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Plata M, Zuluaga L, Santander J, Salazar M, Castaño JC, Benavides-MartÍnez JA, Garzón DL, Schlesinger R, Serrano B, Echeverry M, Silva JM, Varela D, Carvajal A, Azuero J. Performance of the artificial urinary sphincter implantation in men with urinary incontinence: Results from a contemporary long-term real-world nationwide analysis. Neurourol Urodyn 2022; 41:1573-1581. [PMID: 35866192 DOI: 10.1002/nau.25002] [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: 03/08/2022] [Revised: 04/26/2022] [Accepted: 05/10/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE The artificial urinary sphincter (AUS) is one of the most effective surgical treatments for male urinary incontinence regardless of its severity. Current knowledge comes from high-volume centers, but little is known about the performance of this surgery from community practices. This study aims to report contemporary AUS performance in a nationwide observational study in Colombia. METHODS Male patients who underwent AUS surgery with AMS 800™ between 2000 and 2020 in more than 17 centers and four cities were identified. Pre, intra, and postoperative characteristics were evaluated, mainly addressing patient reported outcomes measurements in the postoperative period. Retrospective and prospective data collection and descriptive analysis were completed. Kaplan-Meier analysis was used to determine AUS survival rate. RESULTS Out of an initial 667 cases, a total of 215 patients met inclusion and exclusion criteria and were included. Mean age was 67 ± 9.4 years, and mean follow-up was 6.0 ± 4.4 years with maximum range of 14 years. The etiology of urinary incontinence was prostate cancer surgery in 141 (81%) of the cases. The rest of the cases were related to benign prostatic disease or spinal cord injury. It is noteworthy that out of 115 patients, only 59 (51.3%) reported previous formal pelvic floor rehabilitation. Subjective severity of urinary incontinence determined by a visual analog scale showed a decrease in 4.5 points after sphincter implantation. Sphincter removal was required in 50 (23.2%) cases. The main reasons for implant removal were urethral erosion and infection. The sphincter survival rate at 2, 5, 8, 10, and 14 years was 76%, 70%, 60%, 57%, and 17%, respectively. Of the subjects at the last follow-up with the device still in place, 80.7% defined their urinary condition as "does not cause or causes minor discomfort," and 99% would recommend the device to a friend or relative in the same condition. CONCLUSIONS This series from a community-based practice shows the lack of adherence to clinical practice guidelines and the lack of standardized data collection. In contrast, this study provides real-world data on explantation and revision rates, allows physicians to inform patients and to have clear metrics for a shared decision-making process before the procedure.
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Affiliation(s)
- Mauricio Plata
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine, Bogotá, Colombia
| | - Laura Zuluaga
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine, Bogotá, Colombia
| | - Jessica Santander
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine, Bogotá, Colombia
| | - Milton Salazar
- Department of Urology, Clínica FOSCAL, Bucaramanga, Colombia
| | | | | | - Diana L Garzón
- Department of Urology, Clínica FOSCAL, Bucaramanga, Colombia
| | | | | | | | - José M Silva
- Department of Urology, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana School of Medicine, Bogotá, Colombia
| | - Daniela Varela
- Department of Urology, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana School of Medicine, Bogotá, Colombia
| | | | - Julián Azuero
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine, Bogotá, Colombia
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Lee A, Mmonu NA, Thomas H, Rios N, Enriquez A, Breyer BN. Qualitative analysis of Amazon customer reviews of penile clamps for male urinary incontinence. Neurourol Urodyn 2020; 40:384-390. [PMID: 33165983 DOI: 10.1002/nau.24572] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/06/2020] [Accepted: 10/29/2020] [Indexed: 12/29/2022]
Abstract
AIMS Penile clamps offer an alternative to manage male urinary incontinence in patients who are unfit for surgery. Patient experience with penile clamps is poorly understood. Our study elucidates patient opinions on commercially available penile clamps and the factors that associate with favorable and unfavorable opinions. METHODS We collected Amazon reviews of all penile clamps marketed for male urinary incontinence from November 2011 to January 2020 and qualitatively assessed the overall sentiment towards penile clamps, key praises and key complaints. Covariates such as designated Amazon star rating were further explored for association with coding patterns. RESULTS Amazon reviews of penile clamps were found to be more positive (n = 425) in overall sentiment than negative (n = 294). The most frequent praise was effective incontinence control (n = 334) and the most frequent complaint was bad design or material (n = 166). The majority of reviews were for lower priced penile clamps, had higher Amazon star ratings, were written for Wiesner-produced clamps, and were written more recently (i.e., 2015-2020). Penile clamps with higher Amazon star ratings were more often coded positive and with a praise compared to lower rated penile clamps. CONCLUSIONS Penile clamps are seen favorably by users as an effective treatment modality for male urinary incontinence. User reviews suggest opportunities for improvement in penile clamp design. The most frequently reviewed clamp seen positively is the Wiesner Incontinence Clamp Penile Clamp whereas the most frequently reviewed clamp seen negatively is the Pacey Cuff Male Incontinence Device.
