Long-term results of artificial urinary sphincter for women with type III stress urinary incontinence.

BACKGROUND: The use of the artificial urinary sphincter (AUS) in women is limited. OBJECTIVE: To analyse long-term results and mechanical survival of the AUS (AMS 800; American Medical Systems, Minnetonka, MN, USA) in women with stress urinary incontinence (SUI) due to intrinsic sphincter deficiency (ISD). DESIGN, SETTING, AND PARTICIPANTS: Women with SUI who were treated between January 1987 and March 2007 were included in this prospective study. Only women with low closure pressure at urethral profile and negative continence tests, indicators of severe ISD, were included. INTERVENTIONS: An AUS was implanted. The surgical technique was modified in 1999, involving opening the endopelvic fascia on both sides and dissection in contact with the vaginal wall. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Assessment of complications was made pre- and postoperatively and continence status was based on pad usage. Kaplan-Meier survival curves were used to calculate mechanical survival of the device. Student t test and the chi-square test were used to compare continence and complication rates. RESULTS AND LIMITATIONS: A total of 376 AUS were implanted in 344 patients, whose mean age was 57 yr. The mean follow-up, plus or minus standard deviation, was 9.6±4.0 yr. At last follow-up, postoperative continence rates, assessed as fully continent (no leakage), socially incontinent (some drops but no pad), or incontinent (one pad or more), were 85.6%, 8.8%, and 5.6%, respectively. The 3-, 5-, and 10-yr device survival rates were 92.0%, 88.6%, and 69.2%, respectively. The mean mechanical survival was 176 mo (14.7 yr). Three risk factors for AUS survival were the number of previous incontinence surgeries, the presence of neurogenic bladder, and simultaneous augmentation enterocystoplasty. Principal limitation of the study is the absence of validated incontinence questionnaire. CONCLUSIONS: The AUS provides excellent outcome in women with ISD, with low explantation rate and very good device survival.

[French multicentre prospective study of the use of ACT balloons (Uromedica, Inc., Plymouth, Min, U.S.A.; Medtronic, Minneapolis, U.S.A.) for the treatment of female stress urinary incontinence]. / Etude française prospective multicentrique de l'utilisation des ballons ACT pour le traitement de l'incontinence urinaire d'effort chez la femme.

OBJECTIVE: French multicentre prospective study to evaluate the efficacy and feasibility of ACT (Adjustable Continence Therapy) balloons for the management of female stress urinary incontinence (SUI). MATERIALS AND METHODS: The ACT system comprises two adjustable balloons implanted on either side of the bladder neck in order to restore continence. The feasibility of this technique was evaluated perioperatively. Adverse events were recorded to evaluate the acceptability of the technique. Evaluation of efficacy was based on individual interviews to determine the severity of incontinence (use of pads and quality of life questionnaire (I-QoL)) and by Direct Visual Stress Testing (DVST). RESULTS: 68 patients with SUI were included. The mean operating time was 31.8 +/- 11.7 minutes. The ACT was implanted with no particular difficulties in 91% of cases. Evaluation of patients (mean follow-up: 2 years) after implantation revealed a marked improvement of incontinence (87%), DVST (85%) and I-Qol (score: 75/100). The ACT was removed in 18 patients for various reasons and was reimplanted in 6 cases. The ACTI was removed in 8 patients at their request due to complete absence of efficacy. CONCLUSION: ACT balloon implantation is a new, reversible and promising minimally invasive technique for the management of female stress urinary incontinence. The possibility of percutaneous adjustment of the size of the balloons according to clinical efficacy appears to be an essential advantage of this technique.

[Benign prostatic hyperplasia (BPH): prevalence in general practice and practical approach of French general practitioners. Results of a study based on 17,953 patients]. / Hyperplasie bénigne de la prostate (HBP) : prévalence en médecine générale et attitude pratique des médecins généralistes français. Résultats d'une etude réalisée auprès de 17.953 patients.

OBJECTIVES: To determine the elements taken into account by French general practitioners to establish the initial diagnosis of benign prostatic hyperplasia (BPH) and to estimate the prevalence of BPH. MATERIAL AND METHODS: 1,698 doctors answered a questionnaire on their medical practice, and kept a register for two consecutive weeks comprising all men between the ages of 55 and 70 years seen in their practice. Men with no known BPH completed the IPSS (International Prostate Symptoms Score) questionnaire. The doctors described the management of the first three patients with an IPSS score > 8. RESULTS: The prevalence of BPH in the population of 33,077 men between the ages of 55 and 70 years consulting their general practitioner was 57.5%: 40.8% of patients had known BPH at the time of the visit and 29.9% of patients without known BPH reported voiding disorders (IPSS > or = 8). For the diagnosis of BPH, clinical interview was not systematically followed by digital rectal examination and urinalysis was rarely performed. Laboratory tests and ultrasound were the complementary investigations most frequently performed. CONCLUSION: BPH is a frequent disease whose prevalence is underestimated. This diagnosis should be considered more frequently when patients over the age of 55 consult their general practitioner.

[Solitary fibrous tumours of the kidney]. / Tumeur fibreuse solitaire du rein.

Solitary fibrous tumours (SFT) are mesenchymal tumours that usually arise from the pleura. Renal SFT are exceptional (9 cases reported in the literature). The authors report a new case discovered during assessment of HT and treated by radical right nephrectomy. The histological appearance is characteristic: a tumour with a fibrous centre, composed of a monomorphic proliferation of spindle cells, with positive CD 34, CD 99, and bcl 2 labelling. The prognosis after complete resection is generally favourable.