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International audience; Objective: We aimed to assess the long-term association of therapeutic strategies with urinary, sexual function and health-related quality of life (HR-QoL) for 5-year prostate cancer (PC) survivors. Materials & methods: The VICAN survey consisted of self-reported data prospectively collected, including living conditions, treatment side effects and quality of life (QoL) of cancer survivors. Results: Among the 434 PC survivors, 52.8% reported urinary incontinence (UI) and 55.8% reported erectile dysfunction (ED). Patients treated with radical prostatectomy with salvage radiotherapy reported significantly more UI (p = 0.014) and more ED (p = 0.012) compared with other strategies. UI was significantly associated with physical and mental health-related QoL (p = 0.045 and p = 0.049, respectively). Conclusion: Self-assessed functional outcomes 5 years after PC diagnosis remain poor and could have an impact on health-related QoL.

Context: hormone therapy used in the treatment of breast cancer, could be responsible for pelvic floor disorders, by its anti-estrogenic action. Objective: the main objective of this study was to assess the prevalence of pelvic floor disorders in women treated with hormone therapy for localized breast cancer. Methods: a comparative prospective study was conducted at the Montpellier Cancer Institute and the University Hospital of Montpellier. Women over 50 years of age, menopausal, not metastatic, who underwent surgery after June 2015 with hormone-sensitive or non-sensitive breast cancer could be included in 2 distinct groups: Hormone Therapy Group (HT+) or without Hormone Therapy Group (HT-). Patients answered two validated questionnaires: PFDI 20 and PFIQ7. The primary outcome was the presence of urinary incontinence (UI). Results: 246 patients were included from June 2020 to June 2021. The prevalence of UI was higher in the HT+ group (57.93% vs 36.59%, OR 2.39 [95% CI: 1.38-4.12], p = 0.002). The PFDI-20 score was higher in HT+ patients (28.13 vs 14.58, p< 0.001). The UI risk factors found in multivariate analysis were number of vaginal deliveries ≥ 2 (OR 2.16 [95% CI 1.22-3.80], p=0.007) and hormone therapy intake (OR 2.37 [95% CI 1.33-4.22], p=0.003). The impact on quality of life (PFIQ7 score) was greater in the HT+ group (cIRR 1.86; [95% CI: 1.21-2.85]; p= 0.004). Conclusion: this study found out an increase in urinary incontinence in patients followed for breast cancer and treated with hormone therapy which should lead to a specific treatment of these patients.; Contexte : par son action anti œstrogénique, l’hormonothérapie utilisée dans le traitement du cancer du sein, pourrait être responsable de troubles de la statique pelvienne. Objectif : l’objectif principal de cette étude était d’évaluer la prévalence des troubles de la statique pelvienne chez les femmes traitées par hormonothérapie pour un cancer du sein localisé. Méthodes : une étude prospective comparative, a été réalisée à l’institut du cancer de Montpellier et au CHU de Montpellier. Les patientes âgées de plus de 50 ans, ménopausées, non métastatiques, opérées après juin 2015 d’un cancer du sein hormono sensible ou non pouvaient être incluses dans 2 groupes distincts : groupe hormonothérapie (HT+) ou sans hormonothérapie (HT-). Les patientes ont répondu à deux questionnaires validés : PFDI 20 et PFIQ7. Le critère de jugement principal était la présence d’incontinence urinaire (IU). Résultats : 246 patientes ont été incluses de juin 2020 à juin 2021. La prévalence de l’IU était plus élevée dans le groupe HT+ (57.93% vs 36.59%, OR 2.39 [IC 95% : 1.38-4.12], p

