G. Amarenco

Construction et validation des échelles de qualité de vie

Resume But Levaluation de la qualite de vie est indispensable dans la prise en charge des patients, notamment au cours des decisions diagnostiques et therapeutiques, ce dautant quil sagit de pathologies fonctionnelles. Cette dimension est aussi une preoccupation dans le domaine de la recherche clinique dans le cadre de levaluation des techniques, des soins ou des impacts medico-economiques. Methode La mise au point de scores specifiques ou generalistes procede dune validation psychometrique bien codifiee. Celle-ci est presentee de meme que les etapes des validations linguistiques. Resultats La validite de contenu est le fait que le questionnaire mesure ce quil pretend mesurer. La validite de construction temoigne que le questionnaire est un veritable instrument de mesure. La validite de criteres etablit la validite empirique de lechelle par rapport a un autre questionnaire existant considere comme la reference. La fiabilite est la capacite du questionnaire a se comporter de maniere fiable et de mesurer de maniere reproductible. La reproductibilite est la stabilite de la mesure dans le temps. Lanalyse de la coherence interne est appreciee par le calcul de lalpha de Cronbach. La stabilite est la capacite du questionnaire a mesurer les memes choses chez une meme personne sur un laps de temps donne. Enfin, la sensibilite aux changements est la capacite du questionnaire a reagir. Conclusion Les echelles de qualite de vie sont des outils robustes et fiables, utilisables en pratique quotidienne car valides de maniere precise.

Decrease in urethral pressure following repeated cough efforts: A new concept for pathophysiology of stress urinary incontinence

Aims:u2003 To describe the decrease in maximum urethral closure pressure (MUCP) following repeated coughs in women with stress urinary incontinence (SUI).

Dysautonomie et troubles urinaires au cours de la sclérose en plaques. Étude clinique, urodynamique et cardiovasculaire☆

OBJECTIVEnTo assess symptoms related to autonomic nervous system alteration in a population of patients suffering from multiple sclerosis (MS) and presenting with urinary symptoms.nnnPATIENTS AND METHODSnWe investigated 65 patients (mean age 47.5 years) suffering from MS, and presenting with urological dysfunction by means of symptom scores, urodynamic investigation, cardiovascular autonomic function tests (orthostatic hypotension testing, Valsalva test, deep breath test, cold pressor test) and sympathetic skin responses.nnnRESULTSnForty-five (69%) patients suffered from overactive bladder, 48 (73%) from voiding dysfunction, 14 (21%) from urinary retention and 13 (20%) from fecal incontinence. Urodynamic investigation demonstrated overactive detrusor in 46 (70%) cases, and underactive detrusor in four (6%) cases. Twenty-five (38%) patients had dysautonomia without correlation neither with clinical or urodynamic data, nor gravity of multiple sclerosis (EDSS).nnnCONCLUSIONnIn this series, the prevalence of dysautonomia was high in patients suffering from MS and presenting with urinary disorders.

Therapeutic education and intermittent self-catheterization: recommendations for an educational program and a literature review.

PURPOSEnTo review the literature and to clarify the recommendations for therapeutic education programs for intermittent self-catheterization.nnnMATERIALS AND METHODSnThe literature on Medline, Pubmed, and Cochrane Library, with specific keywords, as well as the recommendations based on expert consensus.nnnRESULTSnClean intermittent self-catheterization (CICS) is the gold standard for managing chronic urinary retention, which allows the patients to improve their quality of life and to reduce the complications of upper urinary tract infections. Patient education needs to have a structured procedure in order to evaluate the ability to understand, accept and perform CISC.nnnCONCLUSIONnTeaching self-catheterization is now well known; nevertheless, the effectiveness of CISC educational therapeutic programs remains to be demonstrated.

Validation of the InCaSaQ, a new tool for the evaluation of patient satisfaction with clean intermittent self-catheterization.

AIMSnIn neurourology, the choice of catheter is of paramount importance. At the time of our study, no simple validated questionnaire has been published, evaluating patient satisfaction with the use of urinary catheters. Our objective was to construct and validate a specific tool referred to as the Intermittent Catheterization Satisfaction Questionnaire (InCaSaQ), for the purposes of evaluating patient satisfaction with intermittent self-catheterization.nnnMETHODSnA simple tool was developed and validated in a neurourology referral centre, with 113 patients affected by a neurological bladder condition, between November 2011 and February 2012. Eight items, separated into four categories (packaging, lubrication, catheter itself, after catheterization) were selected. The mean score obtained with the eight-question questionnaire was calculated for each patient. Face validity was evaluated. Reliability based on internal consistency and test-retest reliability using the intraclass correlation coefficient (ICC) was carried out.nnnRESULTSnThe patients comprehension and acceptance of the questionnaire were good. The questionnaire appears to have been well designed, with a significant Cronbachs alpha coefficient, and the ICC demonstrated good test-retest reliability.nnnCONCLUSIONSnThe InCaSaQ was found to be a valid tool for the evaluation of patient satisfaction with a urinary catheter. It is thus possible to compare the comfort and effectiveness of different types of catheter, and to objectify the need to change the type of catheter, in cases where patients express their dissatisfaction.

Solifenacin is effective and well tolerated in patients with neurogenic detrusor overactivity: Results from the double‐blind, randomized, active‐ and placebo‐controlled SONIC urodynamic study

To investigate the effect on urodynamics of 4 weeks treatment with solifenacin succinate in patients with neurogenic detrusor overactivity (NDO) due to multiple sclerosis (MS) or spinal cord injury (SCI).

Scores de symptômes et de qualité de vie au cours des troubles vésicosphinctériens.

