Use of a new transanal irrigation device for bowel disorder management by patients familiar with the irrigation technique: a prospective, interventional, multicenter pilot study.

BACKGROUND: The aim of this study was to evaluate the feasibility of transanal irrigation (TAI) with a new medical device incorporating an electric pump, the IryPump®R Set. METHODS: An interventional, prospective, open-label, non-comparative, multicenter pilot study on TAI was conducted at three French university hospitals. Patients with experience of TAI were enrolled for a 1-month period during which 5 consecutive TAIs were performed using the IryPump®R Set (B.Braun Melsungen AG Melsungen, Germany). The study's primary efficacy criterion was successful TAI, defined as (i) use of the patient's usual irrigation volume of water, (ii) stool evacuation, and (iii) the absence of leakage between TAIs. The first two TAIs were not taken into account in the main analysis. The secondary outcome measures were device acceptability, bowel dysfunction scores, tolerability, and safety. RESULTS: Fifteen patients were included between November 2016 and May 2017, and 14 were assessed in the main analysis. The TAI success rate was 72.4% (21 out of 29 procedures). The bowel dysfunction scores at the end of the study did not differ significantly from those recorded on inclusion. A high proportion of patients (> 70%) reported that TAI was feasible with the new medical device. There were no serious adverse events or device-related adverse events. At the end of the study, 50% of the participants were willing to consider further use of the new device. CONCLUSIONS: In patients familiar with TAI, using a new medical device incorporating an electric pump was feasible. Levels of patient satisfaction were high, especially with regard to comfort of use and a feeling of security during TAI.

[Botulinium toxin and idiopathic overactive bladder: Multicentric contempory management in Bourgogne]. / Toxine botulique et hyperactivité vésicale idiopathique : évaluation multicentrique des pratiques en Bourgogne.

INTRODUCTION: Since 2014, OnabotulinumtoxinA Botox® (Allergan, Inc., Irvine, USA) represents a new therapeutic option for second-line treatment of idiopathic overactive bladder. The purpose of the current study was to evaluate practices of surgeons using onabotulinium toxin (BoNTA) in this indication. MATERIAL AND METHODS: All urogynecology centers of the country were asked in order to list all patients who were treated since marketing autorisation. Patient symptoms, previous treatments, paraclinic evaluations, data of surgery and the characteristics of the follow up were collected and analyzed. RESULTS: Six centers used BoNTA and five have accepted to participate. Ninety-seven patients have been identified. Sixty-eight first injections (70 %) were carried out with the strict frameworf of the marketing autorisation (urinary frequency, urinary urgency, urinary incontinence). All patients had at least two symptoms. In 69 %, Botulinum toxin was a second-line treatment after the failure of tibial neuromodulation or sacral neuromodulation. Urodynamic evaluation was carried out for 91 % of patients. The search for a post-void residual volume was observed for 59 % of patients during the follow up. CONCLUSION: In our country, BoNTA injections for idiopathic overactive bladder are mainly effected after tibial neuromodulation or sacral neuromodulation failure. Diagnostic, operating and outcome evaluation practices are still very heterogeneous pleading for a greater standardization of this new therapy in this indication. LEVEL OF EVIDENCE: 3.

[Cultural adaptation of the female pelvic floor questionnaire (FPFQ) into French]. / Adaptation culturelle du Female Pelvic Floor Questionnaire (FPFQ) en langue française.

