[Impact of anastomotic strictures on treatment of post-prostatectomy stress incontinence by artificial urinary sphincter]. / Impact des sténoses anastomotiques sur le traitement de l'incontinence urinaire post-prostatectomie par sphincter artificiel.

INTRODUCTION: Stress urinary incontinence (SUI) is a degradation of the quality of life factor in the consequences of radical prostatectomy. Artificial urinary sphincter (AUS) is the standard treatment. Screening and preoperative treatment of anastomotic strictures (AS) is an essential step for the success of the intervention. The objective of the study was to assess the impact of AS on the results of AUA. METHODS: We retrospectively studied 147 AUS settlements from 2005 to 2013 in the urology department of the Centre Hospitalier Lyon by three operators. The demographic characteristics, the irradiation history, the severity of incontinence, the complications of AUS, the continence rate and the postoperative satisfaction were collected. Wilcoxon statistical tests and Fischer and a Kaplan-Meier curve were used to compare the two control groups and AS. Logistic regression analysis looked for predictors of surgical reintervention. RESULTS: Of the 147 patients included, 24 (16.3%) had a history of AS. Of these, 21 (87.5%) were treated with endoscopic urethrotomy. Patients in the AS group had more severe incontinence (P<0.05) than in the control group. Explantation rates, recurrence of incontinence and reoperation was 12.5%, 8.3% and 33.3% in the AS group against 4.9%, 15.4% and 27.6% in the control group. In logistic regression, history of AS has not been found as reoperation risk factor. Continents and satisfied patients rate were 77.8% and 76.5%, respectively in the AS group against 91.1% and 81.1% in the control group. CONCLUSION: The history of AS does not appear to be predictive of poor outcome after implementation of a AUS. Larger cohort studies are needed to confirm these results. LEVEL OF EVIDENCE: 4.

[Temporary urethral stents ALLIUM BUS "BULBAR URETHRAL STENT" for the treatment of detrusor sphincter dyssynergia]. / Intérêt des endoprothèses urétrales ALLIUM BUS « BULBAR URETHRAL STENT ¼ pour le traitement de la dyssynergie vésico-sphinctérienne.

INTRODUCTION: The temporary prosthetic sphincterotomy is a possible treatment for neurologic detrusor sphincter dyssynergia (DSD). The purpose of the study was to verify the feasibility and effectiveness of the urethral stent (US) Temporary ALLIUM BUS "BULBAR URETHRAL STENT". PATIENTS AND METHODS: A prospective, non-comparative, single-center starting in 2015 was conducted. Were included patients over 18 years, with a neurologic DSD proved urodynamically for which medical treatment was not indicated or failed. The primary endpoint was the percentage of patients who had a voiding method considered as improved or much improved at 1 month and the feasibility of the procedure. RESULTS: From January to June 2015, 7 patients, (mean age 47.9 years [24-76 years]) were prospectively enrolled. One patient was lost to sight at one month and therefore excluded. The median follow-up was 8.1 months (1-10 months). All procedures were technically successful. At 1 month, there were 57% of grade 2 complications (Clavien-Dindo), 1 of 6 patients had a migration of the US. At one month, quality of life and the urologic situation was considered good in 3 patients, unchanged in 2 patients and decreased in 1 patient. The study was stopped after the inclusion of seven patients. At the date of the latest news, 5 of 6 patients had a migrated or an explanted US. CONCLUSION: The temporary urethral stent ALLIUM BUS does not seem to be a possible surgical alternative for the treatment of detrusor sphincter dyssynergia. LEVEL OF EVIDENCE: 4.