E. Chartier-Kastler

Étude observationnelle nationale (Association française d’urologie) de l’impact de la nycturie sur le sommeil des patients porteurs d’une hyperplasie bénigne de la prostate

OBJECTIVEnTo assess sleep efficiency in patients presenting with nocturia and symptomatic benign prostatic hypertrophy (BPH).nnnMATERIAL AND METHODSnThis prospective observational survey was carried out in France by 113 urologists. A total of 1376 patients (mean+/-SD age: 68.8+/-9.0 years) consulting for BPH with greater than two nocturia episodes per 24 hours were assessed with a mean I-PSS score of 15.5+/-6.4 (symptoms greater than 19 [severe] in 26.9% of cases). Patients used a sleep diary to record the previous nights total; sleep efficiency is expressed as percentage ratio, representing the total amount of actual sleep between initial sleep onset and final awakening. Sleep disorders were assessed using HD-43 questionnaire based on International classification of sleep disorders.nnnRESULTSn29.2% of the patients suffered from chronic insomnia, considered as primary insomnia (in 29.5% of cases) or related to either BPH (63.0%); snoring/sleep apnoea in 12.5% of cases. The mean sleep efficiency index was 87.2+/-13.7% and appeared to be significantly lower in BPH-related insomnia. Significantly lower sleep efficiency index values were observed as the severity (I-PSS score) of the BPH symptoms increased (89.5+/-12.1% for mildly symptomatic BPH vs. 84.0+/-15.6% for severely symptomatic BPH, P<0.001). Sleep efficiency index lowered with nocturia frequency (89.8+/-11.3% for two nocturia episodes vs. 80.4+/-17.3% for five nocturia episodes or more, P<0.001) and chronic insomnia frequency increased with nocturia frequency (21.4% for two nocturia episodes vs. 45.2% for five nocturia episodes or more, P<0.001).nnnCONCLUSIONSnInsomnia is frequent in patients presenting with BPH-related lower urinary tract symptoms (LUTS) and is mainly secondary to these LUTS. There is a significant correlation between the frequency of nocturia and the severity of insomnia.

Prostatic hyperplasia is highly associated with nocturia and excessive sleepiness: a cross-sectional study

Objectives The objective of this study is to assess the impact of nocturia on sleep in patients with lower urinary tract symptoms (LUTS)/benign prostatic enlargement (BPE) (nocturia≥2). Design Cross-sectional survey. Setting 798 urologists and general practitioners randomly selected from the overall population of urologists and general practitioners of every French region. Participants A total of 2179 LUTS/BPE men (aged 67.5±7.5u2005years old) were recruited. Primary and secondary outcome measures Validated patients self-administered questionnaires were used to assess the severity of LUTS/BPE (the International Prostate Symptom Score), sleep characteristics (sleep log) and sleep disorders (the International Classification of Sleep Disorders (ICSD-2) and the DSM-IV). Sleepiness was assessed with the Epworth Sleepiness Scale (ESS). The volume of 24u2005h diuresis (1500u2005ml) was measured. Results Participants had on average 2.9±0.9 nocturia episodes (three or more episodes in 67%) and the International Prostate Symptom Score of 15.8±5.7; 60.9% complained of insomnia according to the ICSD-2, 7.9% of restless leg syndrome and 6.4% of obstructive sleep apnoea. 32.3% had excessive sleepiness (ESS >10) and 3.1% severe excessive sleepiness (ESS >16). Insomnia was mainly nocturnal awakenings with an average wake after sleep onset of 89±47u2005min. The number of episodes of nocturia per night correlated significantly with wake after sleep onset and ESS but not with total sleep time and sleep latency. Conclusion Nocturia is significantly associated with sleep maintenance insomnia and sleepiness in men with BPE.

Article originalÉtude observationnelle nationale (Association française d’urologie) de l’impact de la nycturie sur le sommeil des patients porteurs d’une hyperplasie bénigne de la prostateImpact of nocturia on sleep efficiency in patients with benign prostatic hypertrophy☆☆☆

