[Male stress urinary incontinence: medium-term results of treatment by sub-urethral bone anchored sling InVance™]. / Efficacité à moyen terme du traitement de l'incontinence urinaire d'effort masculine par bandelette prothétique sous-urétrale à ancrage osseux type InVance™

OBJECTIVE: To analyze the functional and urodynamic results of a compressive sub-urethral sling with bone anchoring InVance™. METHODS: One hundred and six successive patients were operated with this system between August 2004 and March 2009. Urinary incontinence was classified according to the number of daily protections. All the patients have benefited from a clinical, endoscopic and urodynamic pre and post-operative evaluation. The results were classified in four groups, at three months and at one year, according to whether the patients were dry (A), very improved (B), little improved (C), or with no improvement (D). RESULTS: The average age of the patients during the installation of the strip was 67.4 years (46-82). At three months, the rate of dry (A) or very improved patients (B) was of 81.2% (A=75.5%; B=5.7%), and at one year: 75.5% (A=61%; B=14.5%). At three months, the rate of patients little improved (C) or not improved (D) was of 18.8% (C=16%; D=2.8%), and at one year: 24.5% (C=20.3%; D=4.2%). These results deteriorated according to the initial rank of incontinence II, III, and I. Six patients (5.7%) were explanted because of a prosthetic infection which perished at an average of 9 months (3-18). Infection was linked to operative time (p=0.02), and patients age. No osteitis nor urethral erosion were noted. There was a significant rise in the pressures of maximum fence at rest and maximum urethral pressures in reserve (p=0.01). At one year, score ICIQ-UI SF decreased overall by 7.1 points. CONCLUSION: The medium-term results of under-urethral supporting with bone anchoring InVance™ are very encouraging. This technique presents an acceptable morbidity and a good tolerance. It can be proposed in first intention for a urinary incontinence whatever the rank is, even if the effectiveness is particularly present in incontinences of rank I and II.

[Radiotherapy influence, about results of the InVance(®) male sling in men with stress urinary incontinence]. / Influence de la radiothérapie, sur les résultats du traitement de l'incontinence urinaire d'effort chez l'homme, par soutènement sous urétral de type InVance(®).

AIMS: To study impact of previous radiotherapy on urodynamic parameters, continence and complication rate, after prosthetic implantation with InVance® device. PATIENTS AND METHODS: We included 106 patients between August 2004 and March 2009. We stratified urinary incontinence according to pads daily used, in grade I (one to two pads), II (three to four), or III (more than four or condom catheter use). We compared one group of 24 patients with previous radiotherapy (R) to 82 control patients (T) without one. Follow-up was made at three and six postoperative months and then annually. Results were classified into: no leaks, improved or failure. RESULTS: Mean follow-up was 14.8 months (median=12.8) in group R and 12.4 months (median=8.8) in group T. At three postoperative months, continence was achieved in 62.5% patients from group R and in 77% patients in group T (P: ns). At 12 months, results on continence were respectively 52.6% in group R and 63.2% in group T (P: ns). Six patients were explanted because of an infection (5.7%), among which two in group R (8.3%) and four in group T (4.8%). Infection was significantly linked to operative time (P: 0.02). CONCLUSION: Previous radiotherapy has no impact on urodynamic parameters and continence, on short- and mid-term analysis, after implantation of a bone-anchored suburethral sling with InVance® device, preferentially patients with mild to moderate incontinenec urinary.

[The non-neurogenic neurogenic bladder (Hinman's syndrome) in children: What are pronostic criteria based on a 31 cases multicentric study]. / Critères pronostics du syndrome de Hinman (vessie neurogène non neurogène). Etude multicentrique de 31 cas.

PURPOSE: To identify in children the pejorative estimated criteria of a extreme dysfunctional voiding can leading to a Hinman syndrome. PATIENTS AND METHODS: Retrospective and multicentric study of 31 patients (19 boys and 12 girls), resulting from three universitary medical center (Besancon, Lyon, Nantes), which were divided into three groups according to their evolution: A - forms with a serious uronephrologic outcome. B - intermediate forms with persistent voiding dysfunction. C - forms with uneventful outcome. RESULTS: The initial urologic examination was done, on average, on 6.4 years old children (1-16) and the diagnosis at 12.2 years (1.8-26.9). Eighty-four percent of the patients presented initial urologic symptoms, including 35 % of enuresis and 48 % with large amount of stool in the rectal vault (constipation and encopresis in 93 %). Thirty-five percent undergoing significant familial life stresses. In group A, urinary incontinence was present in 29 %. Sixty-two percent were improved by an intermittent catheterisme and 50 % by anticholinergic drugs solely. In group B, 46 % presented major constipation or encopresis and 60 % an urinary infection. A voiding retraining and an intermittent catheterisme improved 71 and 75 % respectively. In group C, no patient presented initial low urinary infection, encopresis or stool impaction. The boys presented more febrile urinary infection (20 % vs. 8 %), more rectal disorders (encopresis: 31 % vs. 8 %) and less urinary incontinence. In this group voiding retraining improved 67 %. CONCLUSION: The Hinman's syndrome is a serious and unusual outcome of the "dysfunctional elimination syndrome". At diagnosis, the patterns of a pejorative outcome are the male sex, the severe fecal retention, the serious psychological disorders, the delay of diagnosis and treatment.

[Study of dissociative disorders and depersonalization in a sample of young adult French population]. / Etude des troubles dissociatifs et de la dépersonnalisation au sein d'un échantillon de la population française adulte jeune.

