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Lepoittevin L, Leon G, Perrouin-Verbe B, Lefort M, Reiss B, Karam G, Rigaud J, Le Normand L, Perrouin-Verbe MA. [External sphincterotomy in neurological patients with detrusor sphincter dyssynergia: Short and mid-term results]. Prog Urol 2021; 32:40-46. [PMID: 33541792 DOI: 10.1016/j.purol.2020.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 12/05/2020] [Accepted: 12/08/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND To evaluate in the short and mid-term the success of external sphincterotomy (ES) in neurological patients with detrusor sphincter dyssynergia (DSD). METHODS Retrospective, monocentric study, conducted in 51 patients who had a first ES between January 2003 and June 2018, with at least two years of follow-up. The success of ES was defined by maintenance of reflex voiding mode at the end of follow-up. Secondary outcomes were early postoperative complications, rate of revision, functional impact, urodynamic follow-up and upper urinary tract impact. RESULTS The median age was 50.6 years and the median follow-up was 4.6 years. The success rate was 80% (n=41). Ten patients had to change their voiding mode. For 5 patients, it was related to secondary detrusor low contractility. A second ES was required for 39% of patients. At the end of follow-up, there was a significant improvement in Autonomic Dysreflexia (AD) (26 vs 7 patients, P<0.001), urinary tract infections (UTI) (31 vs 15 patients, P<0.001) and a significant decrease in post-voiding residuals (200 vs 50mL, P<0.001). CONCLUSION ES allowed to maintain reflex voiding in 80% of our patients. It significantly improves AD and UTI despite a high rate of re-operation (39%). A long-term follow-up is mandatory in order not to ignore a recurrence of bladder outlet obstruction and/or decrease in detrusor contractility, which may justify a re-operation or an alternative bladder management. LEVEL OF EVIDENCE III.
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Affiliation(s)
- L Lepoittevin
- Service universitaire de médecine physique et réadaptation neurologique, centre hospitalier universitaire de Nantes, site Saint-Jacques, 85, rue Saint-Jacques, 44093 Nantes, France.
| | - G Leon
- Service de chirurgie urologique, centre hospitalier universitaire de Nantes, site Hôtel Dieu, 1, place Alexis-Ricordeau, 44093 Nantes, France
| | - B Perrouin-Verbe
- Service universitaire de médecine physique et réadaptation neurologique, centre hospitalier universitaire de Nantes, site Saint-Jacques, 85, rue Saint-Jacques, 44093 Nantes, France
| | - M Lefort
- Service universitaire de médecine physique et réadaptation neurologique, centre hospitalier universitaire de Nantes, site Saint-Jacques, 85, rue Saint-Jacques, 44093 Nantes, France
| | - B Reiss
- Service universitaire de médecine physique et réadaptation neurologique, centre hospitalier universitaire de Nantes, site Saint-Jacques, 85, rue Saint-Jacques, 44093 Nantes, France
| | - G Karam
- Service de chirurgie urologique, centre hospitalier universitaire de Nantes, site Hôtel Dieu, 1, place Alexis-Ricordeau, 44093 Nantes, France
| | - J Rigaud
- Service de chirurgie urologique, centre hospitalier universitaire de Nantes, site Hôtel Dieu, 1, place Alexis-Ricordeau, 44093 Nantes, France
| | - L Le Normand
- Service de chirurgie urologique, centre hospitalier universitaire de Nantes, site Hôtel Dieu, 1, place Alexis-Ricordeau, 44093 Nantes, France
| | - M A Perrouin-Verbe
- Service de chirurgie urologique, centre hospitalier universitaire de Nantes, site Hôtel Dieu, 1, place Alexis-Ricordeau, 44093 Nantes, France
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Matillon X, Terrier JE, Arnouil N, Lalloue F, Pic G, Ruffion A. [Temporary urethral stents ALLIUM BUS "BULBAR URETHRAL STENT" for the treatment of detrusor sphincter dyssynergia]. Prog Urol 2016; 26:532-7. [PMID: 27567746 DOI: 10.1016/j.purol.2016.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 07/11/2016] [Accepted: 07/22/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The temporary prosthetic sphincterotomy is a possible treatment for neurologic detrusor sphincter dyssynergia (DSD). The purpose of the study was to verify the feasibility and effectiveness of the urethral stent (US) Temporary ALLIUM BUS "BULBAR URETHRAL STENT". PATIENTS AND METHODS A prospective, non-comparative, single-center starting in 2015 was conducted. Were included patients over 18 years, with a neurologic DSD proved urodynamically for which medical treatment was not indicated or failed. The primary endpoint was the percentage of patients who had a voiding method considered as improved or much improved at 1 month and the feasibility of the procedure. RESULTS From January to June 2015, 7 patients, (mean age 47.9 years [24-76 years]) were prospectively enrolled. One patient was lost to sight at one month and therefore excluded. The median follow-up was 8.1 months (1-10 months). All procedures were technically successful. At 1 month, there were 57% of grade 2 complications (Clavien-Dindo), 1 of 6 patients had a migration of the US. At one month, quality of life and the urologic situation was considered good in 3 patients, unchanged in 2 patients and decreased in 1 patient. The study was stopped after the inclusion of seven patients. At the date of the latest news, 5 of 6 patients had a migrated or an explanted US. CONCLUSION The temporary urethral stent ALLIUM BUS does not seem to be a possible surgical alternative for the treatment of detrusor sphincter dyssynergia. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- X Matillon
- Service d'urologie, centre hospitalier Lyon Sud, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France; Hospices civils de Lyon, centre hospitalier universitaire, 69002 Lyon, France; Université Claude-Bernard Lyon 1, 69100 Villeurbanne, France.
