[Results of artificial sphincter in a case of sphincter incontinence in the multiple surgery patient]. / Résultat du sphincter artificiel en cas d'incontinence sphinctérienne chez la malade multiopérée.

Stress incontinence represents 77 to 91% of female urinary incontinence, 10% of witch are sphincterial incontinence. The specific treatment of sphincterial incontinence is of periuretral injections or calls for an artificial sphincter. We present the retrospect of 12 patients having undergone several surgical treatments and having at last the benefit of an artificial sphincter since 1990. In majority, these patients had been operated for bladder neck hypermobility. The indication, preoperatory evaluations, surgical technics and results are discussed. During the mean follow-up of 40.5 months, 91.7% of patients are perfectly continent. The results are equal to those of other publications.

[Techniques of urodynamic diagnosis. Measurement--pressure--flow]. / Techniques d'urodynamique diagnostiques. Mesure--pression--débit.

The urodynamic techniques useful for the diagnostic assessment of vesicosphincteric disorders are uroflowmetry, measurement of abdominal, urethral and vesical pressure and electromyography. Uroflowmetry is a very widely used screening examination, as it is atraumatic. Other techniques are more invasive, but provide more pathophysiological information. The methodology is recalled for each of these examinations. The parameters to be analysed are described in detail. The value and limitations of these modalities are emphasised. Combined examinations allow a better understanding of vesicosphincteric equilibria and disequilibria and reveal the concepts of compliance, detrusor pressure, isometric detrusor contractions, hyper and hypoactivity, and pressure transmission.

[Infravesical obstruction]. / Obstruction infravésicale.

Infravesical obstruction presents clinically in the form of dysuria. Urodynamic studies play an important role to distinguish between a disorder of detrusor contractility and a functional or organic obstruction. The value of uroflowmetry, static and voiding urethral pressure profiles, cystometry and electromyography is discussed. The instantaneous voiding profile appears to be the most useful test: it allows calculation of urethral resistance, which is the ratio between bladder voiding pressure and the square of flow. Bladder neck obstruction is present in more than 80% of cases with a value greater than 0.5. Obstacles are more easily identified clinically in women, but the same tests can be applied with a poorer reliability for urethral resistance.