AIMS: The Female Pelvic Floor Questionnaire (FPFQ) is a self-administered tool on pelvic floor function. Our aim was to carry out a cultural adaptation of the FPFQ into French and to assess its psychometric properties. METHODS: After cross-cultural adaptation into French, acceptability and reliability of the questionnaire were assessed through a sample of 56 women in a test-retest. Discriminative construct validity was evaluated by comparing the results obtained by the FPFQ to those of other validated questionnaires. Longitudinal follow-up of the 282 pregnant women included in the PreNatal Pelvic floor Prevention trial (3PN) was used to analyze responsiveness. RESULTS: The proportion of missing data did not exceed 4 % for questions about bladder function, bowel function and pelvic organ prolapse; 10 % for issues related to sexual function. Question 9 was considered difficult to understand by 14 % of women. After rewriting, this issue was retested in a new sample of 52 women and presented no further problems. The intra-class correlation coefficient was greater than or equal to 0.7 for all domains during the test-retest. The FPFQ was strongly and significantly correlated (Spearman r>0.5) with the other validated questionnaires. The French version of FPFQ recorded changes in urinary and sexual symptoms for the women involved in 3PN trial with a standardized response mean equal to 0.83 and 0.44, respectively. CONCLUSION: The French version of the FPFQ is self-administered, reliable, valid, and can detect a change in symptoms during follow-up. LEVEL OF EVIDENCE: Level 4.

Somaesthetic perception of the vertical in spinal cord injured patients: a clinical study.

PURPOSE: The perception of verticality results from the integration of vestibular, visual and somatosensory information. Spinal cord injured patients with complete paraplegia have total somatosensory deafferentation below a certain metameric segment. In our study, we were interested in the implication of somatosensory signal in the construction of verticality and in the possible effect of somatosensory loss on spatial representation. METHOD: We analysed haptic and postural aspects of perceived verticality in 14 spinal cord injured patients with complete paraplegia and in an age- and gender-matched group of 13 controls. We also conducted a structured interview on the existence of vertigo or postural instability in daily life. RESULTS: The spinal cord injured patients perceived verticality without any significant directional bias in the orientation of the vertical but with a greater uncertainty than control subjects, both in haptic and postural modalities. If paraplegic did not report vertigo, half described an altered spatial perception without vision. CONCLUSION: The present results confirm the importance of sensory input from the trunk and the lower limbs in the perception of the vertical. However, visual and vestibular information appear to compensate for somatosensory deafferentation.

[Inquiry among general practitioners' knowledge regarding clean intermittent self-catheterization]. / Enquête de la pratique de l'autosondage intermittent propre auprès des médecins généralistes.

INTRODUCTION: Clean intermittent self-catheterization is the recommended mode of bladder voiding in patients with urinary retention. Hence, this procedure should be well known and understood by the general practitioners (GP) who are responsible for monitoring such patients. OBJECTIVE: To assess GP' state of knowledge regarding clean intermittent self-catheterization and to make recommendations for dealing with problems that occur during patient follow-up. METHOD: A questionnaire focusing on the practice of clean intermittent catheterization was sent to 910 family GP in the Franche-Comté region of eastern France. RESULTS: Two hundred and fourty-six replies were analyzed. Sixty-four percent of GP believed that the appropriate number of bladder catheterizations per day was between two and four. Ninety percent of the GP prescribed perineal cleaning before catheterization and 29% prescribed the use of sterile gloves. Eighty-seven percent of general practitioners considered urinary tract infection to be the main complication of intermittent catheterization. Thirty percent always requested a urine culture in patients performing self-catheterization and 29% prescribed antibiotic therapy in cases of bladder colonization. DISCUSSION: General practitioners need to receive additional information on the role of clean intermittent catheterization in the prevention of urinary tract infection. In accordance with the French Urology Association guidelines, we produced a practical summary guide on preventing asymptomatic bacteriuria and urinary tract infections and/or preparing for urological investigations.

What is the place of electroneuromyographic studies in the diagnosis and management of pudendal neuralgia related to entrapment syndrome?