| | - J-E Terrier
- Service d'urologie, centre hospitalier Lyon Sud, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France; Hospices civils de Lyon, centre hospitalier universitaire, 69002 Lyon, France; Université Claude-Bernard Lyon 1, 69100 Villeurbanne, France.
| | - N Arnouil
- Hospices civils de Lyon, centre hospitalier universitaire, 69002 Lyon, France; Université Claude-Bernard Lyon 1, 69100 Villeurbanne, France; Service d'urologie et de chirurgie de la transplantation, hôpital Edouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France.
| | - F Lalloue
- Service d'urologie, centre hospitalier Lyon Sud, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France; Hospices civils de Lyon, centre hospitalier universitaire, 69002 Lyon, France; Université Claude-Bernard Lyon 1, 69100 Villeurbanne, France.
| | - G Pic
- Service d'urologie, centre hospitalier Lyon Sud, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France; Hospices civils de Lyon, centre hospitalier universitaire, 69002 Lyon, France; Université Claude-Bernard Lyon 1, 69100 Villeurbanne, France.
| | - A Ruffion
- Service d'urologie, centre hospitalier Lyon Sud, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France; Hospices civils de Lyon, centre hospitalier universitaire, 69002 Lyon, France; Université Claude-Bernard Lyon 1, 69100 Villeurbanne, France.
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Tamarelle B, Charvier K, Del Aguila C, Courtois F, Rode G, Ruffion A. [Ejaculation capacity in spinal cord injured patients carrying an endo-urethral stent for incontinentation: Descriptive study]. Prog Urol 2015; 25:482-8. [PMID: 25724862 DOI: 10.1016/j.purol.2015.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 01/26/2015] [Accepted: 01/27/2015] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To assess the impact of endo-urethral stent (EUP) of incontinentation in spinal cord injured (SCI) men on ejaculation capacity. FIRST CRITERIA Presence of ejaculation after EUP. SECONDARY CRITERIA Modification on ejaculation type, stimulation mode, possibility of sperm conservation in the same population. POPULATION AND METHODS A descriptive monocentric study including SCI subjects which underwent placement or change of temporary (Mémokath™ or Allium™) or definitive (Mémotherm™) EUP between January 2004 and January 2014 with at least one ejaculatory test. Are identified for each patient: the presence of ejaculation, type of ejaculation, stimulation mode used, number of frozen specimen and results from semen analysis. RESULTS Over 11 men with tetraplegia, complete for motricity, there were 8 (72%) for whom ejaculation was possible after laying EUP. Of these, 6 (55%) had an antegrade or antero-retrograde ejaculation. It was not possible to make a freezing straw in four of them due to infection of semen (2) or terato-oligo-astenospermia (1) or absence of reproductive project (1). CONCLUSION In this small sample, it was found that over 70% ejaculation have been preserved after laying EUP and more than 50% with antegrade or antero-retrograde ejaculation. A larger study would identify how EUP may alter the ejaculatory capacity or quality of the ejaculate. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- B Tamarelle
- Centre hospitalier Lyon Sud, Pierre Bénite, 39, rue de l'Université, 69007 Lyon, France.
| | - K Charvier
- Hôpital Henry-Gabrielle, 69230 Saint-Genis-Laval, France
| | - C Del Aguila
- Hôpital Henry-Gabrielle, 69230 Saint-Genis-Laval, France
| | - F Courtois
- Institut de réadaptation Gingras-Lindsay de Montréal, Canada
| | - G Rode
- Hôpital Henry-Gabrielle, 69230 Saint-Genis-Laval, France
| | - A Ruffion
- Centre hospitalier Lyon Sud, Pierre Bénite, 39, rue de l'Université, 69007 Lyon, France
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Polguer T, Boissier R, Gaillet S, Lenne Aurier K, Savoie PH, Lechevallier E, Coulange C, Karsenty G. [Treatment of detrusor-striated sphincter dyssynergia with permanent nitinol urethral stent: results after a minimum follow-up of 2 years]. Prog Urol 2012. [PMID: 23182120 DOI: 10.1016/j.purol.2012.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES The aim of this study was to assess the outcomes of nitinol permanent urethral stents used in detrusor-striated sphincter dyssynergia (DSD) treatment on male patients with a spinal cord injury. MATERIALS We investigated retrospectively all patients treated from 2004 to 2012. A total of 22 patients were included, with an age ranging from 22 to 76 years old. The DSD syndrome was due to spinal cord injury (18) or various spinal cord diseases (four) and treated with a nitinol urethral stent (11 Ultraflex(®) and 11 Mémotherm(®)). Every patient had an urodynamical study. The follow-up reached at least 2 years. RESULTS The mean follow-up was 56 months (± 14). Complementary procedures after stenting included: five stent prolongation or displacement (mean interval 7.6 months), six bladder neck incisions (12.2 months), three urethrotomy (42 months), ten obstruction treated by laser (47.3 months). Eight patients had a change of their urinary pattern: four underwent ileal conduit diversion, one had a continent urinary diversion, one chose self intermittent catheterization, two were under indwelling catheterization waiting for another treatment. Stent retrieval was either harmful or impossible for four of them. Three patients were free of complementary procedures. CONCLUSIONS Nitinol urethral stent was an effective treatment initially. However, by the third year, urethral stenosis and hypertrophic growth of the urethral mucosa usually require iterative endoscopic procedures (0.31 per patient per year). Patients treated with permanent uretral stent deserve a yearly endoscopic follow-up. Safety and effectiveness of permanent uretral stent compared to surgical sphincterotomy to treat DSD are discussed.
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Affiliation(s)
- T Polguer
- Service d'urologie, hôpital Gabriel-Montpied, université d'Auvergne, CHU de Clermont-Ferrand, 58, rue Montalemberg, 63000 Clermont-Ferrand, France
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