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To evaluate the feasibility, efficiency, and predictive factors of therapeutic success of Vibration, Diuresis and Inversion (VDI) therapy for the removal of upper urinary tract stones.It is a retrospective, single-center study at the CHU - La Conception, Marseille, France including all patients treated with VDI from 2013 to 2018. VDI was indicated for stones6mm in first-line treatment or for residual fragments6mm after ureteroscopy, PCNL, microPCNL. The protocol included 4 sessions in outpatient care from 2013 to 2015 then 6 sessions from 2015 to 2018 and a final radiological evaluation.In total, 109 patients or 489 sessions are reported: median age was 55 years [14-84], median BMI 25kg/mVDI is a simple, non invasive and well tolerated technique for the elimination of small renal lithiasis after SWL, ureteroscopy, PCNL or as a first-line treatment.

To study the evolutionary aspects of stress urinary incontinence and urinary incontinence by urgency after HoLEP through a series of 200 consecutive cases of the same surgeon then to seek secondarily the predictive factors of occurrence in the service of urology of the Hospital Center of Martigues.This was a monocentric, retrospective, descriptive and analytical study conducted in the urology department of the Martigues Hospital. All patients who were treated with HoLEP for benign prostatic hypertrophy (BPH) between September 2017 and March 2021 were included in the study. Patients with an age greater than 75 years, obese (BMI30) or with neurological disease were excluded from this study.Between September 2017 and March 2021, 204 patients were included in our study. The average urinary incontinence rate was 21.2% 12.2% 7.4% and 2.7% at 1 month, 3 months, 6 months and 12 months respectively. The rate of stress urinary incontinence was 5.4%, 9.2%, 5.6% and 1.8% at 1 month, 3 months, 6 months and 12 months post HoLEP respectively. Urge urinary incontinence was estimated at 13.3%, 3%, 1.8% and 0.9% at M1, M3, M6 and M12 post-HoLEP respectively. Preoperative erectile dysfunction, delivered energy, enucleated prostate weight and total intraoperative time were statistically associated with the occurrence of stress urinary incontinence postoperatively. The operative time and a low operative Qmax were statistically associated with the occurrence of postoperative stress urinary incontinence.HoLEP is at risk of postoperative urinary incontinence. Preoperative information of the patients on the risk of urinary incontinence is essential.

Urine flowmetry (UF) is a key non-invasive urodynamic test for the evaluation of the voiding phase in patients with lower urinary tract symptoms (LUTS). Traditional free urodynamic testing (FUT) performed on a one-time basis in the office is limited by difficulty in capturing normal voiding and high intrapatient variability in urine flow parameters. Home measurement of urine flow by the patient could be a way to obtain multiple data in real-life conditions, addressing its limitations. The objective of this article was to review the literature on the different techniques of home uroflowmetry (HUF) and their clinical interest in comparison with FUT.A search on the PubMed database using the key words "Urodynamics, Uroflowmetry, non-invasive urodynamics, Ambulatory urodynamics, bladder outlet obstruction, male LUTS" was performed to find articles in English or French that had been published with no time limit and March 2022. The sorting by reading the abstract allowed the selection of all articles describing and/or evaluating a HUF technique that were read entirely according to the same collection grid to propose a narrative synthesis.Thirty-one articles were identified, selected, and analyzed. Simple and inexpensive techniques by timing or use of funnels reliably and reproducibly estimate the average and maximum urine flow in relation to the FUT, without providing a complete flow curve. More sophisticated electronic or sonometric methods, some using connected mobile applications, present results that are more consistent with ICS recommendations for flow measurement. With the possibility of studying the average of several values of the maximum urinary flow (Qmax) captured during micturition in physiological conditions, some studies suggest a gain in diagnostic value in the evaluation of the emptying phase and lower urinary tract symptoms in men. However, the literature is sparse, old and the clinical benefits are not yet proven.There is a wide range of techniques for measuring urine flow in the patient's home, all of which aim to fill the gaps in conventional urine flow measurement. Further studies are needed to demonstrate the acceptability of this type of measurement by patients, the existence of a real clinical benefit, to assess the cost/benefit balance and finally to define a possible place for home uroflowmetry in daily practice, compared with traditional free flowmetry and invasive urodynamics (pressure-flow test).