Entrapment of the pudendal nerve may be at the origin of chronic perineal pain. This syndrome must be diagnosed because this can result in the indication of surgical decompression of the entrapped nerve for pain relief. Electroneuromyographic (ENMG) investigation is often performed in this context, based on needle electromyography and the study of sacral reflex and pudendal nerve motor latencies. The limits of ENMG investigation, owing to various pathophysiological and technical considerations, should be known. The employed techniques do not assess directly the pathophysiological mechanisms of pain but rather correlate to structural alterations of the pudendal nerve (demyelination or axonal loss). In addition, only direct or reflex motor innervation is investigated, whereas sensory nerve conduction studies should be more sensitive to detect nerve compression. Finally, ENMG cannot differentiate entrapment from other causes of pudendal nerve lesion (stretch induced by surgical procedures, obstetrical damage, chronic constipation...). Thus, perineal ENMG has a limited sensitivity and specificity in the diagnosis of pudendal nerve entrapment syndrome and does not give direct information about pain mechanisms. Pudendal neuralgia related to nerve entrapment is mainly suspected on specific clinical features and perineal ENMG examination provides additional, but no definitive clues, for the diagnosis or the localization of the site of compression. In fact, the main value of ENMG is to assess objectively pudendal motor innervation when a surgical decompression is considered. Perineal ENMG might predict the outcome of surgery but is of no value for intraoperative monitoring.

[Anatomy and physiology of the lower urinary tract]. / Bases anatomo-fonctionnelles du bas appareil urinaire.

Neurogenic lower urinary tract dysfunction is frequent, due to lesions of the central and/or peripheral somatic and/or autonomic nervous system whose role is to ensure the regulation and control of lower urinary tract function. Due to the presence of both smooth and striated muscle cells in structures of the lower urinary tract, nerve pathways and nerve centres belong to both the somatic and autonomic nervous systems.

[Lower urinary tract dysfunction and herniated disk]. / Troubles vésico-sphinctériens et hernies discales.

Lower urinary tract dysfunction related to herniated disk can raise complex diagnostic and management problems. This article reviews the two main clinical situations encountered: documented lower urinary tract dysfunction in a context of cauda equina syndrome secondary to herniated disk and lower urinary tract dysfunction representing the only clinical sign of herniated disk with no other alteration of the neurological examination. Regardless of the neurological signs, urodynamic assessment is essential to characterize any lower urinary tract dysfunction and to determine the modalities of long-term surveillance.

[Neurogenic bladder dysfunction a main disability of decompression sickness: a case report]. / Troubles vésicosphinctériens comme principale séquelle d'une maladie de décompression: à propos d'un cas.

INTRODUCTION: Bladder dysfunction is common in the acute phase of decompression sickness and often precedes motor disorders. Few studies have reported the persistence of urinary problems, and no prior reports describe a neurogenic bladder in the primary presentation of decompression sickness. CASE REPORT: We report the case of a 21-year-old female scuba diver with no medical history. After two successive deep dives, dysbaric myelitis developed. The risk factors were foramen ovale and history of diving. The patient initially showed tetraparesia, which was quickly followed by paraparesia with urinary retention. Treatment consisted of recompression with high concentrations of inspired oxygen, aspirin administration and continuous drainage by an indwelling catheter. No lesion was found on 2 sessions of magnetic resonance imaging (MRI) (cerebral and spinal), and somatosensory-evoked potentials were normal. Motor-evoked potential onset latencies were delayed. Neuro-urodynamic investigations revealed detrusor sphincter dysynergia and detrusor overactivity. On quick, complete motor recovery, the patient returned to work and continued with sports (except scuba diving). A year later, she still had urinary and faecal urgencies which were not completely resolved with medication and altered her quality of life. CONCLUSION: Half of the cases of neurological decompression involve dysbaric myelitis. Venous ischemia is the most likely cause. Foramen ovale is an important risk factor, but the pathophysiology is obscure. Bladder problems, common in the acute phase of decompression sickness, may be the primary presentation, and may be prolonged.

[Cross-cultural adaptation of health-related quality of life questionnaire: English version of Qualiveen abstract]. / Adaptation culturelle d'un questionnaire de qualité de vie: Qualiveen en langue anglaise.

