[Pelvic floor muscle contraction and maximum urethral closure pressure]. / Contraction des muscles du plancher pelvien et pression de clôture urétrale maximale.

OBJECTIVES: The aim of this study was to precise the relationship between the pelvic floor muscle (PFM) contraction and the maximum urethral closure pressure (MUCP) at rest and during a containing effort. MATERIALS: Longitudinal study, observational, single-center retrospective performed in successively 358 women addressed for urodynamics. MUCP at rest and during a containing effort, gain of MUCP, functional urethral length (FUL), scores USP and ICQ-SF, cervico-urethral mobility (CUM) according to POP-Q classification and leak point pressure were analyzed according to the PFM contraction. RESULTS: One hundred and seventy-three had genuine stress urinary incontinence, 25 urge urinary incontinence, 148 mixed incontinence and 12 had no urinary incontinence. PFM contraction was not associated with a hysterectomy, age, parity, BMI, CUM, FUL, MUCP at rest, the severity of the incontinence assessed by ICIQ-SF score and leak point pressure. There was a proportional relationship between PFM contraction and the value of MUCP measured during this contraction (P<0.0001) on the one hand, and the gain of MUCP (P<0.0001) on the other. MUCP at rest was independent from the MUCP during the containing effort and the gain of MUCP. CONCLUSIONS: The strength of contraction of the PFM is not correlated with MUCP at rest but proportional to the augmentation of the MUCP during the containing effort.

[Clinical and paraclinical evaluations of bladder sensitivity. Review of the literature]. / Évaluation clinique et paraclinique de la sensibilité vésicale. Revue de la littérature.

INTRODUCTION: The aim of this work was to carry out a review of the literature on the clinical and paraclinical evaluation of bladder sensory (BS) to better understand BS disorders in nonneurological patients. METHODS: Thirty-three articles were selected from the Medline(®) Database between 1992 and 2012 using the following key words: "sensory/sensitivity bladder evaluation", "sensory/sensitivity bladder scale", "sensory/sensitivity bladder questionnaire", "urodynamic bladder sensory", "urgency questionnaire" and "Overactive Bladder (OAB) questionnaire". RESULTS: Evaluation of BS by asking questions during cystometry is validated (LE 2). The sensation of the desire to void progresses linearly with bladder filling (LE 2). Many symptoms and quality of life questionnaires related to BS anomalies have been proposed. Bladder diaries, frequency/volume curves (LE 2) and clinical algorithms (LE 3) could be an alternative to evaluate BS. CONCLUSION: Current evaluation only provides a partial view of BS. A multidimensional approach should lead to better understanding of BS disorders.

[Urodynamic examination in the investigation of non neurological female urinary incontinence]. / Examen urodynamique et incontinence urinaire féminine non neurologique.

BACKGROUND: Female urinary incontinence raises various physiopathological mechanisms which can be investigated by urodynamics. The aim of this work is to specify the validity and the relevance of the various urodynamic parameters used in clinical practice. METHODS: A bibliographical research was realized on the basis of Medline data from original articles dealing with the incontinence in the absence of genital prolapse. CONCLUSIONS: Urodynamic examination has to contain uroflowmetry, post void residual, filling cystometry with detrusor pressure measurements during micturition, urethral pressure profile with maximal urethral closure pressure (MUCP) and Valsalva leak point pressure (VLPP). A urodynamic examination is not necessary before conservative treatment of urinary incontinence in the female. A complete urodynamic examination is recommended before any decision of surgical correction of urinary incontinence and in case of surgical failure.

[Comparative study of 230 women to determine the maximum closure pressure and functional length of the urethra at 0, 3, 6 and 9 o'clock]. / Etude comparative chez 230 femmes de la pression de clôture maximale et de la longueur fonctionnelle de l'urètre à 0, 3, 6 et 9 heures.

