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Bladder voiding efficiency (BVE) quantifies bladder emptying function and depends on detrusor contractility, which is quantified by contractility parameters (VBN parameter k and PIP1). BVE [during free flow (FF) and intubated flow (IF)], k and PIP1 are dependent on the main complaint and the urodynamic diagnosis (UD). Our purpose was to search for the most significant parameter of detrusor function in an elderly population.

Los trastornos esfinterianos urinarios son frecuentes y tienen como origen la enfermedad de un órgano (alteración de la estática pélvica, adenoma de próstata) o una enfermedad neurológica. También pueden ser los primeros estigmas del envejecimiento y marcar la entrada en la fragilidad en las personas ancianas. Son el resultado de disfunciones del ciclo vesical que alteran la fase de continencia y/o la fase de micción, cuyo equilibrio está controlado por del sistema nervioso vegetativo (simpático torácico y parasimpático sacro) y somático (nervio pudendo, raíces sacras). La anamnesis, completada con el diario miccional, ocupa un lugar importante en el proceso diagnóstico. Los cuestionarios sobre los síntomas funcionales permiten cuantificar la repercusión en la calidad de vida. El estudio urodinámico (EUD), constituido por una flujometría, una cistomanometría y una perfilometría, permite dar respuesta a la mayoría de situaciones complejas e instaurar una respuesta terapéutica adecuada cuando un tratamiento de primera línea no se ha mostrado eficaz. De este modo, el médico tratante puede guiar el proceso diagnóstico a partir de los primeros elementos clínicos y las exploraciones complementarias y solicitar una opinión especializada con un EUD en caso de situación atípica. Actualmente se dispone de medios terapéuticos eficaces que pueden aplicarse de forma óptima tras un estudio etiológico que tenga en cuenta los síntomas urinarios.

Urinary prostheses for the treatment of male stress urinary incontinence ranged from simple to adjustable bulbourethral compressing devices to complex artificial urinary sphincter. Those devices have remarkably evolved since the 1950s. In this article, we review the story of a patient who experienced this device evolution. His history provides us with the opportunity to retrieve the historical transformation of the incontinence prostheses around time. Moreover, this patient story challenges us on those devices past and present limitations.

An increasing number of women over 80 years of age, treated with one or more anticholinergic drug (ACh), are referred for urodynamics (UDS). As ACh drugs are mainly prescribed in case of overactive bladder symptoms, we studied the effect of anticholinergic burden (AB) on urodynamic diagnoses dependent on detrusor contractility.

La chute est une problématique de santé publique, qui pourrait être prévenue notamment par un dépistage dans les populations à risque. Plusieurs outils existent, dont certains évaluent les symptômes du bas appareil urinaire (SBAU). Notre objectif était d’examiner les connaissances et les pratiques concernant l’évaluation des SBAU lors du dépistage du risque de chute chez les personnes âgées.

To compare 3 detrusor contractility indices, projected isovolumetric pressure (PIP-BCI), PIP1, and kfrom the VBN mathematical model, for women referred for evaluation of various lower urinary tract symptoms (LUTS) in relationship to age, presenting complaint and urodynamic diagnosis.

Nomograms using the VBN model of women micturition allowed evaluating detrusor contractility (k) and urethral obstruction (U) from pressure-flow (PFs) recordings. While the model worked for most of the patients, an intriguing result, negative U value was observed for patients with high flow-low detrusor pressure (Qp voids). To explain that condition, our hypothesis was a weak urethral resistance to dilatation or increased expansibility (URD).

Continent cutaneous urinary diversion (CCUD) is proposed to patients suffering from chronic neurologic retention and undergoing intermittent self-catheterization (ISC). In case of neurogenic detrusor overactivity (NDO), augmentation enterocystoplasty is often required. The aim was to identify the prevalence of urinary stomal and/or urethral leakage in patients who had not undergone enlargement.

The aims of the study were to evaluate the reproducibility of bladder voiding efficiency (BVE) between free flow (FF) and intubated flow(IF) in old women, and to search for a relationship of this index with complaint and urodynamic diagnosis.

