[Consequences of coelioscopic sacrocolopoxy on the sexuality of the couple]. / Impact des cures de prolapsus pelviens par promontofixation laparoscopique sur la sexualité du couple.

AIM: To assess the impact on the sexuality of the couple of pelvic organ prolapse repair with coelioscopic sacrocolopoxy. MATERIAL: Pilot, prospective, monocentre study conducted in Nîmes university hospital. Consecutive patients undergoing coelioscopic sacrocolpopexy and their partner were invited to participate. Women attended a pre-surgical visit and a 6-month post-surgery visit where pelvic organ prolapse status was clinically assessed. In the same time, they and their partner filled general quality of life and specific sexual quality of life questionnaires (questionnaires PISQ12, PFDI-20 in women, medical history, IIEF, modified PISQ12 questionnaires in men). RESULTS: From May to December 2010, 25 couples were assessed. Anatomical success rates (POPQ<2) in the middle, anterior and posterior compartments were respectively of 100%, 95.4% and 66.7%. After surgery, 65.2% of pairs (n=15) reported an at least hebdomadal frequency of sexual intercourse, as compared with 54.2% (n=13) of pairs before surgery (P<0.001). Two cases of decrease of sexual intercourses frequency were reported and appeared partner-related. There was an overall non-significant improvement in sexual quality of life in men and women. General pelvic organ distress, urinary incontinence and specific pelvic organ prolapse distresses were significantly improved after surgery. CONCLUSION: Coelioscopic sacrocolpopexy does not impair couple's sexuality, assessed as sexual intercourses frequency and could even improve it. Partner's assessment can bring important information with respect to the interpretation of functional sexual results of surgery.

Impact of preoperative immunonutrition on morbidity following cystectomy for bladder cancer: a case-control pilot study.

PURPOSE: To compare postoperative complications in patients with or without preoperative immunonutrition before cystectomy. METHODS: A prospective, multicenter, pilot, case-control study was conducted during 6 months. Patients with 7-day preoperative immunonutrition were prospectively included and compared with a retrospective, matched control group without immunonutrition. Early complication rates and the length of hospital stay were analyzed. The bilateral type I error was <0.05; the power was 90%. Thirty patients in each group were required. RESULTS: Thirty patients were included in each group, on a comparable basis. In the immunonutrition group, fewer postoperative complications (40 vs. 76.7%; p = 0.008), less paralytic ileus at D7 (6.6 vs. 33.3%; p = 0.02), fewer infections (23.3 vs. 60%; p = 0.008), and in particular less pyelonephritis (16.7 vs. 46.7%; p = 0.03) occurred. Clavien's grades for complications were higher in the control group (p = 0.04). Mortality, pulmonary embolism, anastomotic fistulae, and wound dehiscence were similar between two groups. The length of stay was reduced by 3 days in the immunonutrition group. CONCLUSIONS: In this pilot case-control study, immunonutrition is associated with a decrease in postoperative complications, urinary tract infections, Clavien's grade for complications, and paralytic ileus in patients undergoing cystectomy for bladder cancer. Prospective randomized placebo control studies are needed to confirm these promising results.

[Sub-urethral sling Advance(®) midterm results: patient selection and predictors of success]. / Bandelette sous-urétrale Advance(®) : résultats à moyen terme : sélection des patients et facteurs prédictifs.

INTRODUCTION AND OBJECTIVES: Sub-urethral trans-obturator male slings have been propose to treat men urinary incontinence. Medium term results are lacking: only one study has been published. AIM: To evaluate the efficacy of the sub-urethral sling Advance(®) (American Medical System, Minnetonka, MN, USA) and determinate factor of success. MATERIALS AND METHODS: Single center retrospective study of patients implanted with an Advance(®) for urinary incontinence after radical prostatectomy. The degree of incontinence was evaluated by number of pads used per days: mild (use of 1 to 2 pads/day), moderate (3 to 4p/day) and severe (≥5p/day). The "Cure" was defined as no pad or just one for "security reason" and "improved" as decreased more than 50% of pads use. RESULTS: Between October 2007 and November 2009, 69 slings were implanted. Mean follow-up was 32.4months (±8.4months). Before treatment, 37.68% of the patients suffered from mild, 42.03% moderate and 20.29% severe urinary incontinence. At midterm, 21.8% of the patients were cured and 50.7% cured or improved. For patients who suffered from mild or moderate urinary incontinence, 23.6% were cured and 58.2% were cured or improved. The cure rate decreased with the severity of incontinence. It was respectively 30.8%, 17.2% and 14.2% for mild, moderate and severe incontinence. Failure rate was more important with severe incontinence: 78%. For patients with urethral fence pressure less than 57cmH2O, the risk of failure was multiply by 6.6. No severe complication was noted during follow-up. Only one male sling was removed. CONCLUSIONS: At midterm, one patient on five was cure and half was cured or improved. The technique presented an acceptable morbidity and a good tolerance. Two predictors of success were identified: severity of incontinence and residual sphincter function. Good candidates used less than three pads per day.

Impact of stimulation dose and personality on autonomic and psychological effects induced by acupuncture.

Acupuncture has been shown to exhibit distinct effects on the autonomic nervous system. We tested whether the autonomic and psychological response to acupuncture depends on the stimulation dose and the personality of the treated subjects. 52 healthy subjects were randomized to receive either low dose (one needle at point Hegu bilaterally) or high dose (additional 4 needles at non-acupoints bilaterally) acupuncture stimulation after stratification according to their personality to "reduce" or "augment" incoming stimuli. Outcomes were changes of electrodermal activity (EDA), high frequency component of heart rate variability, heart rate, mean arterial blood pressure, respiration rate and subjective parameters for psychological well being and perceived intensity of needling. Electrodermal activity increased during needle insertion and decreased under baseline when subjects were resting with the needles in the body for 20 min. The initial EDA increase was significantly (GEE ANCOVA p<0.001) more pronounced during high dose stimulation and independent of personality. All other physiological parameters did not show any significant group effect. Strong stimulated augmenters perceived acupuncture most painful and increased with their psychological activation after the acupuncture session in contrast to the other groups, which showed a decrease of activation in the pre-post comparison (overall group effect p=0.032). The data indicate that during needle insertion high dose acupuncture stimulation leads to a higher increase of sympathetic nerve activity than low dose stimulation independent of personality. After needle insertion subjects who tend to augment incoming stimuli might show a lack of psychological relaxation when receiving high dose stimulation.

Renal cell carcinoma with Xp11.2 translocation in a 7-year-old boy.

BACKGROUND: More than 90% of pediatric renal tumors are nephroblastomas while renal cell carcinomas (RCC) are rare in children (< 5%). PATIENT: According to the clinical diagnoses of a nephroblastoma stage IV a 7-year-old boy with a kidney tumor and peripheral pulmonary lesion was preoperatively treated for 8 weeks with Vincristine, Actinomycin D and Adriamycin. The resected kidney displayed a RCC with Xp11.2 translocation. There was no tumor regression and the pulmonary lesion was no longer detectable. Hence chemotherapy was put to a halt. CONCLUSION: Fine needle aspiration biopsy (FNA) would have allowed to adjust the tumor subtype. Prognosis of pediatric RCC with translocation seems more favourable than without translocation though definitive evidence will only be possible by documentation in a clinical diagnose-related register.