L’HoLEP est de plus en plus utilisée dans le traitement de l’hypertrophie bénigne de prostate en alternative aux techniques de référence. Cependant la morbidité de cette technique et en particulier la survenue d’une incontinence urinaire post opératoire n’est que peu étudiée dans la littérature. L’objectif de ce travail était d’évaluer la morbidité précoce avec au premier plan l’incontinence urinaire survenant après l’HoLEP, et d’en caractériser la nature, ainsi que l’évolution spontanée à 1, 3 et 6 mois postopératoire. Nous avons également recherché des facteurs pré ou peropératoires pouvant être associés à la survenue de celle-ci. Nous avons étudié de manière prospective 171 patients opérés par HoLEP dans notre centre entre novembre 2015 et janvier 2017. L’incontinence urinaire était de 43 % à 1 mois, 36 % à 3 mois et 33 % à 6 mois post opératoire. La proportion d’incontinence urinaire à l’effort était environ 3 fois plus élevée que celle par urgenturie. La survenue de cette complication semblait être associée à une énergie délivrée per opératoire trop importante ( OR = 1.07 {1.01-1.16} ; p = 0.045). Ces résultats impliquent une remise en question de la technique employée mais aussi une nouvelle réflexion sur les indications avec une mesure de la balance bénéfice-risque adaptée à chaque cas particulier.

Resume Objectif. – Mesures des resistances maximales a la rupture des ligaments pelviens utilises dans les cures de prolapsus et d'incontinence urinaire. Patientes et methodes. – Nos mesures sont effectuees a partir de ligaments pelviens de cadavres. Nous avons disseque 29 bassins de cadavres feminins dont les modes de conservation differaient. Dix cadavres etaient frais congeles, dix frais et neuf formoles. Sur chacun, nous avons disseque le ligament pre-vertebral au niveau du promontoire, les ligaments pectines, sacro-epineux et les arcs tendineux du fascia pelvien. Une evaluation subjective clinique de la qualite ligamentaire par l'examen et la palpation digitale nous a permis d'effectuer une classification en trois groupes de qualite : A, B et C. Ces memes ligaments etaient ensuite aiguilles par un fil, prenant l'ensemble de leur epaisseur, et les ligaments etaient soumis a une traction dans l'axe du vagin jusqu'a obtenir leur rupture. L'appareil de mesure est un dynamometre de type Samson, adapte a notre etude. La resistance a la rupture des ligaments est rapportee en newtons. Resultats. – Il existe une grande variabilite dans les mesures de resistance maximale a la rupture des ligaments. Les valeurs minimales obtenues sont de l'ordre de 22 newtons, et proches de 200 newtons pour les valeurs maximales. Les resultats montrent une grande disparite. Le ligament pre-vertebral est en moyenne plus resistant. Lorsqu'on compare la resistance en fonction des trois modes de conservation, il n'existe une difference significative de resistance que pour les ligaments pre-vertebraux aux depens des sujets formoles. Pour tous les autres ligaments il n'existe pas de difference significative en fonction du mode de conservation. On ne retrouve pas de difference significative entre les mesures droite et gauche pour les ligaments bilateraux. Le ligament pectine est significativement plus resistant que le ligament sacro-epineux et que les arcs tendineux du fascia pelvien. Il existe un lien significatif entre l'appreciation subjective de la qualite ligamentaire et les mesures objectives de resistance. Discussion et conclusion. – La litterature ne donne pas de reference concernant la resistance a la rupture des ligaments pelviens. Ces ligaments sont pourtant utilises couramment dans presque toutes les interventions de cures de prolapsus ou d'incontinence urinaire. Les resultats rapportes permettent de constater que ces ligaments sont de resistance tres variable d'une patiente a l'autre, d'un ligament a l'autre, voire chez une meme patiente et pour un meme ligament d'un cote a l'autre. Ces observations pourraient permettre d'expliquer certains echecs des techniques chirurgicales et soulignent l'interet de rechercher des techniques d'evaluation de ces resistances en pre-operatoire. Ceci nous permettrait de modifier les indications chirurgicales en fonction de la qualite des ligaments. L'evaluation subjective per-operatoire de la resistance est globalement correlee aux mesures objectives et devrait donc etre un element determinant dans le choix per-operatoire des ligaments de suspension pour les montages chirurgicaux.