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Affiliation(s)
- Austin Lee
- Department of Urology, University of California-San Francisco, San Francisco, California, USA
| | - Nnenaya A Mmonu
- Department of Urology, University of California-San Francisco, San Francisco, California, USA
| | - Hannah Thomas
- Department of Urology, University of California-San Francisco, San Francisco, California, USA
| | - Natalie Rios
- Department of Urology, University of California-San Francisco, San Francisco, California, USA
| | - Anthony Enriquez
- Department of Urology, University of California-San Francisco, San Francisco, California, USA
| | - Benjamin N Breyer
- Department of Urology, University of California-San Francisco, San Francisco, California, USA.,Department of Biostatistics and Epidemiology, University of California-San Francisco, San Francisco, California, USA
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Complications after male adjustable suburethral sling implantation. Wideochir Inne Tech Maloinwazyjne 2020; 15:496-502. [PMID: 32904554 PMCID: PMC7457203 DOI: 10.5114/aoms.2020.97413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 06/26/2020] [Indexed: 12/19/2022] Open
Abstract
Introduction Argus suburethral sling implantation is a minimally invasive operation with the possibility to adjust the tension of the sling at any time after the procedure, which provides good treatment results for male stress urinary incontinence (SUI). Aim To determine the predictive factors, the incidence, severity and timing of the onset of complications after Argus sling implantation for males with post-operative SUI. Material and methods A total of 41 patients who underwent Argus sling implantation due to post-operative SUI were included. Median follow-up was 12 months. All complications were captured and graded according to severity and classified by timing of onset. Logistic regression analysis was performed to identify predictors of the most common side effects. Results Overall 22 (54%) of 41 males have experienced 31 complications. Three (7%) patients have experienced only intra-operative, 16 (39%) patients only post-operative and 3 (7%) patients both intra-operative and post-operative complications. The most common intra-operative complications were bladder perforation (12%) and external iliac vein injury (5%), while post-operative complications were acute urinary retention (29%), infection (10%) and perineal pain (7%). Previous radiotherapy has significantly increased the risk of intra-operative complications, while a non-significant tendency was observed for younger age, previous androgen deprivation therapy and grade 3 SUI. In terms of severity, most post-operative complications were classified as grade 3 according to the modified Clavien-Dindo system. Conclusions Argus sling implantation provides a tolerable complication rate, where acute urinary retention was the most common side effect. Previous radiotherapy significantly increases the risk of serious intra-operative complications.
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Abstract
The field of prosthetic urology demonstrates the striking impact that simple devices can have on quality of life. Penile prosthesis and artificial urinary sphincter implantation are the cornerstone procedures on which this specialty focuses. Modern research largely concentrates on decreasing the rates of complication and infection, as the current devices offer superior rates of satisfaction when revision is not necessary. These techniques are also able to salvage sexual function and continence in more difficult patient populations including female-to-male transgender individuals, those with ischemic priapism, and those with erectile dysfunction and incontinence secondary to prostatectomy. This review summarizes modern techniques, outcomes, and complications in the field of prosthetic urology.
