[Antibiotic prophylaxis in urodynamics: Clinical practice guidelines using a formal consensus method]. / Antibioprophylaxie et bilan urodynamique : recommandations de bonne pratique par consensus formalisé.

OBJECTIVE: The aim of this work was to issue clinical practice guidelines on antibiotic prophylaxis in urodynamics (urodynamic studies, UDS). MATERIALS AND METHODS: Clinical practice guidelines were provided using a formal consensus method. Guidelines proposals were drew up by a multidisciplinary experts group (pilot group = steering group), then rated by a panel of 12 experts (rating group) using a formal consensus method, and then peer reviewed by a reviewing/reading group of experts (different from the rating group). RESULTS: Urine (bacterial) culture with antimicrobial susceptibility testing is recommended for all patients before UDS (strong agreement). In patients with no neurologic disease, the risk factors for tract urinary infection (UTI) after UDS are age > 70 years, recurrent UTI, and post-void residual volume > 100ml. In patients with neurologic disease, the risk factors for UTI after UDS are recurrent UTI, vesicoureteral reflux, and intermicturition pressure > 40cmH2O. If the urine culture is negative before UDS and there is no risk factor for UTI, antibiotic prophylaxis is not recommended (Strong agreement). If the urine culture is negative before UDS, but there are one or more risk factors for UTI, antibiotic prophylaxis is optional. If antibiotic prophylaxis is initiated, a single oral dose (3g) of fosfomycin-tromethamine two hours before UDS is recommended (Strong agreement). If there is bacterial colonization on UCB before UDS, antibiotic therapy is optional (Undecided). If prescribed, it should be adapted to the antimicrobial susceptibility of the identified bacterium or bacteria, started the day before and stopped after UDS (except for fosfomycin-tromethamine: a single dose the day before UDS is necessary and sufficient) (Strong agreement). In the event of UTI before UDS, the UTI should be treated and UDS postponed (Strong agreement). The proposed recommendations should not be changed for patients with a hip or knee replacement (Strong agreement). No antibiotic prophylaxis of bacterial endocarditis is necessary, including in high-risk patients with valvular heart disease (Strong agreement). CONCLUSION: These new guidelines should help to harmonize clinical practice and limit exposure to antibiotics. LEVEL OF EVIDENCE: 4.

[ACT device: what place in the treatment of female urinary incontinence?]. / Ballons ACT: quelle place dans le traitement de l'incontinence urinaire de la femme?

OBJECTIVES: Assessment of the adjustable continence therapy device (ACT) in the treatment of female stress or mixed urinary incontinence in terms of efficacy and complications. MATERIAL: Between April 2005 and September 2011, the device ACT was put by two different operators to treat a stress and/or mixed urinary incontinence at women. The results were studied under two shutters: complications and efficacy. RESULTS: Seventy-seven women were operated. Mean age of the patients was of 68 years (34-87). Mean follow-up was of 22 months (1-72). Over the 77 patients, eight peroperative complications (10%) were noted. Twenty-five explantations were required in 22 patients (28%). In terms of efficacy, after an average follow-up of 22 months, the results were: 19 patients (25%) were continents, 25 (33%) very improved and five (6%) improved regards to the initial stage preceding the implantation. Fifteen patients (19%) were in failure. Seven patients (9%) were unchanged and in the course of adjustment (recent implantation) and six others (8%) explanted waiting for another implantation. CONCLUSION: The ACT procedure was feasible on a population of multi-operated women with 64% of improvement in our hands. Complications were rare, easily detected and repaired. The risk of explantation was reported to be 28%.