International audience; GOAL: The aim was to review the literature on nitric oxide and female lower urinary tract. MATERIAL: A literature review through the PubMed library until December, 31 2012 was carried out using the following keywords: lower urinary tract, bladder, urethra, nervous central system, innervation, female, women, nitric oxide, phosphodiesterase, bladder outlet obstruction, urinary incontinence, overactive bladder, urinary tract infection. RESULTS: Two nitric oxide synthase isoforms, the neuronal (nNOS) and the endothelial (eNOS), are constitutively expressed in the lower urinary tract. Nevertheless, nNOS is mainly expressed in the bladder neck and the urethra. In the bladder, NO modulates the afferent neurons activity. In pathological condition, inducible NOS expression induces an increase in detrusor contractility and bladder wall thickness and eNOS facilitates Escherichia coli bladder wall invasion inducing recurrent urinary tract infections. In the urethra, NO play a major role in smooth muscle cells relaxation. CONCLUSION: The NO pathway plays a major role in the female lower urinary tract physiology and physiopathology. While it acts mainly on bladder outlet, in pathological condition, it is involved in bladder dysfunction occurrence.

International audience; PURPOSE: To evaluate the usefulness of MRI to assess the anatomical and functional relationships between the transobturator male sling Advance(®) and the uretral sphincter, in patients treated for postprostatectomy urinary incontinence. PATIENTS: For 12 patients treated for postprostatectomy urinary incontinence using the transobturator male sling Advance(®), a pelvic real-time MRI was performed between 1 and 3 months postoperatively. A comparison between pre- and postoperative MRI was performed in eight patients. The static sequences studied the anatomical relationships between the sling and the uretral sphincter, as well as the impact on the location of the vesico-uretral anastomosis. The dynamic sequences by coughing looked for the existence of an uretral sphincter mobility. Finally, the voiding sequences studied the impact of the sling on the uretral lumen during the micturition. RESULTS: The position of the sling was always visible, located at a median distance of 5mm from the posterior wall of the uretra. On transverse sections, the angles between the transobturator arms and the horizontal line between the ischial tuberosities varied from 28 to 59 degrees. The vesico-uretral anastomosis location was not modificated between pre and postoperative MRI. On the preop sequences by coughing, four patients had uretral mobility, which didn't exist on postop sequences. To finish, the seven patients who were able to void during MRI, had micturition without uretral stenosis. CONCLUSION: Pelvic MRI was a useful tool to assess the positioning of the sling and the relationships with the uretral sphincter. When correctly positioned, the sling was retro-uretrally and no urethral stenosis was visible during the micturition.

International audience; L'importance de l'obésité est étroitement corrélée à la prévalence et la sévérité de l'incontinence urinaire, quel qu'en soit le type. La prise en charge hygiéno-diététique doit être le traitement de première intention.

International audience; Obstetric vesicovaginal fistula is nowadays rare in developed countries. We are reporting two cases of patients with obstetric vesicovaginal fistula that occurred after operative vaginal deliveries performed in a French hospital. Early postpartum symptoms were vaginal urine leakage and infectious syndrome. The fistula has been cured by vaginal surgery one case and combined (laparotomy and vagina surgery) in the other case. Patients were totally healed a few months following the surgery.

International audience; BACKGROUND: Clinical outcomes and socioeconomic consequences after a stroke may differ between regions. METHODS: One cohort was established prospectively in Kunming (China) to compare with a cohort of 156 stroke patients included in Limoges (France). During 1 year, patients hospitalized within 48 hours for a first-ever hemispheric stroke were included. Demographic data and neurocardiovascular risk factors were registered. Hemiplegia was evaluated. Functional outcome was assessed using the Barthel Index (BI) after 3 months. RESULTS: One hundred and eighteen patients were included in Kunming. Patients of Kunming were younger (61.4 ± 13.4 vs 72.3 ± 14.6 years in Limoges, P70 years (HR=6.29, 95% CI [2.36, 16.59]). Despite a better baseline BI for patients of Kunming (50.0 ± 34.9 vs 37.4 ± 34.2, P=0.0031), after adjustment for confusing, patients in Limoges had a 2.11 OR 95% CI [1.03, 4.31]) to reach a BI>80 at 3 months. CONCLUSIONS: Functional recovery for patients of Kunming was not as good as expected. The socioeconomic consequences of stroke in Kunming are significant as they involved younger subjects who were still in work.