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Affiliation(s)
- Kole P Akula
- Department of Urology, Tulane University School of Medicine, 1430 Tulane Avenue, 86-42, New Orleans, LA 70112-2699, USA
| | - Omer A Raheem
- Department of Urology, Tulane University School of Medicine, 1430 Tulane Avenue, 86-42, New Orleans, LA 70112-2699, USA
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Al Adem KM, Bawazir SS, Hassen WA, Khandoker AH, Khalaf K, McGloughlin T, Stefanini C. Implantable Systems for Stress Urinary Incontinence. Ann Biomed Eng 2017; 45:2717-2732. [PMID: 29022114 DOI: 10.1007/s10439-017-1939-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 09/29/2017] [Indexed: 01/23/2023]
Abstract
Stress urinary incontinence (SUI), the involuntary urine leakage due to failure of the urethral closure mechanism, is a global health challenge with substantial human suffering and socioeconomic costs. Approximately 167 million male and female patients are predicted to suffer from SUI in 2018, worldwide. A wide range of surgical interventions are available for the treatment of SUI. Severe cases, however, usually require the implantation of artificial urinary sphincter devices. This review comparatively presents and analyzes the working principles, as well as the challenges, associated with the current implantable SUI systems in clinical use. These include slings, urethral bulking agents, artificial urinary sphincters, and adjustable continence devices. It further reports on recent research progress and state-of-the-art in the field of SUI implants, including an original approach proposed by the authors with a pressure feedback sensory mechanism. The new emerging field of artificial muscle devices, including electroactive polymers, provides a promising innovative solution for replacing the weakened urethral sphincter in SUI patients.
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Affiliation(s)
- Kenana M Al Adem
- Department of Biomedical Engineering, Khalifa University of Science and Technology, P.O. Box 127788, Abu Dhabi, UAE
| | - Sarah S Bawazir
- Department of Biomedical Engineering, Khalifa University of Science and Technology, P.O. Box 127788, Abu Dhabi, UAE
| | - Waleed A Hassen
- Cleveland Clinic Lerner College of Medicine of Case Western University, Cleveland, OH, USA
- Urology, Surgical Subspecialties Institute, Cleveland Clinic, Abu Dhabi, UAE
| | - Ahsan H Khandoker
- Department of Biomedical Engineering, Khalifa University of Science and Technology, P.O. Box 127788, Abu Dhabi, UAE
| | - Kinda Khalaf
- Department of Biomedical Engineering, Khalifa University of Science and Technology, P.O. Box 127788, Abu Dhabi, UAE
| | - Tim McGloughlin
- Department of Biomedical Engineering, Khalifa University of Science and Technology, P.O. Box 127788, Abu Dhabi, UAE
| | - Cesare Stefanini
- Department of Biomedical Engineering, Khalifa University of Science and Technology, P.O. Box 127788, Abu Dhabi, UAE.
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Traverso P, Mantica G, Gallo F, Benelli A, Becco D, De Rose AF, Simonato A. Risk factors for resurgery in men with artificial urinary sphincter: Role of urethral strictures. Low Urin Tract Symptoms 2017; 11:O16-O20. [PMID: 28990346 DOI: 10.1111/luts.12205] [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: 04/26/2017] [Revised: 07/20/2017] [Accepted: 08/22/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aims of the present study were to evaluate the outcome of implantation of an artificial urinary sphincter (AUS) in male patients with iatrogenic urinary incontinence and to analyse possible risk factors for resurgery, with particular focus on the effects of posterior urethral strictures (US). METHODS The outcomes of AUS implantation surgeries performed by 2 surgeons on consecutive patients between January 1999 and 2015 were evaluated retrospectively. Univariate analysis with Cox proportional hazard regression was used to assess correlations between resurgery (explantation or substitution of the urethral cuff) and risk factors. Hazard ratios (HR) associated with AUS survival and 95% confidence intervals (CI) were calculated and Kaplan-Meier were constructed. Patients who underwent resurgery for mechanical failure were excluded from the study. RESULTS In all, 73 male patients were monitored for a maximum of 190 months (median follow-up duration 36 months). The risk of resurgery was 3.75-fold greater in patients with than without stenosis (HR 3.75; 95% CI 1.47-9.59). In addition, Kaplan-Meier survival curves showed a significantly shorter AUS survival time in patients with than without stenosis treatment. CONCLUSIONS Prior treatment for US increases the relative risk of AUS failure. Despite not being an absolute contraindication for AUS implantation, we suggest that patients with previous treatment for US are informed of potential risks.