Since the 1970s, self-catheterization is the preferred method of urine drainage in case of urinary retention of neurological etiology (paraplegia, multiple sclerosis…) and non-neurological cause (benign prostatic hypertrophy, acontractile bladder of the elderly subject…). The main objective is to allow the physiological alternation of filling and complete emptying phases, in order to preserve the renal function and prevent urinary infections. The learning of self-catheterization is simple but requires a therapeutic education session with trained personnel, at home or in a specialized center. Cognitive disorders, poor vision, lack of dexterity or lack of knowledge of urogenital anatomy are the main limitations to their implementation. Their success depends on the frequency of catheterization (every 4h), which is performed in a clean but non-sterile manner. The benefit/risk ratio is largely in favor of using them to replace the indwelling probe whenever possible.

The purpose of this first french guideline is to provide a clinical framework for the diagnosis, treatment and follow-up of anterior urethral strictures. The statements are established by the subgroup working on uro-genital reconstruction surgery (GURU) from the CAMS-AFU (Andrology and Sexual Medicine Committee from the French Association of Urology).These guidelines are adapted from the Male Urethral Stricture : American Urological Association Guideline 2016, updated by an additional bibliography from January 2016 to December 2019. Twenty-seven main scenarios seen in clinical practice are identified: from diagnosis, to treatment and follow-up. In addition, this guidelines are powered by anatomical diagrams, treatment algorithms, summaries and follow-up tables.Anterior urethral strictures are a common condition (0,1 à 1,4 %) in men. The diagnosis is based on a trifecta including an examination with patient reported questionnaires, urethroscopy and retrograde urethrography with voiding cystourethrography. Short meatal stenosis can be treated by dilation or meatotomy, otherwise a urethroplasty can be performed. First line treatment of penile strictures is urethroplasty. Short bulbar strictures (2cm) may benefit from endourethral treatment (direct visual internal urethrotomy or dilation). In case of recurrence or when the stenosis measures more than 2 cm, a urethroplasty will be proposed. Repeated endourethral treatment management are no longer recommended except in case of palliative option. Urethroplasty is usually done with oral mucosa graft as the primary option, in one or two stages approach depending on the extent of the stenosis and the quality of the tissues. Excision and primary anastomosis or non-transecting techniques are discussed for bulbar urethra strictures. Follow-up by clinical monitoring with urethroscopy, or retrograde urethrography with voiding cystourethrography, is performed at least the first year and then on demand according to symptoms.Anterior urethral strictures need an open surgical approach and should be treated by urethroplasty in most cases. This statement requires a major paradigm shift in practices. Training urologist through reconstructive surgery is the next challenge in order to meet the demand.

The management of urology patient is currently disrupted by the COVID-19 epidemic. In the field of functional urology, there are clinical situations with a high risk of complication if management is delayed and a great heterogeneity of advisable reprogramming times after cancellation. A prioritization of functional urology procedures is necessary to adapt management during the COVID-19 crisis and to better organize post-epidemic recovery.The advice of AFU scientific committees in the field of functional urology (neuro-urology, female and perineology, male LUTS) was requested and supplemented by a review of the currently available recommendations on the subject of urology and COVID-19. These opinions were combined to draw up temporary recommendations to help reorganize practices during the epidemic and prepare the post-critical phase.Most of the recommendations available on career-oriented social networks (Twitter, LinkedIn) or in literature concern cancer or general urology. Eight out of ten propose a cancellation of all functional urology procedures without distinction. But the 3 AFU committees covering the field of functional urology have identified three clinical situations in which surgical procedures that can be maintained during the COVID-19 epidemic (priority level A): conclusion of a neuromodulation test in progress (implantation or explantation), botulinum toxin A bladder injections for unbalanced neurologic bladder, cystectomy and ileal conduit for urinary fistula in perineal bedsore or refractory unbalanced neurologic bladder with acute renal failure and vesico-enteric or prostato-pubic fistulas. Management adaptation of the other pathologies are proposed, as well as the application of 3 priority levels (B, C, D) for rescheduled procedures for a better management of the post-crisis activity resumption.The joint functional urology committees indicate that there are specific clinical situations in this field that demand non-delayed care during COVID crisis. They underline the need to establish a hierarchy for the cancelled surgeries, in order to reduce the arm of long reschedule delays and to optimize post-lockdown activity resumption.