INTRODUCTION: The Qualiveen questionnaire is a urinary disorder-specific health-related quality of life (HRQL) instrument. Developed in French, the instrument's translation into English was the first step of a process leading to an HRQL questionnaire that can be used in a different culture. However, the cultural adaptation of an HRQL questionnaire is achieved only when the psychometric properties of the translated questionnaire are documented. AIM: To develop an equivalent English version of the Qualiveen questionnaire and to assess its discriminative measurement properties. METHODS: Fifty-five Canadian out-patients with multiple sclerosis (MS) completed a set of questionnaires, including the Qualiveen; the MS Quality Of Life-54 (MSQOL-54), an MS-specific HRQL questionnaire; urinary function assessment; and the expanded disability status scale (EDSS) twice at an interval of 2 to 4 weeks. RESULTS: The English Qualiveen proved to be test-retest reliable (intraclass correlation coefficient=0.94). Consistent with a priori predictions, we found a strong association between overall Qualiveen score and degree of incontinence (0.63), a moderate association with type of urinary symptoms (0.49), a weak association with manner of voiding (0.28) and weak or absent associations with MSQOL-54, EDSS bladder/bowel and global EDSS domains. Predictions proved to be generally accurate (weighted kappa=0.65). CONCLUSION: The test-retest reliability and cross-sectional construct validity of the English version of Qualiveen are excellent and similar to the original French version. Further studies should explore Qualiveen's longitudinal validity and responsiveness.

[Symptom and quality of life assessment in urinary disorders]. / Scores de symptômes et de qualité de vie au cours des troubles vésicosphinctériens.

OBJECTIVES: To identify all available symptom and quality of life questionnaires for men and women with urinary disorders and assess their psychometric properties. METHODS: We systematically reviewed the literature in Medline using the key words urinary disorders, urinary incontinence, bladder, score, quality of life, questionnaire, and psychometric validation. RESULTS: The first search using the terms urinary incontinence and quality of life resulted in 1018 Abstracts. Articles mentioning but not measuring quality of life were not investigated. Questionnaires were selected because their psychometric properties were tested and they assessed how much a person was bothered by urinary symptoms or quality of life specific to urinary disorders. The questionnaires were usually gender specific. Their psychometric value was far from uniform, and, for most, responsiveness was not reported. CONCLUSION: Few quality of life questionnaires are at an advanced stage of validation to be applied in clinical practice. They need to be shorter, responsive and validated in different populations to permit their easy use.

[Detrusor-sphincter dyssynergia and botulinum toxin]. / Dyssynergie vésico-sphinctérienne et toxine botulique.

OBJECTIVE: Botulinum toxin (BT) injection into the external urethral sphincter is a promising therapy for neurogenic voiding disorders due to detrusor-sphincter dyssynergia (DSD). However the optimal treatment protocol remains unclear. METHOD: A PubMed reference search and manual bibliography review were performed, along with a search in the Annales de réadaptation et de médecine physique and in the reports of the International French-language Society of Urodynamics and the International Continence Society, which allowed us to select twelve pertinent articles with PubMed, two articles from the Annales and two conference reports. Our analysis gave special emphasis to assessment criteria, application, dosage and BT injection technique. RESULTS: Used for the first time in 1988 in spinal cord injury patients to reduce outflow obstruction due to DSD, BT injections have been shown to be a valuable alternative management of bladder dysfunction with DSD. They have been proposed in neurological patients unable to perform self-catheterisation, after drug failure and before surgery. Parameters for results assessment are mostly clinical (increased free interval between voiding, decreased post-void residual urine volumes), urodynamic (improvement in bladder emptying, increase in functional bladder capacity and decrease in urethral pressure) and electromyographic (denervation of striated urethral sphincter). The literature data regarding type of BT, dosage and protocol vary widely. Duration of action is from 2 to 12 months. Both transurethral and transperineal injections monitored by EMG are equally effective in improving detrusor-sphincter dyssynergia. CONCLUSION: With few side effects and satisfactory medium-term results, BT should be recommended as a component of DSD therapies. We propose a practical method for BT use.