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Affiliation(s)
- Paolo Traverso
- Department of Urology, Ospedale Policlinico San Martino - Istituto di Ricerca e Cura a Carattere Scientifico per l'oncologia, University of Genoa, Genoa, Italy
| | - Guglielmo Mantica
- Department of Urology, Ospedale Policlinico San Martino - Istituto di Ricerca e Cura a Carattere Scientifico per l'oncologia, University of Genoa, Genoa, Italy
| | - Fabio Gallo
- Section of Biostatistics, Department of Health Sciences, University of Genova, Genoa, Italy
| | - Andrea Benelli
- Department of Urology, G. Salvini Hospital, Milan, Italy
| | - Davide Becco
- Department of Urology, Ospedale Policlinico San Martino - Istituto di Ricerca e Cura a Carattere Scientifico per l'oncologia, University of Genoa, Genoa, Italy
| | - Aldo Franco De Rose
- Department of Urology, Ospedale Policlinico San Martino - Istituto di Ricerca e Cura a Carattere Scientifico per l'oncologia, University of Genoa, Genoa, Italy
| | - Alchiede Simonato
- Section of Urology, Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Palermo, Italy
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Urinary Artificial Sphincter ZSI 375 for Treatment of Stress Urinary Incontinence in Men: 5 and 7 Years Follow-Up Report. Urologia 2017; 84:263-266. [DOI: 10.5301/uj.5000243] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2017] [Indexed: 11/20/2022]
Abstract
Study Design This is a retrospective, non-randomised study. Objectives The aim of this study was to evaluate safety and efficacy of artificial urinary sphincter ZSI 375 inserted in male patients with stress urinary incontinence (SUI). Methods Between May 2009 and January 2017, 45 men with SUI underwent ZSI 375 device insertion. Operations were performed in two French centres by one surgeon. Complications and pad used to manage continence were recorded. Results From May 2009 to January 2012, 45 patients with a mean age of 70.42 years underwent placement of the ZSI 375 device in France. The most common cause for incontinence was radical prostatectomy (RP, 33/45 patients, 73.33%). The minimal period of incontinence was 6 months. Twenty-seven out of 45 patients (60.00%) had a severe incontinence (at least four pads per day), 13 patients (28.89%) had moderate incontinence (three pads per day) and five patients (11.11%) had two pads per day. With a long follow-up, the ZSI 375 device was considered to be successful in 73.33% patients after 5 years (60 months) and 72% of patients after 7 years (84 months). The infection rate was 2.2 % affecting one in 45 patients. Six out of 45 patients presented a urethral erosion (13.33%). Mechanical failure with a revision occurred in three patients (6.67%). Conclusions The ZSI 375 device is a safe and effective device to treat severe SUI in men.