in the study that were suitable for inclusion criteria and quality evaluation. Seven of the studies were conducted only in university students, while 3 were community-based. As a result of the analysis, 2399 of 8845 university students used waterpipe (31.0%; 95% CI: 27.3-34.7), while 356 of the 33,129 individuals used waterpipe (1.2%; 95% CI: 0.04-2.0) in community-based studies. Conclusions: As a result of the comprehensive literature research, it was found that the studies on waterpipe use were less in literature and prevalence was higher than expected in university students. Key messages: In university students, the use of waterpipe was more common than the community, and intervention studies about the use of waterpipe were needed. Waterpipe use and surveillance studies in the communities are important for taking preventive measures and monitoring health outcomes. Background: Low back pain (LBP) is one of the leading contributors to disease burden worldwide [1]. In 2018, French health care insurance launched a population awareness campaign in order to promote effective behaviour change in France. Because LBP acute episodes often lead to emergency visits, Sante publique France, the French Public Health Agency and the Federation of Observatories for Emergency Medecine, performed a pre-campaign situational analysis of LBP in the French emergency department (ED) involved in the OSCOUR O network. Methods: The OSCOUR network is part of the French syndromic surveillance system SurSaUD O [2] coordinated by Sante publique France since 2004. In 2017, the system collects daily individual data from about 700 ED representing 92% of the French ED attendances. Those data contain demographic, administrative and medical information including discharge diagnosis coded according ICD-10. ED attendances with a diagnosis related to LBP were analyzed from 2014 to 2017. Temporal distribution of LBP attendances, hospitalizations after discharge and stay duration in ED services were also analyzed. Results: From 2014 to 2017, 504 ED were included in the analysis and LBP represented 1.12% (N = 481,291) of ED all visits. This proportion remained stable over the period. 60% of LBP attendances concerned 18 to 50 years old adults and almost 10% were hospitalized after discharge. This proportion increased with age to reach 43% for the 85 years old and more. LBP attendances were more frequent on Monday. Median stay duration were almost 3 hours but increased with age and for hospitalized patients. Conclusions: The broad coverage of the ED OSCOUR O network on the whole territory and the strong partnership between epidemiol-ogists and clinicians enable Sante publique France to produce reliable results which are also consistent with ED physician's perception. Finally those results can be used as a reference contributing to evaluate potential benefits of this campaign. Key messages: This description of low back pain ED attendances is consistent with emergency physicians perception on field and can be used as a reference to evaluate potential benefits of the prevention campaign.

During idiopathic Parkinson's disease (IPD), lower urinary tract symptoms and dysfunctions are frequent, dominated by overactive bladder and detrusor overactivity (OAB, DO). Intradetrusor Injection (IDI) of Botulinum Toxin A (BTA) is recommended as second-line treatment for neurogenic urinary incontinence related to DO in multiple sclerosis or spinal cord injury patients. However, there is little data on BTA IDI to treat incontinence owing to OAB and DO during idiopathic Parkinson's disease. The objective of this study is to evaluate efficacy and tolerance of BTA IDI in patients suffering IPD.We conducted a retrospective study in IPD patients treated with BTA IDI from 2012 to 2018. For each patient we compared patient clinical and urodynamic data at baseline before the first injection and 8 weeks following the injection. We defined 3 levels of effects (perfect, improved, failure), corresponding to 3-dimension composite criteria: clinical, quality of life (Likert scale), urodynamics.Sixteen patients were included from 2012 to 2018. The median age was 73 (70-78.25). The median number of micturition/day before and after TBA was 13 (10-16) and 9 (6.75-13.25) (p=0.022). The median number of pad used/day before and after BTA was 5.4 (2-5) and 1 (0-5) (p=0.035). Median USP scores for OAB was 15.5 (11.75-20) and 14 (6.75-15.25). Median score on the Likert scale was 1 (0-1.5) meaning "slight improvement" felt by the patient. The median maximum cystometric capacity raised from 130cmIn this retrospective study we observe some short-term efficacy of TBA IDI to treat urinary incontinence owing to OAB/DO in patients with IPD in 60% of patients. These results are consistent with findings from previous retrospective studies. Prospective data coming from larger cohorts are now tremendously needed to clarify the best patient responders profiles, the actual TBA dose, and eventually to define TBA IDI place in the therapeutic algorithm of IPD patients' incontinence.4.