International audience; Several imaging modalities are available ranging from fluoroscopic techniques to ultrasonography and MRI for the evaluation of patients with pelvic floors disorders. High-resolution ultrasonography and MRI not only provide superior delineation of the pelvic floor anatomy but also reveal pathology and functional changes. This article focuses on standard imaging procedures including defecography, ultrasonography, and MRI and discusses its use in clinical practice by illustrating both normal and abnormal patterns.

International audience; INTRODUCTION: Female urinary incontinence (UI) is a frequent affection that generates handicap and expenses. There is a link between UI and pregnancy; onset of UI during pregnancy is a risk factor for permanent UI. Postnatal pelvic floor exercise has shown efficacy to improve postnatal UI. However, it remains uncertain if benefits last more than few months. Publication of our rationale for prenatal pelvic floor exercise is an opportunity to expose our pre-specified hypotheses and help health professionals' awareness. OBJECTIVES: The purpose of PreNatal Pelvic floor Prevention (3PN) is to compare the effects of prenatal pelvic floor exercise versus sole written instructions on UI one year after delivery. METHODS AND POPULATION: It is a multicenter, randomized, single blind study. Main inclusion criteria are first, single and non-complicated pregnancy over 18 years. Women randomized in pelvic floor exercise group will undergo eight sessions with a physiotherapist between six and eight months of pregnancy. Our principal criterion is UI score (International Consultation on Incontinence Questionnaire Short Form [ICIQ-SF]) one year after delivery. We plan to include 280 pregnant women in five centers over a 12-month screening period to show a one-point difference on UI score. ETHIC AND FINANCING: The study was approved by the IRB Comit?e protection des personnes Sud-Ouest et Outre-Mer. It was registered by French Health Products Safety Agency (AFSSAPS) and Clinical Trials.gov. It is supported by the French Ministry of Health through the 2007 Hospital Plan for Clinical Research (PHRC). PERSPECTIVES: We plan to assess if prenatal pelvic floor exercise reduces postnatal medical consultations or physiotherapy sessions.

International audience; PURPOSE: We determined whether urinary leakage in some circumstances is associated with intrinsic sphincter deficiency, defined by a low maximum urethral closure pressure of 30 cm H(2)O or less, in women presenting for urinary incontinence. MATERIALS AND METHODS: We retrospective analyzed the records of 100 consecutive women who underwent complete urodynamic evaluations for complaints of urinary leakage. RESULTS: Logistic regression adjusted for age showed that leakage while running or during physical exertion, leakage while walking and leakage with no obvious reason were associated with intrinsic sphincter deficiency, while leakage upon coughing or sneezing was not. CONCLUSIONS: These results suggest that different mechanisms may govern incontinence during prolonged vs brief stress. Low maximum urethral closure pressure may be a sign of abnormal sphincter fatigability.

Objective To compare two policies for episiotomy: restrictive and systematic. Design Quasi-randomised comparative study. Setting Two French university hospitals with contrasting policies for episiotomy: one using episiotomy restrictively and the second routinely. Population Seven hundred and seventy-four nulliparous women delivered during 1996 of a singleton in cephalic presentation at a term of 37–41 weeks. Methods A questionnaire was mailed 4 years after delivery. Sample size was calculated to allow us to show a 10% difference in the prevalence of urinary incontinence with 80% power. Main outcome measures Urinary incontinence, anal incontinence, perineal pain, and pain during intercourse. Results We received 627 responses (81%), 320 from women delivered under the restrictive policy, 307 from women delivered under the routine policy. In the restrictive group, 186 (49%) deliveries included mediolateral episiotomies and in the routine group, 348 (88%). Four years after the first delivery, there was no difference in the prevalence of urinary incontinence (26 versus 32%), perineal pain (6 versus 8%), or pain during intercourse (18 versus 21%) between the two groups. Anal incontinence was less prevalent in the restrictive group (11 versus 16%). The difference was significant for flatus (8 versus 13%) but not for faecal incontinence (3% for both groups). Logistic regression confirmed that a policy of routine episiotomy was associated with a risk of anal incontinence nearly twice as high as the risk associated with a restrictive policy (OR = 1.84, 95% CI: 1.05–3.22). Conclusions A policy of routine episiotomy does not protect against urinary or anal incontinence 4 years after first delivery.

