[Efficacy of suburethral TVT in cases of stress urinary incontinence associated with severe sphincter insufficiency. Report of 22 cases]. / Efficacité de la bandelette sous urétrale TVT en cas d'incontinence urinaire d'effort associée à une insuffisance sphinctérienne sévère. A propos de 22 cas.

INTRODUCTION: The TVT system has revolutionized the management of female stress urinary incontinence (SUI). Less favourable results have been observed in patients with urinary incontinence associated with a low maximum urethral closing pressure (MUCP). The objective of this prospective study was to evaluate the efficacy of TVT in this situation. MATERIAL AND METHODS: From October 1999 to June 2001, 22 patients between the ages of 53 and 84 years (median: 66.7 years) were operated for SUI with an MUCP < 25 cm H2O (mean: 17.6 cm H2O, range: 6 to 22 cm H2O) present for more than 8 months (range: 8 to 48 months). Three patients also had associated urgency. The Ulmstem manoeuvre was positive in every case and the Bonney manoeuvre was positive in 19 patients. Insertion of TVT was associated with sacral colpopexy in two patients. Success of treatment was defined by complete absence of incontinence and voiding disorders after the operation. RESULTS: One patient was lost to follow-up. The median follow-up was 7.5 months (range: 3 to 27 months). The mean duration of bladder catheterization was 1.3 days (range: 1 to 5 days). Fifteen patients were completely cured by TVT (71.4%). In these cases, uroflowmetry and post-voiding volume were not affected by the operation. Treatment was ineffective in 6 patients (4 cases of uncontrolled leaks, one case of de novo urge incontinence, one case of postoperative dysuria with a post-voiding residue of 120 ml). CONCLUSION: The TVT system appears to be an effective method for the treatment of most patients with SUI associated with severe manometric sphincter incompetence. However, these favourable results need to be confirmed by a longer follow-up.

[Non-typhus Salmonella urinary tract infections]. / Infections urinaires à salmonella non typhique.

Non-typhus Salmonella urinary tract infections are rare. Based on a clinical case and a review of the recent literature, the authors analyse the diagnostic setting and discuss the necessary investigations and treatment modalities. Non-typhus Salmonella urinary tract infections generally occur in a predisposed clinical setting, such as immunodepression or acquired (stones, schistosomiasis) or congenital uropathy. As in the present case, it can also be the first clinical expression of AIDS, which must be systematically investigated. Antibiotic therapy must be continued for at least two weeks and consists of a third generation cephalosporin or fluoroquinolones, but the prognosis is directly related to the underlying clinical condition.