Living donor kidney transplants give the best results in term of renal function and are the principal solutions for the transplant shortage. However, donors selection and kidney function evaluation after surgery are essential. The objective of this study was to evaluate the prevalence and to identify the predictive factors of chronic renal failure for the donor, after living donor nephrectomy.It was a retrospective and monocentric study, including all the patients who underwent a living donor nephrectomy from 2007 to 2015 at the hospital of the Conception in Marseille. The primary study endpoint was renal function mesured by the glomerular filtration rate (GFR in mL/min) at 1 year and 5 years after surgery. The identification of moderate kidney failure predictive factors was achieved by an univariate and a multivariate analysis under Cox model.Ninety-one patients were included. There was 40,7 % of men and media nage was 49 years (21; 70). Median pre-operative GFR was 94mL/min (67; 160). Median follow-up was 24 months (1; 120). Post operative GFR at 1 month, 1 year and 5 years was respectively 63mL/min (33; 90), 65mL/min (38; 107) and 67mL/min (56; 126) ans significantly lower than pre operative GFR (respectively P0,001, P0,001 et P=0,005). The prevalence of moderate kidney failure at 1 month, 1 year and 5 years was respectively 43,1 %, 33,3 % ans 25 %. In univariate and multivariate analysis, the only parametre significantly associated with a 1 year GFR60mL/min wasp re operative GFR90mL/min OR 3,61 IC95 % (1,27; 10,28) P=0,02.Living donor nephrectomy leads to an important medium to long term loss of renal function. Donors with pre operative GFR90mL/min should benefit from a rigorous supervision and nephrological care.3.

The objective of our study was to evaluate, in a review of the literature, the impact of diagnostic ureteroscopy before total nephroureterectomy (NUT) on the risk of bladder recurrence.We conducted a literature review in the Pubmed database in March 2018. Initial research identified 45 publications. Following full text screening, 9 studies were finally included, with a total of 1041 NUT with URS prior versus 2909 NUT alone. The primary endpoint was bladder recurrence. Secondary objectives were specific survival and overall survival.Bladder recurrence was reported in the 9 studies included. Diagnostic ureteroscopy was significantly associated with an increased risk of post-NUT bladder recurrence (HZ 1.42 [1.29-1.56], P0.01). The specific survival and overall survival at 5 years, were reported in respectively 4 and 2 studies. There was no impact of the pre-NUT diagnostic URS on the specific survival (HZ 0.75 [0.54-1.03], P=0.08) or post-NUT overall survival (HZ 1.15 [0.68-1.96], P=0.59).The URS diagnostic before NUT for TVEUS is associated with a significant increase in the risk of postoperative bladder recurrence.

