Search

Resume Objectifs L’objectif de cette etude etait d’identifier des profils de reponse a un traitement anticholinergique utilise chez l’homme pour le traitement de troubles de stockage, et d’identifier des facteurs pouvant etre associes a ces profils. Materiels et methodes Une etude observationnelle a ete menee chez des patients consecutifs traites pour la premiere fois par anticholinergiques. Les caracteristiques cliniques, sociodemographiques, le score Urinary Symptom Profile (USP), le questionnaire Ditrovie et un score de severite des symptomes ont ete mesures a l’inclusion et apres 3 mois de traitement. Une partition des profils de reponse au traitement selon le score USP a ete generee par une analyse multifactorielle en cluster. Les caracteristiques des patients des deux clusters (bon et mauvais repondeurs) ont ete comparees. La satisfaction des patients et l’evolution des scores symptomes ont ete etudies, avec recherche de facteurs associes par regression logistique. Resultats Sur 1018 patients evalues, 823 ont ete inclus sans donnees manquantes et 410 patients avaient des donnees de suivi disponibles. Un anticholinergique a ete prescrit chez tous les patients (solifenacine dans 92,4 % des cas), et 25 % des patients avaient recu un alpha-bloquant. L’analyse en cluster a identifie deux categories de repondeurs. Des troubles recents, un âge jeune, l’absence d’obesite ou de traitement concomitant, et la presence d’urgenturies sans incontinence etaient associes a un meilleur resultat clinique. L’analyse du sous-score USP-Dysurie a montre que 12,4 % des patients ont degrade legerement leur vidange vesicale, l’anciennete des troubles etant le seul facteur associe significatif. Conclusions Les anticholinergiques sont efficaces dans le traitement des troubles de remplissage chez l’homme. Certains facteurs (âge, obesite, traitements associes, presence d’une incontinence par urgenturie) pourraient influencer les resultats cliniques et leur identification pourrait conduire a une meilleure selection des patients. Niveau de preuve 4.

To describe, using cluster analysis methods, the existence of a clinical typology specific to men, who are responding or not to anticholinergic treatment, and identify predictive factors associated with treatment success.An observational study was conducted in consecutive male patients who were prescribed anticholinergics for the first time. Sociodemographic data, patient characteristics, urinary symptom profile (USP) questionnaire, Ditrovie scale and symptom severity were assessed at inclusion and after 3 months of treatment. A cluster analysis according the hierarchical classification of Ward was used to discriminate two clusters (low and strong persistence of urinary disorders, respectively). Logistic regression was used to identify factors associated with evolution of treatment satisfaction and symptoms.Out of 1018 patients evaluated, 410 had available follow-up data. A treatment with anticholinergic was prescribed to all of patient among which solifenacin represented 92.4% and 27.6% of patients received also an alpha-blocker. Cluster analysis identified two populations of responders. Recent symptoms, young age, absence of obesity or associated treatment, and urgency without incontinence were associated with a better clinical outcome under treatment. The USP questionnaire showed voiding difficulties in 12.4% of patients, and the only associated factor was symptom duration before consultation.Anticholinergics are efficacious for management of storage lower urinary tract symptom management in men. Clinical factors (age, obesity, treatments, urge urinary incontinence) could influence treatment outcome and allow a better patient selection for clinical decision-making.4.

To determine the prevalence of overactive bladder (OAB) syndrome in France and gather data about initial patient trajectories in the healthcare system.A dedicated questionnaire (41 questions) has been sent to a 12,000 sample of people representative of the global population. The following data were investigated: social and demographic features, medical history, Urinary Symptom Profile questionnaire, bother, history of symptoms, care seeking and treatments received. Patient were considered having OAB in case if presenting at least two episodes of urgency per week, or being under treatment of OAB. OAB prevalence was the main outcome, and associated factors were characterized by univariate and multivariate analysis.Based on 8842 available questionnaires, the global prevalence of OAB was estimated to be 14.4%. Prevalence was significantly higher in women, older age groups, as well as obesity, irritable bowel syndrome, urinary tract infections, enuresia, constipation, anxiety/depression, neurological diseases, sleep apnea syndrome, asthma, chronic obstructive pulmonary disease, diabetes and hypertension. Only 34.6% of patients with OAB had visited a health practitioner for this problem. General practitioners were most frequently implicated in patient primary care and evaluation. Seventy-two percent of patients with OAB had had additional investigations (mostly a urine culture) and only 6% of patients had to complete a bladder diary. The most frequent treatment option was oral antimuscarinics. Physical therapy and rehabilitation have been prescribed in 26% of cases, as well as dietary advice.OAB is a frequent syndrome. Its prevalence increases with age, and OAB frequently concern elderly frail people with many other associated diseases.3.

Our purpose was to identify measures implemented by urologists and radiation oncologists at the initiation of a 6-month formulation of luteinizing hormone releasing hormone (LHRH) agonist in patients with advanced PCa.This cross-sectional cohort survey was conducted during 6 months. Participants completed a questionnaire of 15 items on the first prescription of an androgen deprivation therapy (ADT), the parameters prescribed for monitoring and information provided to patients.The median age of the 1100 enrolled patients was 75 years (range: 51-98 years); 245 patients (29.0%) were metastatic and 411 (39.4%) had a Gleason score ≥ 8. Prior to the treatment initiation, the dosage of the total testosterone was not very often performed (4.8%). Associated comorbidities such as arterial hypertension (53.6%) and hypercholesterolemia (31.8%) did not constitute a barrier to the initiation of ADT, alone (60.5%) or combined with anti-androgens (61%). According to the recommendations of the French Association of Urology (AFU), fasting glycemia was required in 427 patients (41.1%), lipid profile in 380 (36.1%), a blood count in 219 (21.1%) and bone densitometry in 111 (10.8%). The advice given to patients involved diet and lifestyle rules (61%). The potential risks of adverse events (AEs) mentioned were mainly hot flashes (95.5%).Some recommendations seem insufficiently followed by the French specialists on information and monitoring procedures of ADT, especially in the cardiovascular field.