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Farag F, van der Doelen M, van Breda J, D'Hauwers K, Heesakkers J. Decline in artificial urinary sphincter survival in modern practice-do we treat a different patient? Neurourol Urodyn 2016; 36:1350-1355. [DOI: 10.1002/nau.23110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 08/11/2016] [Indexed: 12/24/2022]
Affiliation(s)
- Fawzy Farag
- Department of Urology; Radboud University Medical Center; Nijmegen The Netherlands
- Department of Urology; Sohag University Hospital; Sohag Egypt
| | | | - Jetske van Breda
- Department of Urology; Radboud University Medical Center; Nijmegen The Netherlands
| | - Kathleen D'Hauwers
- Department of Urology; Radboud University Medical Center; Nijmegen The Netherlands
| | - John Heesakkers
- Department of Urology; Radboud University Medical Center; Nijmegen The Netherlands
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Lim B, Kim A, Song M, Chun JY, Park J, Choo MS. Comparing Argus sling and artificial urinary sphincter in patients with moderate post-prostatectomy incontinence. J Exerc Rehabil 2014; 10:337-42. [PMID: 25426474 PMCID: PMC4237852 DOI: 10.12965/jer.140152] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 10/15/2014] [Indexed: 11/22/2022] Open
Abstract
Post-prostatectomy incontinence (PPI) is a main complication of radical prostatectomy. The purpose of this study was to compare the efficacy and safety of the Argus male sling (Argus) with that of artificial urinary sphincters (AUS) in patients with moderate PPI. A total of 33 moderate PPI patients underwent AUS or Argus implantation from January 2009 to June 2013 (13 AUS, 20 Argus). We defined moderate PPI as the use of 2-4 pads per day. To compare efficacy, we assessed the success rate between the two groups. Success was defined as the daily need for no pads or one small safety pad that remained dry most of the day. The mean patient age was 73.5±6.3 yr in the AUS group and 70.9±5.1 yr in the Argus group, and the mean follow-up period was 29.8±14.9 months in the AUS group and 24.7±11.8 months in the Argus group. The success rate was 72.7% in the AUS group and 85.0% in the Argus group (P=0.557). Abnormal postoperative pain persisted in more patients in the Argus group (6/20, 30%) than in the AUS group (1/13, 7.7%) (P=0.126). However, the rate of other complications was not different between the two groups (7.7% and 15.0% for AUS and Argus, respectively, P=0.822). Argus surgery showed similar success and complication rates to those of AUS in moderate PPI patients, indicating that it could be an alternative surgical option for the treatment of moderate PPI.
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Affiliation(s)
- Bumjin Lim
- Department of Urology Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Aram Kim
- Department of Urology Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Miho Song
- Department of Urology Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji-Youn Chun
- Department of Urology Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Junsoo Park
- Department of Urology Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Myung-Soo Choo
- Department of Urology Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Léon P, Chartier-Kastler E, Rouprêt M, Ambrogi V, Mozer P, Phé V. Long-term functional outcomes after artificial urinary sphincter implantation in men with stress urinary incontinence. BJU Int 2014; 115:951-7. [PMID: 24958004 DOI: 10.1111/bju.12848] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate long-term functional outcomes of artificial urinary sphincters (AUSs) and to determine how many men required explantation because of stress urinary incontinence (SUI) caused by sphincter deficiency after prostate surgery. PATIENTS AND METHODS Men who had undergone placement of an AUS (American Medical Systems AMS 800®) between 1984 and 1992 to relieve SUI caused by sphincter deficiency after prostate surgery were included. Continence, defined as no need for pads, was assessed at the end of the follow-up. Kaplan-Meier survival curves estimated the survival rate of the device without needing explantation or revision. RESULTS In all, 57 consecutive patients were included with a median (interquartile range, IQR) age of 69 (64-72) years. The median (IQR) duration of follow-up was 15 (8.25-19.75) years. At the end of follow-up, 25 patients (43.8%) still had their primary AUS. The AUS was explanted in nine men because of erosion (seven) and infection (two). Survival rates, without AUS explantation, were 87%, 87%, 80%, and 80% at 5, 10, 15, and 20 years, respectively. Survival rates, without AUS revision, were 59%, 28%, 15%, and 5% at 5, 10, 15, and 20 years, respectively. At the end of the follow-up, in intention-to-treat analysis, 77.2% of patients were continent. CONCLUSION In the long term (>10 years) the AMS 800 can offer a high rate of continence to men with SUI caused by sphincter deficiency, with a tolerable rate of explantation and revision.
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Affiliation(s)
- Priscilla Léon
- Department of Urology, Pitié-Salpétrière Academic Hospital, Paris, France
| | | | - Morgan Rouprêt
- Department of Urology, Pitié-Salpétrière Academic Hospital, Paris, France
| | - Vanina Ambrogi
- Department of Statistics, Assistance Publique-Hôpitaux de Paris, Pierre and Marie Curie Medical School, Paris 6 University, Paris, France
| | - Pierre Mozer
- Department of Urology, Pitié-Salpétrière Academic Hospital, Paris, France
| | - Véronique Phé
- Department of Urology, Pitié-Salpétrière Academic Hospital, Paris, France
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