The REVELA13 observatory is a unique epidemiological tool listing the new cases of kidney tumors, bladder tumors and acute leukaemias in the Bouches-du-Rhône county (France). Aim was to exploit for the first time data from this observatory regarding new cases of bladder tumors≥T1 in women from 2012 to 2014.This epidemiological study was observational and descriptive. Fifteen non-nominative variables from the REVELA13 database were analyzed in order to describe the clinical and pathological characteristics of the incident cases as well as their spatial and temporal distribution. The incidence rates expressed in new cases per year per 100000 inhabitants were standardized on the world age, calculated with 95 % confidence intervals and compared to national estimates for the same period.Incident bladder tumor cases were recorded in 291 women, corresponding to a standardized incidence on the world age of 3.85 [3.32-4.37] new cases per year per 100,000 population, 54 % higher than the national estimates of 2012 and 2015. Median age of diagnostic was 75.9 years. Sex ratio was 19.41 % (W/M). Tumors were predominantly non-muscle-invasive (52 %), high grade (69 %) and without associated carcinoma in situ (Cis) (49 %). The two most affected territories were Marseille and Aubagne-La Ciotat.The REVELA13 observatory has improved our epidemiological knowledge on female bladder tumors in Bouches-du-Rhône county and highlighted a local over incidence.3.

Our objective was to validate the VPSS (visual prostatic symptom score) score in the French language for the identification and monitoring of BPH-related LUTS in urological practice.A prospective observational survey was carried out between September the 15th 2014 and July the 30th 2015 in urology practices. The first 4 consecutive patients aged over 60 years, with BPH-related LUTS requiring prescription of an alpha-blocker, were enrolled. We translated a "visual prostatic symptom score" (VPSS) into French and adapted it slightly. At the first visit and follow-up visit (1-3 months after the first visit), the patient completed 2 questionnaires: the French language version of the IPSS and the VPSS.Of the urologists contacted, 169 enrolled at least one patient and returned information; 550 questionnaires were included in the statistical analysis. The median IPSS and VPSS total scores, subscores and quality of life scores all decreased significantly (P0.0001) between enrolment and the follow-up visit 1-3 months later. Correlations between the IPSS and VPSS at enrolment and the follow-up visit and their variation were all significant. Total VPSS was significantly correlated with total IPSS, as were the irritative, obstructive and quality of life subscores evaluated on the corresponding pictograms.This study showed the VPSS to be a simple and useful tool for identifying and monitoring BPH-related LUTS.4.

Introduction : l’observatoire REVELA13 est un outil epidemiologique unique recensant l’incidence et les caracteristiques epidemiologiques des nouveaux cas de tumeur du rein, de la vessie et des leucemies aigues dans le departement des Bouches-du-Rhone depuis le 2 avril 2012 en reponse a un nombre croissant de cancers constates en peripherie des sites industriels des Bouches-du-Rhone. L’objectif de cette etude etait d’exploiter pour la premiere fois les donnees de cet observatoire concernant les nouveaux cas de tumeurs de vessie (≥pT1) de la femme dans les Bouches-du-Rhone sur la periode 2012-2014. Methodes : il s’agissait d’une etude epidemiologique prospective descriptive observationnelle. Les nouveaux cas ont ete recueillis a partir de signalements directs a l’observatoire, de signalements indirects via les fiches issues des Reunions de Concertation Pluridisciplinaire (RCP) et d’une enquete d’exhaustivite comparant les donnees des cabinets d’anatomo-pathologie et des Departements d’Information Medicale (DIM) des etablissements de sante du departement. Leurs incidences ainsi que leurs caracteristiques medico-sociales, anatomo-pathologiques geographiques et temporelles ont ete analysees. Resultats : 291 nouveaux cas ont ete recueillis, soit une incidence standardisee sur l’âge mondial de 3.85 [3.32-4.37] nouveaux cas/an/100 000 habitants, superieure a toutes les dernieres donnees disponibles issues des registres de surveillance du cancer en France et superieure respectivement de 54%, 54% et 67% aux dernieres estimations nationales, regionales et departementales. La tendance evolutive etait a la hausse (+28% en 2 ans). 119 (41%) etaient issus de signalements directs, 125 (43%) de signalements indirects (fiches RCP) et 47 (16%) ont ete ajoutes apres realisation d’une enquete d’exhaustivite. 216 cas (74%) ont ete diagnostiques dans des etablissements prives, 57 (20%) dans des etablissements publics et 18 (6%) dans des centres de lutte contre le cancer. 44 cas (15%) n’ont jamais ete identifies sur les RCP transmises. L’âge median au diagnostic etait de 75.9 ans avec des extremes a 40.7 ans et 97.9 ans. 141 (52%) tumeurs n’infiltraient pas le muscle tandis que 135 (46%) l’envahissaient. 113 (39%) tumeurs etaient unifocales contre 100 (34%) multifocales. 32 (11%) etaient associees a du Cis tandis que 142 (49%) en etaient depourvues. Il y avait 16 (5%) grade 1, 54 (19%) grade 2 et 201 (69%) grade 3. Les territoires les plus touches concernaient Marseille et Aubagne-La Ciotat. Il n’a pas ete mis en evidence de sur-incidence locale autour de l’etang de Berre. Conclusion : l’existence d’un observatoire departemental tel que REVELA13 a demontre l’interet d’un recueil local quasi exhaustif des donnees permettant de suivre l’evolution spatio-temporelle des particularites territoriales des nouveaux cas de tumeurs de vessie chez la femme dans le departement des Bouches-du-Rhone. Tout en ameliorant notre connaissance epidemiologique et donc notre prise en charge, l’exploitation de ses donnees se heurte encore a plusieurs freins reglementaires illustrant les difficultes du Data Mining dans le domaine medical et remet en question certaines pratiques actuelles de surveillance du cancer en France.

