ABSTRACT
AIM: To analyse current practice patterns and to evaluate (long-term) effectiveness and adverse events of sacral neuromodulation with InterStim™ Therapy based on data collected in a national register and to discuss the strengths and weaknesses of the register. PATIENTS AND METHODS: This is a French multicenter prospective observational trial including patients with a permanent implant (2003-2009). Voiding diary variables and patient satisfaction were analysed based on last follow-up visit since implantation. RESULTS: One thousand four hundred and eighteen patients (median age: 63 years, 1206 females) were included in the database (median follow-up: 12 months). One thousand and eighty-nine patients had non-neurological disease. The principal diagnosis was overactive bladder syndrome ([OAB], n=1170) and retention (n=151). Implantation occurred in 1358 patients; 1172 patients had greater than or equal to one registered follow-up. Clinical improvement of greater than or equal to 50% was seen in 447/527 patients with OAB at 12 months follow-up (median number of voids per 24 hours decreased from 15 at baseline to 8 at 12 months) and in 42/54 of patients with retention (median number of catheterization per 24 hours dropped from 5 at baseline to 0 at 12 months). Clinical improvement remained relatively stable up to 60 months. Median patient satisfaction with treatment was between 60 and 80%. Five hundred and twenty-four patients had at least one adverse event; loss of efficacy (n=244) occurred most frequently. CONCLUSIONS: In this large database sacral neuromodulation with InterStim™ Therapy seems to be an effective treatment through routine practice in the long-term (up to 60 months) for patients refractory to medical treatment.
Subject(s)
Electric Stimulation Therapy , Urinary Incontinence/therapy , Female , France , Humans , Lumbosacral Plexus , Male , Prospective Studies , RegistriesABSTRACT
The authors report the case of a giant diverticulum of the bladder compressing the iliac vessels. They go on to make an anatomicopathological, clinical and therapeutical study of these giant diverticula.
Subject(s)
Diverticulum/complications , Iliac Vein , Urinary Bladder Diseases/complications , Vena Cava, Inferior , Constriction, Pathologic/etiology , Diverticulum/diagnosis , Diverticulum/surgery , Humans , Male , Middle Aged , Vascular Diseases/etiologyABSTRACT
The authors report a case of prostatic cancer in a 50-year-old patient, for which the sole clinical manifestation was recurrent hemospermia. There was an undoubted connection, in this case, between the hemospermia and the cancer, which is rare. The treatment was endoscopic associated with cobalt therapy. The follow-up is four years.
Subject(s)
Blood , Prostatic Neoplasms/diagnosis , Semen , Humans , Male , Middle Aged , Prostatic Neoplasms/therapyABSTRACT
Peridural catheterization connected to a sub-cutaneous morphine reservoir can provide an effective and prolonged analgesia for certain pelvic pains of a urological origin which resist the usual sedative therapies. The authors describe the method of catheterization and the results which they have obtained in five patients treated in this way.
Subject(s)
Morphine/administration & dosage , Pain, Intractable/drug therapy , Prostheses and Implants , Aged , Catheterization/methods , Epidural Space , Humans , Infusions, Parenteral/instrumentation , Infusions, Parenteral/methods , Middle Aged , Morphine/therapeutic useABSTRACT
Additional examinations of pregnant women (radiology...) are a real danger, but radiographies CT scans and ultrasound examinations must be carried out when necessary.
Subject(s)
Diagnosis , Pregnancy , Clinical Laboratory Techniques , Female , Humans , Radiography , UltrasonographyABSTRACT
The authors describe two cases of severe septic complications after caesarean section. They compare primary closure of the abdomen with the method of leaving it open. This should only be used very rarely but may help to shorten the stay in hospital and lessen the severity of the complications of severe peritonitis, which still today in these rare cases of surgery carry very heavy mortality.