OBJECTIVEnTo assess sleep efficiency in patients presenting with nocturia and symptomatic benign prostatic hypertrophy (BPH).nnnMATERIAL AND METHODSnThis prospective observational survey was carried out in France by 113 urologists. A total of 1376 patients (mean+/-SD age: 68.8+/-9.0 years) consulting for BPH with greater than two nocturia episodes per 24 hours were assessed with a mean I-PSS score of 15.5+/-6.4 (symptoms greater than 19 [severe] in 26.9% of cases). Patients used a sleep diary to record the previous nights total; sleep efficiency is expressed as percentage ratio, representing the total amount of actual sleep between initial sleep onset and final awakening. Sleep disorders were assessed using HD-43 questionnaire based on International classification of sleep disorders.nnnRESULTSn29.2% of the patients suffered from chronic insomnia, considered as primary insomnia (in 29.5% of cases) or related to either BPH (63.0%); snoring/sleep apnoea in 12.5% of cases. The mean sleep efficiency index was 87.2+/-13.7% and appeared to be significantly lower in BPH-related insomnia. Significantly lower sleep efficiency index values were observed as the severity (I-PSS score) of the BPH symptoms increased (89.5+/-12.1% for mildly symptomatic BPH vs. 84.0+/-15.6% for severely symptomatic BPH, P<0.001). Sleep efficiency index lowered with nocturia frequency (89.8+/-11.3% for two nocturia episodes vs. 80.4+/-17.3% for five nocturia episodes or more, P<0.001) and chronic insomnia frequency increased with nocturia frequency (21.4% for two nocturia episodes vs. 45.2% for five nocturia episodes or more, P<0.001).nnnCONCLUSIONSnInsomnia is frequent in patients presenting with BPH-related lower urinary tract symptoms (LUTS) and is mainly secondary to these LUTS. There is a significant correlation between the frequency of nocturia and the severity of insomnia.

Dérivation urinaire non continente pour fistule urétropérinéale chez le blessé médullaire : devenirs urologique et fonctionnel à long terme au sein d’une équipe multidisciplinaire

Objectifs La derivation urinaire peut etre indiquee pour obtenir la cicatrisation des escarres perineales avec fistule uretrale chez le blesse medullaire (BM). L’objectif de notre etude etait de rapporter les resultats urologiques et fonctionnels a long terme des derivations urinaires non continentes (DUNC) dans la prise en charge des escarres avec fistules uretroperineales chez le BM, et caracteriser le profil de ces patients. Methodes Etude retrospective ayant inclus tous les patients BM operes entre 1999xa0et 2015xa0d’une DUNC pour escarre avec fistule uretroperineale. Les donnees suivantes ont ete rapporteesxa0: antecedents, facteurs de risque cardiovasculaire, etat nutritionnel, donnees perioperatoires et complications precoces ( Resultats Au total, 54xa0BM d’âge median 49xa0ans (19–83) ont ete inclus. Le suivi median etait 60xa0mois (10–203). Vingt-quatre patients (44xa0%) etaient en sonde a demeure et 46 (85xa0%) avaient une incontinence urinaire preoperatoire. Le taux de complications precoces etait de 33xa0% ( n xa0=xa018) avec 15xa0% de Clavien IIIb. Un deces a ete rapporte a 137xa0jours (SDRA). Un patient avec Bricker isole a presente une recidive d’escarre sur pyocyste ayant necessite une cystectomie 3xa0ans apres la chirurgie initiale. Au terme du suivi, le taux de reoperation etait de 24xa0% ( n xa0=xa013) dont 10xa0% pour drainage du haut appareil urinaire. Vingt-neuf patients (54xa0%) etaient autonomes pour l’appareillage et la fonction renale etait preservee (clairance moyennexa0=xa087xa0mL/min [22–190]). La cicatrisation de l’escarre a ete obtenue pour 81xa0% des patients ( n xa0=xa044). Conclusion La DUNC avant chirurgie de recouvrement d’escarre perineale permet la cicatrisation tout en preservant la fonction renale dans la population de patients BM. L’absence de suivi, le sondage prolonge et l’incontinence urinaire semblent favoriser les escarres avec fistules uretrales chez ces patients. La cystectomie concomitante est a privilegier car pourrait permettre d’eviter la survenue de pyocyste et la recidive d’escarre.

Chapitre C-1 B - Traitement pharmacologique de l’hyperactivité détrusorienne neurologique : drogues intrathécales

Intrathecal clonidine has been tested in spinal cord injury patients not supporting or resistant to anticholinergic drugs. Although the acute effect of clonidine on urodynamic parameters was satisfactory, cardiovascular adverse effects limited the long-term efficacy of this treatment. Intrathecal baclofen has a limited effect on overactive bladder in patients with spinal spasticity, but can modify the quality of erections and induce an incapacity to trigger ejaculation by vibratory penile stimulation.

La fertilité chez le blessé médullaire. Effet du niveau de la lésion médullaire

RésuméLes blessés médullaires souffrent d’anéjaculation dans une grande majorité des cas ainsi que d’anomalies de la qualité du sperme qui altèrent leur fertilité. La prise en charge doit prendre en compte les comorbidités que sont la spasticité, les troubles urinaires et la fonction anorectale qui modifient la fonction sexuelle. Le niveau de la lésion médullaire ainsi que son étendue ont un impact à la fois sur la possibilité d’obtention d’une éjaculation réflexe et sur la qualité du sperme.AbstractThe majority of spinal cord injured males cannot procreate naturally due to anejaculation as well as abnormal sperm characteristics. Treatment of this impaired fertility must be associated with treatment of neurogenic urinary tract disorders, bowel dysfunction and spasticity. The level of the spinal lesion and the spinal cord injury syndrome influence the possibility of inducing reflex ejaculation by penile vibratory stimulation and sperm quality.