Objectifs La sclerose en plaques (prevalence 83/100 000 en Europe) est la premiere cause de handicap neurologique acquis de l’adulte jeune. Les troubles vesicosphincteriens y sont frequents : 75 % a 10 ans d’evolutivite de la maladie. L’objectif de notre etude etait de decrire et d’analyser la morbi-mortalite et l’impact sur la qualite de vie, de la realisation d’une derivation urinaire non continente type Bricker chez des patients atteints de sclerose en plaques avec des troubles urinaires du bas appareil refractaires aux traitements conservateurs. Methodes L’etude etait retrospective et multicentrique. Dix centres francais membres du GENULF ont identifie les patients atteints de SEP ayant beneficie d’un Bricker entre janvier 2010 et decembre 2015 avec un suivi superieur a 6 mois. Etaient evalues l’anciennete de la SEP, le score EDSS preoperatoire, le dernier mode mictionnel, les traitements des TUBA avant derivation, le DFG, l’anatomie renale preoperatoire et le nombre total d’hospitalisation pour infection urinaire. La morbidite postoperatoire precoce etait gradee selon Clavien-Dindo, et tardive par le DFG, l’anatomie renale, la survenue d’infection urinaire febrile avec hospitalisation et le deces lie a une complication urinaire. La qualite de vie pre- et postoperatoire par questionnaire Qualiveen Short Form et le PGI-I. Resultats Ont ete analyses 211 patients (77,3 % de femmes) d’âge moyen 54 ans. L’anciennete de la SEP etait de 20,9 ans (±ET 9,8). L’EDSS median preoperatoire etait de 7,5 (IQR 7–8). La duree moyenne de l’hospitalisation etait de 17,5 jours. Le suivi median a ete de 22 mois (IQR 9–44). Quarante-quatre pour cent des patients avaient des complications postoperatoires precoces : 87 % Clavien I, II ou IIIa et 10 % IIIb ou IV ; 1 deces d’un choc septique d’origine pulmonaire. Dix-neuf patients sont decedes entre j30 et la derniere visite (2/19 d’un sepsis d’origine urinaire). Le DFG postoperatoire moyen etait de 101,5 mL/min contre 102,6 mL/min preoperatoire ( p = 0,709). L’anatomie renale etait inchangee chez 73,2 % des patients, s’est amelioree dans 8,1 % des cas et 18,7 % ont developpe une dilatation uni- ou bilaterale. Il y avait une nette amelioration de la qualite de vie ( Figure 1 , Figure 2 , Figure 3 ). Conclusion Nous avons rapporte la plus grande serie de cas de Bricker realisee chez des patients atteints de SEP qui souffrent de TUBA en phase terminale. Les complications postoperatoires precoces etaient frequentes mais majoritairement de faible grade Clavien. Au suivi moyen, la fonction renale restait inchangee, bien qu’une dilatation des voies urinaires majoree soit apparue (18,7 %). La qualite de vie liee au mode mictionnel a ete considerablement amelioree et l’impression de l’amelioration du patient etait elevee.