UNLABELLED: Questioned by several researches about dissociative disorders, the authors study differences established on the nosographic register, through a quantitative study and a psychodynamic argumentation in a sample of french population. From the utilisation of the Dissociative Experiences Scale (DES) created by Bernstein E and Putnam FW (1986), which is an excellent screening tool for dissociative disorders and constructed on DSM II diagnostic criterions, the authors will show the interest of a psychodynamic analysis of dissociative disorders, in the face of the diagnostic difficulty in relation to several approaches of this concept. This difficulty is studied giving the background to dissociative disorders and depersonalization. Ionescu (1999) shows that between 1890 and 1910 dissociation represents one of major themes of psychology, psychopathology and psychiatry. Then, this interest about dissociation decreases and will be almost non-existent in the middle of the twentieth century. The interest for dissociative disorder will grow in the eighties with north-american studies about multiple personality disorders. Until 1980, dissociative disorders exist in DSM II as a list of symptoms included into hysterical neurosis, among the conversive disorders. In 1980, the publication of DSM III replaces the notion of hysteria with the notion of dissociative disorder. In this way, we can see on the one hand somatoform disorders quarterly corresponding to the ancient version of conversive hysteria, and on the other hand dissociative disorders characterized by a perturbation of consciousness, memory, identity or perception of environment. In 1994, The DSM IV delete the notion of hysteria and neurosis and keeps only the notion of dissociative disorders. They include now the five following categories: dissociative amnesia, dissociative fugue, depersonalization disorder, dissociative identity disorder, dissociative disorder not otherwise specified (including derealization). Depersonalization disorders consist of "persistent or recurrent episodes of depersonalization characterized by a feeling of detachment or estrangement from one's self. The individual may feel like an automation or like he or she is living in a dream or movie" (DSM IV). Depersonalization disorder cannot be diagnosed if it is part of schizophrenia, panic disorder, acute stress disorder or dissociative identity disorder. Various depressive disorders, hypocondriasis or obsessive-compulsive disorders can accompany depersonalization disorder. The first purpose of this study will search the frequency of dissociative disorders and depersonalization in a sample of normal population. Further, the inclusion of depersonalization amongst dissociative disorders seems not so evident: depersonalization belongs to self-consciousness disorder in french psychiatry. This fact seems more logical insofar as dissociative disorders have all together a memory and consciousness perturbation, and this perturbation is missing from depersonalization's feeling. The second purpose will be to clarify and specify the particularity of depersonalization among dissociative diorders, from the psychopathological point of view. METHODOLOGY: The sample (n = 248) is made up of french young adults aged 17 to 30 (mean age = 20, SD = 15 and 24% is male population). Subjects were streamming from universities. The screening tool which was used is the Dissociative Experiences Scale, a 28-item patient questionnaire regarding various dissociative symptoms. The subject is asked to indicate the percentage of time, to the nearest 5%, that particular symptom is experienced. The score is made by adding the various percentages and finding a mean that is expressed in numbers from 0 to 100. Normal scores are in the range of 5 to 15 in american adults. RESULTS: The utilization of principal component analysis (PCA) with varimax rotation is justified by the will to compare this study with American's studies. The mean score obtained is 17.44%, and 13.3% of the scores exceed a psychiatric threshold at 30%. The descriptive analysis shows that the component 1 (PCA without varimax rotation) represents 33.02% of total explained variance. This result demonstrates that the structure of the DES is based on one concept, the same as the american population, it is the concept of dissociation. The Principal Component Analysis with varimax rotation of the DES ratings yielded a tree-factor solution: imaginative absorption (F1), depersonalization-derealization (F2) and dissociative amnesia (F3). Mean score for each factor is respectively: F1 = 21.56%, F2 = 13.95%, F3 = 11.04%. DES reliability was studied through computation of Cronbach's coefficient (0.92). The PCA with varimax rotation brings to the fore a full dissociative disorder without any trouble of memory and consciousness. This fact questions again once more the link between hysteria and dissociative disorders. There is here a clinical distinction between depersonalization-derealization and other dissociative disorders. Indeed, the absence of significant alteration of memory and conscience is specific of depersonalization and derealization in this study. CONCLUSION: Finally, this study concurs with DSM IV dissociative criterions. At last, one factor of PCA is composed by the association of depersonalization and derealization, in contradiction with DSM IV definition. This result shows that, into the french population, we cannot divide the two concepts.

[Neurological manifestations of alveolar echinococcosis]. / Manifestations neurologiques de l'échinococcose alvéolaire.

Among 78 cases of alveolar echinococcosis reported in Lorraine, France, 5 had neurologic complications which in 3 cases revealed the disease. Results of parasitic tests are discussed and emphasis is placed on differences between this disease and hydatidosis. Encephalic localizations (3 cases) were multiple making neurosurgery impossible. The outcome was fatal in 2 cases: 1 month after the initial neurologic signs in the absence of treatment (case 1) and 4 months after treatment with flubendazole (case 2). This drug was however effective in the 3rd case (hepatic, pulmonary and cerebral form) with follow-up now at 4 years. Epidemiologic, histopathologic, clinical, diagnostic characteristics and course of these encephalic localizations are reviewed. Spinal localizations (2 cases) presented with a picture of spinal cord compression. After laminectomy and flubendazole, the course was marked by relapse with death in one case and a satisfactory neurologic course with a 4 year follow-up in the other one.