R. Caremel

Le parcours de l’opéré en neuro-urologie : de la programmation opératoire à la convalescence. L’avis d’expert du Comité de neuro-urologie de l’AFU

The surgical care pathway of neurologic patients has two aims: preventing urinary morbidity and mortality and improving their quality of life. It requires taking into account the specificities of disabilities in domains of body functions: circulatory, ventilation and digestive physiology, motor functions, sensory functions, mental functions, and skin fragility which are responsible of dependencies in this heterogeneous group of patients. This management is necessarily multidisciplinary to be optimal and through specific clinical care pathway, providing guidance to the surgical procedure: preparation of the surgery, its realization, and post-operative rehabilitation. The indication for surgery must be coordinated and validated in neuro-urology multidisciplinary staff. Preoperative stay in a physical and rehabilitation medicine center may be useful to ensure a complete assessment and anticipate problems related to surgery. The patient will be hospitalized in the urology department in a single room suited to their disabilities and handicaps. The chronic treatments should be not modified if possible. The lack of sensitivity does not dispense anesthesia to prevent autonomic hyperreflexia, the most severe complication after high complete spinal cord injury. The laparoscopy and sub-peritoneal surgery, the early removal nasogastric tube and early refeeding make it possible to early resumption of intestinal transit. In many cases, the patients should be transferred to a physical and rehabilitation medicine during post-operative period where the nursing care will be most suitable. A quickly adapted rehabilitation must be able to reduce loss of function and physical dependence.

Sacral neuromodulation and pregnancy: Results of a national survey carried out for the neuro-urology committee of the French Association of Urology (AFU)

To assess the impact of sacral neuromodulation (SNM) on pregnancy and vice‐versa, by identifying women who had received SNM for lower‐urinary tract symptoms (LUTS) and had become pregnant.

Lumbar to sacral root rerouting to restore bladder function in a feline spinal cord injury model: Urodynamic and retrograde nerve tracing results from a pilot study

Lumbar to sacral rerouting surgery can potentially allow voiding via a skin‐central nervous system‐bladder reflex pathway. Here, we assessed if this surgery was effective in treating neurogenic bladder dysfunction/sphincter in felines.

Thérapie cellulaire dans l’incontinence urinaire d’effort : étude comparative de deux types de cellules souches mésenchymateuses

Objectifs.— La mise en place d’une bandelette sous-uretrale pour incontinence urinaire apres prostatectomie radicale peut avoir un resultat incomplet. Il n’existe pas de recommandations pour le traitement de l’incontinence urinaire residuelle apres pose de bandelette. Nous presentons les resultats de la pose de ballons Pro-ACT apres echec de bandelette sous-uretrale. Methodes.— Douze patients consecutifs presentant une IU-PR ont ete traites par mise en place de ballons Pro-ACT 14 cm (avec cystoscopie en retrovision) en raison d’une incontinence persistante apres mise en place d’une bandelette sous-uretrale (6 Advence, 6 TOMS). Les symptomes urinaires ont ete evalues avant la pose de la bandelette (T0), avant la pose de ballons (T1) et un an apres pose des ballons (T2) avec les questionnaires suivants : ICIQ, USP, ULCA-PCI, nombre de protections urinaires. Resultats.— L’âge moyen de la population etait de : 69,1 ans. Le pad test/24 h moyen a T0 etait de 220 g/24 h. Le volume d’ajustement des ballons etait en moyenne de 4,2 cm3 a T2. Le delai moyen entre la pose de bandelette et de ballons Pro-ACT etait de 12,2mois. Un cas de perforation uretrale postoperatoire a rendu impossible la pose de ballons. Un patient a ete perdu de vue apres la pose de ballons. Aucun cas d’explantation n’a ete note. Les scores moyens a T0, T1, T2 chez les 10 patients ayant recu des ballons etaient respectivement : ICIQ : 16,7± 1,8, 12,6± 3,3, 3,6± 3,7 (p < 0,0001) ; USP-incontinence d’effort : 8± 2, 5,8± 2,5, 0,8± 0,8, (p < 0,0001) ; USP-dysurie : 0,3± 0,9, 1,2± 1,8, 1,2± 1,2 (NS) ; nombre de protections urinaires : 2,7± 1, 1,85± 1, 0,3± 0,4 (p < 0,0001) ; gene urinaire UCLA-PCI : 10± 12, 22,5± 7,5, 75± 28 (p < 0,0001). Le nombre de patients sans protection ou avec une protection de securite etait de 1 apres bandelette et de 8 apres ballons. Conclusion.— La mise en place de ballons Pro-ACT ameliore significativement la continence en cas de resultat incomplet apres bandelette sous-uretrale.

785 A multi-centre randomized controlled study comparing surgical and pharmacological therapy to treat mixed urinary incontinence

INTRODUCTION AND OBJECTIVES: Mixed urinary incontinence (MUI) defined as the combination of stress and urge incontinence accounts for approximately 33% of all cases of incontinence in women. No consensus exist in literature either medical or surgical treatment has to be proposed first and the usual attitude to treat the dominant symptom first is not supported by any evidence and often disappointing. Our aim to determine the most effective strategy and sequence of therapy between surgery and anticholinergics in females suffering from mild to severe MUI. METHODS: 66 women were included in a prospective multicentre randomized study with an optimal cross over. In phase 1 of the study patients were randomized into two groups: TVT-O (J&J Women’s Health) procedure or Oxytrol patch (Paladin) 3.9 mg/Q3D for 12 weeks. In phase 2 patients not satisfied with the result of their initial treatment were offered a cross over. Our primary outcome was 24h pad test. Cure was defined by a 24-h pad test of 8 g or less. Improvement was defined by a reduction of pad weight 25% in comparison to base line and failure less 25% reduction of pad weight. The follow-up was 56 weeks. RESULTS: 66 patients were randomised and 62 patients completed the study. In phase 1, 31 patients received Oxytrol treatment and 31 patients TVT-O procedure. At 12 weeks, 64% (20/31) of patients having had TVT-O as first line were satisfied (80% (16/20) cured). Only 16% (5/31) patients having had Oxytrol as first line were satisfied (20% (1/5) cured). At 12 weeks, the odds ratio for subjects in TVT-O group to be satisfied and cured were respectively 11.57 times (11.57, 95% CI 2.93-45.67, p 0.05) and 8.03 times (8.03, 95% CI 2.93-45.67, p 0.05) higher than those in Oxytol group. At 12 weeks, 84% (26/31) of patients who started with Oxytrol crossed over to TVT-O and 61,5% (16/26) were cured at 56 weeks after surgical procedure. Only 35% (11/31) of patients who started with TVT-O crossed over to Oxytrol and 18% (2/11) were cured at 56 weeks. CONCLUSIONS: Patients with moderate to severe MUI treated surgically in first line have statistically better chance to be cured in comparison to a patient treated pharmacologically.