Objectif| Le but de cette etude etait de comparer les resultats de la debitmetrie et de la mesure du residu postmictionnel (RPM) par echographie sus-pubienne au ressenti du patient evalue a l’aide d’une echelle visuelle analogique (EVA).

Men with spinal cord injury present a unique infertile population. Only 10 % of them can father children without medical assistance, owing to potential impairments in erection, ejaculation and semen quality. The algorithm typically followed is to retrieve semen by Penile Vibratory Stimulation, in case of failure by Electro Ejaculation. Most of these patients have normal sperm concentrations but abnormally low sperm motility and vitality in the ejaculate. The reasons for poor semen quality in spinal cord injured men are reviewed. If semen cannot be obtained by Electro Ejaculation, or if the ejaculate from Penile Vibratory Stimulation or Electro Ejaculation contains an insufficient quantity or quality of sperm for in vitro fertilization with intracytoplasmic sperm injection, then retrieval of sperm from reproductive tissues is attempted. Despite abnormal semen quality, successful pregnancies with sperm from spinal cord injured male partners have occurred by intravaginal insemination, intrauterine insemination, and in vitro fertilization with intracytoplasmic sperm injection. The prevailing pregnancy and fecundity rates in couples with a spinal cord injured male partner are reviewed.

L’hyperactivite vesicale est definie comme un trouble associant une urgenturie avec ou sans incontinence et frequemment associee a une pollakiurie et a une nycturie. Un ensemble d’observations recentes permet en effet desormais d’etablir que l’hyperactivite vesicale correspond d’abord a une anomalie du traitement sensoriel regulant la continence. Les differents cadres etiopathogeniques chez l’homme partagent un ensemble de desordres similaires au niveau de l’urothelium, des nerfs et du muscle lisse du detrusor. Ces desordres s’inscrivent pour partie dans le cadre d’une neuroplasticite orchestree par les facteurs de croissance nerveuse.

Resume La toxine botulique de type A (TBA) aurait un roledans la modulation du message douloureux par son actionsur la voie afferente vesicale. Cette nouvelle approche aconduit a utiliser la TBA contre la douleur et l’urgenturiechez les patients atteints de syndrome de vessie doulou-reuse-cystite interstitielle.Objectif : Evaluer l’interet de l’utilisation de la TBA dans letraitement du syndrome de vessie douloureuse-cystiteinterstitielle par une revue de la litterature.Methode : Une recherche d’etudes cliniques a ete realiseegrâce au moteur de recherche Pubmed en utilisantbotulinum toxin et interstitial cystitis comme mots cles, etles resultats ont ete analyses.Resultats : Onze etudes cliniques ont ete repertoriees(252 patients). Neuf articles ont montre une ameliorationsignificative sur les symptomes, mais aucun patient n’a eteasymptomatique. Six articles ont etudie les troubles de lavidange vesicale apres injection de TBA : 20 a 63 % despatients etaient dysuriques, conduisant 12,5 % d’entre euxa la realisation d’autosondages. Deux etudes n’ont pasretrouve d’amelioration clinique apres injection, exceptepour un patient qui etait asymptomatique.Discussion : La majorite de ces etudes conclut a uneefficacite de la TBA dans le traitement du syndrome devessie douloureuse-cystite interstitielle malgre le faiblenombre de patients asymptomatiques apres injection (un sur252 patients). Dix sur 11 de ces articles ont un faible niveaude preuve scientifique, et les resultats ont ete exploites defacon differente, rendant les comparaisons difficilementobjectives : duree de l’effet de l’injection de TBA, troublesde la vidange, alors qu’il est etabli que la dysurie et laretention augmentent la douleur dans cette pathologie.Conclusion : La TBA ne devrait pas etre utilisee commetraitement du syndrome de vessie douloureuse-cystite inter-stitielle, excepte dans le contexte d’essai controle randomise.Mots cles Cystite interstitielle ·Syndrome de vessie douloureuse · Toxine botulique AAbstract Background: Botulinum toxin appears to have arole in the genesis of nociceptive messages through its effecton afferent pathways. This new approach is behind the use ofBTA to treat pain and frequency problems for patients withbladder pain syndrome-interstitial cystitis (BPS-IC).AIM: To assess the value of using BTA in the treatment ofBPS-IC, through a literature review.Method: A Medline search for clinical studies withbotulinum toxin and interstitial cystitis was carried out,extracted data were reviewed and analysed.Results: Eleven clinical studies were found (252 patients).Nine articles showed significant improvement of symptomsbut no patient was symptom free. Six studies evaluatedvoiding dysfunction after BTA injection: dysuria-retentionaffected 20 to 63% of whom 12.5% resorted to selfcatheterisation. The two remaining studies had disappoint-ing results: no clinical improvement with TBA except forone patient who was symptom free.Discussion: Most of these articles conclude that BTA iseffective, despite only one patient being symptom free. Tenof the 11 studies had a low level of evidence (4) and datawere evaluated in different ways, making it difficult tocompare them objectively: duration of the effect of BTAand voiding dysfunction in particular, as it is well knownthat dysuria and retention increase pain in BPS-IC.Conclusion: BTA should not be used in the treatment ofBTA-IC except in a randomised control trial.Keywords Interstitial cystitis · Painful bladder syndrome ·Botulinum toxin A

