Evaluation des bonnes pratiques de sondage vésical à demeure chez l'adulte par les soignants: utilisation de « vignettes cliniques »

Introduction. Le sondage urinaire ou vésical est une technique utilisée depuis l'antiquité qui repose sur l'utilisation de dispositifs médicaux invasifs pour le patient. Cet acte de soin doit se faire de façon sécurisée et s'appuyer sur des référentiels. Les objectifs ont été l'évaluation durespect des recommandations du protocole institutionnel sur la pose d'une sonde urinaire à demeure chez l'adulte, le respect del'hygiène et de l'asepsie et l'évaluation des conduites à tenir lors d'une fuite urinaire sur sonde.Matériel et méthodes. Dans le cadre d'une démarche d'évaluation des pratiques professionnelles, une enquête prospective basée sur le concept des « vignettes cliniques » a été menée, avec des mises en situations des soignants du CHU Charles Nicolle, Bois-Guillaume et Oissel en 2011.Résultats. L'enquête révèle un suivi des recommandations sur certains points comme le respect de l'asepsie et du système clos. Des divergences ont été mises en évidence concernant notamment l'usage de la bandelette urinaire chez le patient sondé, le choix du type de sonde et les couples de produits à utiliser pour la détersion et l'antisepsie.Conclusion. Des axes d'améliorations sont proposés comme la sensibilisation des équipes soignantes mais également médicales par le biais notamment d'une plaquette simple et illustrée de support d'information sur les bonnes pratiques de sondage vésical à demeure chez l'adulte et des kits «prêts à l'emploi » de produits pour la détersion et l'antisepsie

Rolled Vaginal Wall Flap for the Treatment of Stress Urinary Incontinence

Objectives: Anterior vaginal wall slings (AVWS) have been used for decades in the treatment of female stress urinary incontinence (SUI). The main drawback of using the vaginal wall as a sling is its tendency to weaken and stretch over the course of years. The use of synthetic tapes for the treatment of SUI is effective but costly. For patients who cannot afford synthetic tapes; we describe the preliminary results of a modified AVWS technique for the treatment of SUI types II and III. Patients and Methods: In this series; a modification of the AVWS was applied in 35 female patients with SUI. A fortified and rolled flap is used to provide compression and support of the urethra. The vaginal mucosal surface of the flap is cauterized and two diagonal sutures are placed across it. The flap is then rolled on itself with a running 2/0 vicryl suture. Two sutures attached to both ends are passed retropubically to the anterior abdominal wall and tied over the rectus sheath. Results: All 35 female patients had type II/III SUI. After a median follow up of 43 months; 91of the patients were dry or used 0-1 pad per day. Only one patient suffered from transient retention for one week post-operatively. Conclusion: This is a simple method to reinforce vaginal wall flaps. It could offer a durable and effective option for the treatment of SUI in patients who can not afford synthetic tapes. Long-term follow up is required to evaluate the durability of the procedure

Tension-Free Vaginal Tape Versus Transobturator Tape for Treatment of Female Stress Urinary Incontinence

The transobturator tape (TOT) is based on a similar principle as the tension-free vaginal tape (TVT); but introduced through the obturator foramen. The aim of this study was to compare these slings as surgical procedures for the treatment of stress urinary incontinence (SUI) in women. Patients and Methods This is a retrospective case-control study including female patients with SUI; either due to urethral hypermobility or intrinsic sphincter deficiency. Thirty patients were treated with TVT (group 1) and 30 were treated with TOT (group 2). The parameters studied were: pre-operative clinical data; operative data and surgical outcome. Results The post-operative complications in group 1 consisted of bladder perforation in one patient (3.3); urinary retention in 3 (10) and de novo urgency in 3 (10). The post-operative complications in group 2 consisted of vaginal xposure in 2 patients (6.7); de novo urgency in 2 (6.7) and transient urinary retention in one (3.3). In the TVT group; objective cure was achieved in 27/30 patients (90); while 3 patients (10) reported subjective cure; failure was not encountered. In the TOT group; objective cure was achieved in 24/30 patients (80) and subjective cure in 4 patients (13.3); and it failed in 2 patients (6.7). Conclusion TVT and TOT are effective procedures for the treatment of female SUI; with comparable results regarding operative time; hospital stay and the risk of complications