C. Allenet

Robot-assisted artificial urinary sphincter implantation in female patients: A multicenter study

Hypothesis / aims of study The morbidity related to artificial urinary sphincter (AUS) implantation in women is usually considered as the drawback which has limited its widespread. In order to decrease this morbidity, several teams have recently reported the use of a robotic approach to implant the AUS in female patients. The aim of this study was to report the perioperative and functional outcomes of robotic AUS implantation in women.

Intradetrusor Injections of Botulinum Toxin Type A in Children With Spina Bifida: A Multicenter Study

OBJECTIVE To assess the effectiveness of intradetrusor injections of botulinum toxin type A (IDBTX-A) in children with spina bifida. METHODS All patients aged less than 16 years old who underwent IDBTX-A between 2002 and 2016 at 6 institutions were included in a retrospective study. Our primary endpoint was the success rate of IDBTX-A defined as both clinical improvement (no incontinence episodes between clean intermittent catheterizations [CICs], absence of urgency, and less than 8 CICs per day) and urodynamic improvement (resolution of detrusor overactivity and normal bladder compliance for age) lasting ≥12 weeks. Predictive factors of success were assessed through univariate analysis. RESULTS Fifty-three patients with a mean age of 8.5 years were included. All patients were under CIC and 88.7% had received anticholinergics with either poor efficacy or bothersome adverse events. The global success rate of the first injection (clinical and urodynamic) was 30%. Patients with closed spinal dysraphism had a significantly better success rate than patients with myelomeningocele (P = .002). The clinical success rate was 66% and was significantly associated with maximum urethral closure pressure (34 cm H2O vs 54.4 cm H2O, P = .02). The urodynamic success rate was 34%. Maximum cystometric capacity (P <.0001) and compliance (P = .01) significantly improved after the first IDBTX-A and maximum detrusor pressure tended to decrease (P = .09) except in the subgroup of patients with poor compliance. After a mean follow-up of 3.7 years, 23 patients (43.4%) required augmentation cystoplasty. Excluding 6 patients who were lost to follow-up, 38.3% of patients were still undergoing botulinum toxin injections at last follow-up. CONCLUSION In this series, despite the fact that IDBTX-A enabled clinical improvement in 66% patients, urodynamic outcomes were poor resulting in a low global success rate (30%).

Robot-assisted AMS-800 Artificial Urinary Sphincter Bladder Neck Implantation in Female Patients with Stress Urinary Incontinence

BACKGROUND Widespread adoption of the AMS-800 artificial urinary sphincter (AUS) in female patients has been hampered by the surgical morbidity of its implantation through an open approach. OBJECTIVE To describe a standardized technique of robotic bladder neck AUS implantation in female patients, and to report the perioperative and functional outcomes obtained by multiple surgeons with this technique. DESIGN, SETTINGS, AND PARTICIPANTS We retrospectively reviewed the charts of all female patients who underwent robotic AUS implantation for urinary incontinence due to intrinsic sphincter deficiency between March 2012 and March 2017 in five institutions. Most of the 10 surgeons involved were not highly experienced in female AUS implantation and/or in robotic surgery. SURGICAL PROCEDURE The AUS is implanted at the bladder neck through a transperitoneal robotic approach. The finger placed by the assistant surgeon in the vagina is paramount to expose the vesicovaginal space and guide the robotic surgeon throughout the bladder neck dissection. MEASUREMENTS The primary endpoint was the incontinence categorized as complete continence(ie, no pads used), improved incontinence, or unchanged incontinence. RESULTS AND LIMITATIONS Forty-nine female patients underwent a robotic AUS implantation. There were eight intraoperative complications (16.3%): five bladder neck injuries and three vaginal injuries. Nine patients experienced postoperative complications (18.3%), but only two were Clavien ≥3 (4.1%). After a median follow-up of 18.5 mo, one explantation (vaginal erosion, 2.1%) and three revisions (one mechanical and two nonmechanical failure, 6.1%) were needed. At last follow-up, 40 patients were fully continent (81.6%), six had improved incontinence (12.2%), and three had unchanged incontinence (6.1%). CONCLUSIONS In this first multicenter series of robot-assisted AUS implantation, our technique appeared feasible, safe, and reproducible with perioperative and functional outcomes in the early learning curve not inferior to those reported in large series of open AUS implantation from tertiary referral centers. PATIENT SUMMARY Robot-assisted bladder neck AMS-800 artificial urinary sphincter implantation in female patients with stress urinary incontinence resulting from intrinsic sphincter deficiency is feasible, safe, and reproducible with promising outcomes.