Il s’agit d’une revue de la litterature sur 34 articles comprenant 764 patients traites par toxine botulique (TB) pour hyperactivite detrusorienne (HD). Est etudiee l’efficacite de la TB dans l’HD idiopathique en termes d’amelioration des parametres urodynamiques et de la qualite de vie evaluee par des questionnaires. La dose, le site d’injection, la duree d’efficacite, la reinjection et les effets indesirables sont detailles pour les etudes du plus haut niveau de preuve, et toutes les donnees sont resumees dans un tableau. A l’issue de cette etude, la TB confirme son indication dans l’HD idiopathique uniquement en situation d’echec de toutes les autres therapeutiques, dans le cadre d’une etude clinique, chez des patients prevenus de l’eventualite des autosondages et capables de les faire.

There is currently no guideline regarding the management of neurogenic detrusor overactivity (NDO) refractory to intra-detrusor botulinum toxin injections. The primary objective of the present study was to find a consensus definition of failure of botulinum toxin intra-detrusor injections for NDO. The secondary objective was to report current trends in the managment of NDO refractory to botulinum toxin.A survey was created, based on data drawn from current literature, and sent via e-mail to all the experts form the Group for research in neurourology in french language (GENULF) and from the comittee of neurourology of the French urological association (AFU). The experts who did not answer to the first e-mail were contacted again twice. Main results from the survey are presented and expressed as numbers and proportions.Out of the 42 experts contacted, 21 responded to the survey. Nineteen participants considered that the definition of failure should be a combination of clinical and urodynamics criteria. Among the urodynamics criteria, the persistence of a maximum detrusor pressure40 cm H2O was the most supported by the experts (18/21, 85%). According to the vast majority of participants (19/21, 90.5%), the impact of injections on urinary incontinence should be included in the definition of failure. Regarding the management, most experts considered that the first line treatment in case of failure of a first intra-detrusor injection of Botox(®) 200 U should be a repeat injection of Botox(®) at a higher dosage (300 U) (15/20, 75%), regardless of the presence or not of urodynamics risk factors of upper tract damage (16/20, 80%).This work has provided a first overview of the definition of failure of intra-detrusor injections of botulinum toxin in the management of NDO. For 90.5% of the experts involved, the definition of failure should be clinical and urodynamic and most participants (75%) considered that, in case of failure of a first injection of Botox(®) 200 U, repeat injection of Botox(®) 300 U should be the first line treatment.