OBJECTIVESnTo identify all available symptom and quality of life questionnaires for men and women with urinary disorders and assess their psychometric properties.nnnMETHODSnWe systematically reviewed the literature in Medline using the key words urinary disorders, urinary incontinence, bladder, score, quality of life, questionnaire, and psychometric validation.nnnRESULTSnThe first search using the terms urinary incontinence and quality of life resulted in 1018 Abstracts. Articles mentioning but not measuring quality of life were not investigated. Questionnaires were selected because their psychometric properties were tested and they assessed how much a person was bothered by urinary symptoms or quality of life specific to urinary disorders. The questionnaires were usually gender specific. Their psychometric value was far from uniform, and, for most, responsiveness was not reported.nnnCONCLUSIONnFew quality of life questionnaires are at an advanced stage of validation to be applied in clinical practice. They need to be shorter, responsive and validated in different populations to permit their easy use.

Le réflexe pubo-caverneux. Démonstration électrophysiologique

Resume INTRODUCTION : Chez le blesse medullaire, la percussion sus-pubienne est un puissant stimulus capable de declencher une contraction vesicale. Elle sˈaccompagne en regle dˈun renforcement de lˈactivite striee perineale. Si cette reponse des muscles perineaux a la stimulation sus-pubienne a ete mentionnee chez lˈanimal, elle nˈa jamais ete specifiquement etudiee chez lˈhomme tant spinal quˈindemne de lesion neurologique. OBJECTIFS : Decrire lˈexistence dˈun reflexe pubo-caverneux et analyser ses caracteristiques electrophysiologiques. MATERIEL ET METHODExa0: Vingt et un patients neurologiquement sains, consultants pour des troubles mictionnels ont ete examines. Il sˈagissait de 14 femmes et de sept hommes, dˈâge moyen 51 ans (ecart typexa0=xa014,2). Les symptomes etaient pour les femmes une incontinence urinaire a lˈeffort pure dans dix cas et une incontinence par imperiosite dans quatre casxa0; tous les hommes (7/7) souffraient de signes irritatifs (pollakiurie, imperiosite) dont trois secondaires a une hypertrophie benigne de la prostate. Chaque patient a eu une etude du reflexe pubo-caverneux avec analyse des reponses electromyographiques du muscle bulbo-caverneux par electrode aiguille apres stimulation mecanique supra pubienne a lˈaide dˈun marteau electronique. RESULTATSxa0: La reponse electromyographique verifiee par deux fois est stable et reproductible (analyse de variance avec pxa0 DISCUSSIONxa0: Cette etude demontre lˈexistence chez lˈhomme normal dˈun reflexe pubocaverneux. Les reponses obtenues ont les caracteristiques dˈun reflexe polysynaptique (latence courte le differentiant dˈune contraction volontaire, jitter, habituation, caractere polyphasique, latence proche de la reponse R2 polysynaptique du reflexe bulbo-caverneux electrique). Lˈintegration de ce reflexe est vraisemblablement sacree, lˈeffecteur etant le nerf pudendal et lˈafferent possiblement le nerf pelvien. Les recepteurs stimules sont probablement les tenso-recepteurs detrusoriens. CONCLUSIONxa0: Chez lˈhomme spinal, ce reflexe entre tres certainement en competition avec le reflexe proprioceptif cutaneo- ou vesico-detrusorien (declenchement de la contraction vesicale par percussion sus-pubienne) et represente probablement ainsi dans certains cas un obstacle a une vidange complete de la vessie. Chez le sujet normal, il sˈagit dˈun reflexe de continence, permettant une contraction perineale reflexe a un stimulus susceptible dˈengendrer une hyperpression abdominale.

Intérêt de l'auto-sondage en cas de rétention urinaire

En cas de retention urinaire complete ou de vidange vesicale incomplete en l’absence d’obstacle urologique, l’auto-sondage est la methode de reference de drainage des urines. Il permet d’obtenir a la fois la continence et une protection optimum du haut appareil urinaire. Le succes des auto-sondages quant a la prevention des complications sur le haut appareil repose sur la frequence des sondages (5 a 6/24xa0h) et leur realisation propre, non sterile. Son apprentissage est rapide et le rapport benefices/risques est largement en faveur de son utilisation.

Efficacy of posterior tibial nerve stimulation (PTNS) on overactive bladder in older adults

IntroductionThe main objective of this retrospective study is to determine the efficacy of transcutaneous posterior tibial nerve stimulation (TPTNS) in older patients with overactive bladder (OAB) syndrome. The secondary objective is to look for predictive factors of efficacy of this treatment.MethodsAll patients aged over 65xa0years with OAB syndrome for which TPTNS was introduced between 2010 and 2016 in two neuro-urology centers were included. Age, gender, etiology of OAB, urinary symptoms and detrusor overactivity (DO) were retrospectively collected. The main outcome was efficacy of TPTNS (i.e., purchase of the device between 3 and 6xa0months).ResultsA total of 264 patients were included (mean age 74.1xa0±xa06.5xa0years; 63.3% of women), of whom 53% had neurogenic OAB. Urinary incontinence was reported by 83.7% of patients and DO was found on urodynamic studies in 154 patients. The overall efficacy of TPTNS was 45.1%. None of the tested factors were significantly predictive of efficacy, especially age (≥xa075xa0years, pxa0=xa00.62), associated stress urinary incontinence (pxa0=xa00.69) and presence of DO (pxa0=xa00.60), whether neurogenic or not.ConclusionTPTNS is an effective treatment in older patients with OAB syndrome. No predictive factors of efficacy were found, especially age and DO. This treatment seems to be a good alternative to antimuscarinics against overactive bladder in older adults.