OBJECTIVE: The maximum closure pressure (MCP) of the urethra, measured by the urethral profile, constitutes an index of urinary continence. The objective of this study, in a large population of women, was to evaluate the possible variations of MCP and functional length (FL) of the urethra, according to the position of a urodynamic probe designed to perform lateral sectorial measurements. MATERIAL AND METHODS: Measurements were performed between July and December 1998, in 230 patients with a mean age of 55 years, using a probe perfused with water and equipped with an urethral side orifice. We compared, by analysis of variance for repeated measures, MCP and mean FL at 0 o'clock (MCPm0, LFm0), 3 o'clock (MCPm3, LFm3), 6 o'clock (MCPm6, LFm6) and 9 o'clock (MCPm9, LFm9). RESULTS: The values for MCPm and LFm obtained according to the rotation of the probe were as follows: MCPm0 = 65.68 +/- 12.46 cmH20, MPCm3 = 55.44 +/- 16.97 cmH20, MCPm6 = 58.07 +/- 15.85 cmH20, and MCPm9 = 53.85 +/- 16.89 cmH20, LFm0 = 28.92 +/- 5.32 mm, LFm3 = 30.18 +/- 6.82 mm, LFm6 = 32.40 +/- 6.82 mm and LFm9 = 30.83 +/- 6.07 mm. CONCLUSION: LCP may variable considerably in the same subject according to rotation of the probe. In our series, MCPm at 0 o'clock was significantly higher than MCPm at 3 o'clock, 6 o'clock and 9 o'clock. This difference appears to increase with age. The lowest values for MCPm were observed at 3 o'clock and 9 o'clock. The MCPm at 6 o'clock was intermediate and the closest value to the mean pressure calculated from MCPm in the four positions. On the other hand, FL varied only slightly according to the position of the probe.

Transvaginal colpo-urethropexy with fibrin sealant: 4 years-follow up in 23 cases.

A method of transvaginal colpo-urethropexy, using fibrin sealant was studied clinically. After a fingertip vaginal retropubic dissection, fibrin sealant is instilled in the retropubic space with the intent of inducing fibrosis between the elevated urethro-vesical junction and the retropubic periosteum. Twenty-three patients with urinary stress incontinence underwent this procedure with 82% of satisfactory results and 18% failure. Complications were minimal. In the future, this technique could be useful for ambulatory surgery.

Physiological evidence of neural pathways involved in reflexogenic penile erection in the rat.

To elucidate neural pathways responsible for the occurrence of reflexogenic erections, the response of the corpus cavernosum to electrical stimulation of the dorsal nerve of the penis (DNP) was measured in anesthetized, acutely spinalized rats. Stimulation elicited a dramatic increase in intracavernous pressure (ICP). ICP response was decreased by 70% after sectioning the pelvic nerve homolaterally to the stimulated DNP and abolished after bilateral section. ICP response was not impaired by curarization, but its latency was lengthened. Thus we physiologically evidenced a reflex loop independent from supraspinal centers between DNP and the pelvic nerve supporting penile reflexogenic erection.

[Management of a short femur discovered via ultrasound in utero. Prenatal diagnosis of Stuve-Wiedemann syndrome]. / Conduite à tenir devant la découverte échographique d'un fémur court in utero. A propos d'un diagnostic anténatal de syndrome de Stuve-Wiedemann.

The authors report a case of familial Stuve-Wiedemann syndrome where the diagnosis was made in utero. Following this case the authors discuss the management of short femur discovered by ultrasound. The analysis of the morphology, the ultrasound appearance and the radiographic appearance (X-ray of the uterine contents) may make it possible sometimes to diagnose the syndrome. An important element is a study of the genealogy to discover the way in which a large number of these bone diseases are transmitted. The prognosis for life is very variable according to the severity of the syndrome.

[Antenatal diagnosis and management of congenital chylothorax]. / Diagnostic anténatal et prise en charge du chylothorax congénital.

A case of congenital chylothorax diagnosed with prenatal ultrasonography is described. Thoracocentesis was performed at 33 weeks of gestational age but recurrence of chylothorax, increasing hydramnios and subcutaneous oedema made cesarean section necessary at 37 weeks. Mechanisms of chylothorax during the fetal life and its management before and after delivery are discussed.