Le présent article constitue le rapport de la réunion de travail multi-disciplinaire organisée par le GRAPPPA (groupe de recherche appliquée à la pathologie pelvi-périnéale des personnes âgées). L’objectif est de dresser une synthèse de l’utilisation de la toxine botulinique A (TBA) dans la prise en charge des troubles pelvi-périnéaux du sujet âgé.

L’objectif de ce travail était d’émettre des recommandations de bonne pratique concernant l’antibioprophylaxie dans le cadre d’un BUD.

L’objectif de cet article était d’effectuer une revue des données de la littérature concernant les effets cardiovasculaires des traitements anticholinergiques à visée urinaire chez la personne âgée.

Population ageing has as consequence an increasing number of women older than 80 years with lower urinary tract symptoms (LUTS). Despite old age, urodynamic study is often performed to diagnose the cause of LUTS. Our purpose is to discuss the contribution of urodynamics to manage that population.

L’objectif de cet article était d’effectuer une revue des données de la littérature concernant la physiopathologie de l’hypoactivité détrusorienne chez la personne âgée.

Nomograms based on Valentini-Besson-Nelson (VBN) model implying only 3 measurements (filling bladder volume, maximum flow-rate [Qmax] and detrusor pressure at Qmax) were recently developed to evaluate detrusor contractility (k) and urethral obstruction (U) in women. As their algebraic fitting leads to fast evaluations (Excel®software), our aims were applications to populations of non-neurologic women without and with bladder outlet obstruction (BOO).

Study design:A retrospective observational study.Objective:To describe specificities of pregnancy in a traumatic spinal cord-injured (SCI) population managed by a coordinated medical care team involving physical medicine and rehabilitation (PMR) physicians, urologists, infectious diseases' physicians, obstetricians and anaesthesiologists.Setting:NeuroUrology Department in a University Hospital, France.Methods:All consecutive SCI pregnant women managed between 2001 and 2014 were included. A preconceptional consultation was proposed whenever possible. Obstetrical and urological outcomes, delivery mode and complications were reported.Results:Overall, thirty-seven pregnancies in 25 women, of a mean age of 32±4 years, were included. Thirty-five children were born alive (three miscarriages, a twin pregnancy) without complications except for a case of neonatal respiratory distress in premature twins born at 33 weeks. The mean birth weight was 2979±599 g. Twenty-one (57%) pregnancies benefited from preconceptional care. A weekly oral cyclic antibiotic programme was prescribed in 28 (75%) pregnancies. The main complications during pregnancy included pyelonephritis (30%), lower urinary tract infections (UTI) (32%), pressure sores (8.8%) and prematurity (12% deliveries before 37 weeks, with only one delivery before 36 weeks). Two patients suffered from autonomic dysreflexia, one with serious complication (brain haematoma). Caesarean sections were performed for 68% of deliveries (23/34) to prevent syringomyelia deterioration (n=10), stress urinary incontinence aggravation (n=3) or for obstetrical reasons (n=7).Conclusions:Mothers’ and infants’ outcomes were satisfying after pregnancy in SCI women, but required many adjustments. Pregnancy must be prepared by a preconceptional consultation, and managed by a multidisciplinary team involving specialists of neurological disability and pregnancy.

We assume that the voiding process in women is governed by the detrusor contractility and a “urethral resistance”. The value of these 2 parameters, respectively named kand Uin the VBN (Valentini-Besson-Nelson) mathematical model of micturition is deduced from the VBN analysis of pressure-flow recordings (PFs). Our objectives were to search for a correlation between these 2 parameters and clinically relevant variables such as chief complaint, urodynamic diagnosis (UD), and age by decades.

Ice Water Test (IWT) is not frequently used today. IWT triggers a non-inhibited involuntary detrusor contraction (NIDC) when the bladder is being filled with cold saline solution. NIDC is unmasked via a segmental reflex loop different from the physiological micturition reflex. Our purpose was to search for usefulness of IWT to expose detrusor overactivity (DO).