PD64-08 CAN WE AVOID BLADDER AUGMENTATION IN CASE OF FAILURE OF A FIRST INTRADETRUSOR BOTULINUM TOXIN INJECTIONS IN PATIENTS WITH SPINAL DYSRAPHISM?

courses per patient). The urodynamic patterns were detrusor overactivity in 48.6% of patients, isolated poor compliance in 33.6% of patients and combination of poor compliance and detrusor overactivity in 17.8%. The toxin used was in the vast majority onabotulinum toxin A at a dosage of 200 U in 43 patients (34.7%) and 300 U in 62 patients (49.2%). Twenty patients (16.1%) received initially abobotulinum toxin A 750 injections. Global success rate of the first injection was 68.8% with resolution of urinary incontinence in 73.5% of patients. Ninety-six patients (76.8%) underwent a second injection and the mean interval between the first and second injections was 7.5 months. Success rate was significantly lower in case of poor compliance (49% vs. 87%; p<0.0001). In contrast, success rates did not differ significantly between open and closed spinal dysraphism (66.7% vs. 72.3%; p1⁄40.51). The two other predictors of success were female vs. male gender (83.3% vs. 51.7%; p1⁄40.0002) and age (OR1⁄40.1; p1⁄40.005). Out of 561 injections, 20 adverse events were noted (3.6%) including three fatigue/muscular weakness. CONCLUSIONS: IDBTI seems effective in spina bifida patients showing detrusor overactivity regardless of the type of spinal dysraphism (open or closed). In contrast, the effectiveness is much lower in spina bifida patients with poor compliance bladder. The safety of IDBTI in patients with spinal dysraphism is statisfactory

PD64-07 INTRADETRUSOR INJECTIONS OF BOTULINUM TOXIN A IN ADULT PATIENTS WITH SPINAL DYSRAPHISM: RESULTS OF A MULTICENTER STUDY

METHODS: The charts of all patients who underwent a switch to IDI of ATA after failure of an IDI of OTA at six departments of neurourology were retrospectively reviewed. The main outcomes of interest were the bladder diary data and four urodynamic parameters: maximum cystometric capacity (MCC), maximum detrusor pressure (PDET max) and volume at first uninhibited detrusor contraction (UDC). Data were compared before and after treatment with OTA and ATA, using Stuart, Wilcoxon and paired-t tests for paired samples and univariate logistic regression was performed to seek for predictors of switch success. RESULTS: Out of 57 patients included, 38.6% were primary non-responders to Botox, and in secondary non-responder a median number of 5 OTA IDI were performed before failure (range 1-17). Persistent urinary incontinence was observed in 84.2% patients, and 75.4% had persistent detrusor overactivity. Six weeks after the first injection of Dysport, no adverse events were reported. A significant decrease in number of urinary incontinence episodes per day was observed in 52.63% of patients (p <0.001) and all patients experienced a reduction in PDET Max (-8.1 cmH20 on average; p1⁄40.003). MCC significantly increased by a mean of 41.2 ml (p1⁄40.02). The proportion of patients with no UDC increased significantly at after ATA injections (from 15.79% to 43.9%; p1⁄40.0002). Hence, 32 patients draw clinical and/or urodynamic benefits from the botulinum toxin switch from OTA to ATA (56.14%). After a median follow up of 21 months, 87% of responders to BTA switch were still treated successfully with BTA. In univariate analysis, three variables were associated with BTA switch success: low MCC before first ATA IDI (OR1⁄420.4;p1⁄40.01) and dose of ATA (OR1⁄4 10.9; p1⁄40.048) were predictive of increased success rates; poor compliance was predictive of lower success rate (OR1⁄40.2; p1⁄40.04). CONCLUSIONS: Most patients refractory to OTA (Botox) (56.14%) draw benefits from the switch to ATA (Dysport). Low MCC and dose of ATA were predictive of success of BTA switch while poor compliance was predictive of failure.

Can we avoid bladder augmentation in case of failure of a first intradetrusor botulinum toxin injections in patients with spinal dysraphism

Peyronnet B1, Amarenco G2, De Sèze M3, Even Schneider A4, Verrando A5, Hascoet J1, Castel-Lacanal E6, ChartierKastler E7, Denys P4, Schurch B8, Manunta A9, Gamé X6 1. Rennes University Hospital, 2. Tenon University Hospital, 3. Saint-Augustin institute, 4. Raymond Poincaré Hospital, 5. Tenon Hospital, 6. Toulouse university hospital, 7. Pitié-Salpétrière Hospital, 8. Lausanne University Hospital, 9. Rennes university hospital