininemie post operatoire etait stable. Quinze patients avaient un residu vesical post mictionnel inferieur a 100 ml et chez quatre il etait inferieur a 200 ml. Un patient etait expiante. Conclusion Le traitement de l’obstruction cervicoprostatique par mise en place d’une prothese permanente urethrale est une alternative a la chirurgie, pour les patients juges temporairement ou definitivement in operables. L’indication reste exceptionnelle, mais a connaitre, compte tenu des resultats a moyen terme qui sont satisfaisants avec une morbidite faible pour un geste realise sous anesthesie locale pure.OBJECTIVE To evaluate the medium-term and long-term results of treatment of symptomatic benign prostatic hyperplasia (BPH) by permanent transprostatic urethral stenting in high surgical risk patients. MATERIALS AND METHODS Single-centre retrospective study on 19 consecutive patients with a mean age of 79.5 years (range: 61-96) treated by nitinol permanent urethral stent (Boston Scientific Corp.) from December 1995 to July 2006 for bladder neck obstruction. All patients presented a major contraindication (ASA III or IV) to immediate conventional surgical management. Stenting was performed under endourethral Xylocaine gel local anaesthesia. Fourteen patients presented acute urinary retention and 4 had chronic obstructive renal failure. One patient with an indwelling catheter had a history of recurrent acute prostatitis. The functional results were assessed by resumption of voiding, determination of post-voiding residual volume, serum creatinine and presence or absence of symptomatic urinary tract infection. The anatomical assessment was performed by voiding and retrograde cystourethrography and urethral endoscopy. RESULTS This series of 19 patients had a mean follow-up of 20 months (1-62). No intraoperative complication was observed. Resumption of voiding was achieved immediately postoperatively in 18 patients. One patient required more prolonged urinary drainage before voiding was restored. No cases of stent migration were observed. Postoperative serum creatinine was stable. Post-voiding residual volume was less than 100 ml in fifteen patients and less than 200 ml in four patients. One patient was explanted. CONCLUSION The treatment of bladder neck obstruction by permanent urethral stenting is an alternative to surgery for patients considered to be temporarily or permanently inoperable. This indication remains exceptional, but should be kept in mind in view of the satisfactory medium-term results to associated with a low morbidity for a procedure performed exclusively under local anaesthesia.