Le but de l’étude était de préciser les relations entre la contraction volontaire des muscles du plancher pelvien (MPP) et la pression de clôture urétrale maximale (PCUM) mesurée au repos et lors d’un effort de retenue.

Décrire les effets sur le système nerveux central des médications anticholinergiques utilisées dans le traitement de l’hyperactivité vésicale chez le sujet âgé.

Les dysraphismes vertébromédullaires sont la première cause d’atteinte médullaire chez l’enfant. Les dysraphismes fermés, maladie uniquement locorégionale, entrent souvent dans un contexte polymalformatif avec une déficience neuro-orthopédique et des troubles sphinctériens. Les dysraphismes ouverts, anomalie générale du système nerveux central, comportent en plus des troubles cognitifs une malhabileté manuelle. Le passage de l’adolescent en milieu adulte obéit à des règles. Le suivi en milieu adulte est peu différent des atteintes médullaires acquises.

A gamma-ray scanner has been used to develop in vivo a rapid, noninvasive technique for the estimation of the mass of successive body scans, and the positions of the centres of those masses. The integrated data are computed to calculate the mass supported by each vertebra and the coordinates of the centre of these masses. These coordinates are transfered from the coordinate system of the gamma ray table to the coordinate system of the X-ray radiographs. In this way, the anatomical relations of the centres of these masses are visualized on the frontal and sagittal full spine radiographs.

The centres of gravity of 44 complete chronic spinal cord injured patients and 24 normal subjects were measured using a gamma ray scanner (Barycentremetre). The results are expressed as a percentage of body length and as anatomical level. The mean weight of paraplegic patients was 12kg less than the controls. The centre of gravity was 5% of body length higher in the paraplegic patients than in the controls, equivalent to 3 to 4 vertebrae level. The importance of such changes in the centre of gravity for the design of stable wheelchairs is discussed.

Although urinary disturbances are more frequent in multiple system atrophy (MSA) than in Parkinson's disease (PD), the striatonigral degeneration (SND) type of MSA is difficult to distinguish from PD, especially when the latter is associated with orthostatic hypotension or urinary symptoms. The pattern of urinary symptoms and urodynamic dysfunction was analyzed in 15 SND and 35 PD patients with urinary complaints. In SND, dysuria with or without chronic retention, frequently associated with a hypoactive detrusor and low urethral pressure, permitted early and reliable diagnosis. In PD, urgency to void, with or without difficulty voiding, but without chronic retention, associated with detrusor hyperreflexia and normal urethral sphincter function, predominated. In clinical practice, the study of urinary symptoms and bladder function may help to distinguish SND from PD in patients with urinary disturbances.

La incontinencia urinaria (IU) del anciano no debe trivializarse. Constituye un verdadero problema de salud pública por sus costes directos (actos médicos, paramédicos y quirúrgicos) e indirectos (aislamiento social, pérdida de actividades). Lo importante es poder diferenciar la IU de una dependencia psicológica o física, de una patología orgánica o de una fragilidad, que debe detectarse tras un estudio general que puede requerir la experiencia de un geriatra. De esta diferencia dependerá la actitud terapéutica, que podrá ser similar a la de la mujer más joven en ausencia de fragilidad.

L’entérocystoplastie d’agrandissement (EA) a pour but de protéger le haut appareil urinaire et améliorer le confort mictionnel des patients ayant une vessie neurologique. Peu de données existent sur le suivi à long terme des patients spina bifida, opérés d’une EA à l’âge adulte. Le but de notre travail était de rapporter les résultats fonctionnels de l’EA chez les patients spina bifida.

Peu d’études portent sur les résultats des ballons ajustables péri-urétraux ACT®dans le traitement de l’incontinence urinaire d’effort (IUE) féminine. Les ballons ACT®pourraient être proposés aux patientes âgées non éligibles au sphincter urinaire artificiel. Notre objectif était de rapporter les résultats fonctionnels des ballons ACT®implantés chez des patientes de plus de 80ans.