AIM: The physiology of urinary continence during stress is complex and the role of passive and active mechanisms remains unclear. Coughing leads to a contraction of urethral rhabdomyosphincter and pelvic floor muscles leading to a positive urethro-vesical gradient and continence. Neuromuscular fatigue can involve all striated muscles, including rhabdomyosphincter, peri-urethral and pelvic floor muscles. This article reviews results of studies assessing perineal muscular fatigue in urinary incontinence. MATERIALS AND METHODS: A systematic review of the literature (Medline, Pascal and Embase) with use of the MESH keywords fatigue, stress, urinary incontinence, pelvic floor, urethra, urethral pressure, and muscle. RESULTS: Animal models have shown that the pelvic muscles (iliococcygeus and pubococcygeous) exhibit more neuromuscular fatigue than classical skeletal striated muscles (i.e. soleus muscle). Although the human external urethral sphincter is considered to be a highly fatigue-resistant muscle with its high proportion of slow muscle fibers, repeated coughing seems to lead to decreased urethral pressure in numerous women affected with stress urinary incontinence. In this case, "urethral fatigue" might be a possibility. CONCLUSIONS: Although few studies have focused on perineal muscular fatigue, such increased fatigue in pelvic floor muscles may play a role in the pathophysiologic features of stress urinary incontinence in women.

International audience; INTRODUCTION: Urinary complications following sub urethral sling procedures are common, and management of these complications continue to be discussed. METHODS: The literature available on Medline/PubMed, relating to urinary complications associated with suburethral sling procedures, was reviewed. RESULTS: Bladder perforation, which occurs with an incidence of 5.7% in tension-free vaginal tape procedure, requires repositioning of the sling, but does not cause any increase in postoperative morbidity. The trans-obturator approach appears to decrease this risk. Urethral perforation, which is uncommon (0.4-1%), is a contraindication to maintenance of the sling. Bladder erosion is rare, requiring resection of the mesh with a combined abdominal and cystoscopic approach. Urethral mesh erosion (0.07% to 1.5%) also requires surgical sling removal, but few patients remain continent because this removal requires a large urethrolysis (recurrence rate of incontinence is 66% following removal of the sling). Bladder outlet obstruction occurs frequently after sub-urethral procedures. When complete obstruction is clinically evident 2 days after a sub-urethral sling procedure, immediate reintervention is performed with a rapid return to normal voiding. Recurrence rate of stress incontinence is less than 30% following reintervention.

International audience; BACKGROUND: To use a computer assisted analysis of urodynamic tracings (VBN method) in order to propose a quantitative description of the relationship between detrusor activity and firing of efferent motor neurons. METHODS: Modeling of the nervous control implies three definitions of the detrusor excitation: (1) related to the contractile force (EF), (2) related to the calcium turnover (ECa) and (3) ratio of firing motor neurons (rr). The associate variables have been computed from each uroflow recording of healthy volunteers (male and female) and patients (107 men with lower urinary tract symptoms due to benign prostatic enlargement and 138 women with stress urinary incontinence). RESULTS: A "standard excitation" governs all the voidings of healthy volunteers. For 47% of male patients and 75% of female patients, a non-standard excitation is observed: beginning as the standard excitation, then sudden break at a time tc (9.7 +/- 2.5 s for male and 4.0 +/- 2.7 s for women). rr has an all-or-none value in case of standard excitation and exhibits a two steps behavior with after tc: = 0.53 +/- 0.21 for men and 0.41 +/- 0.18 for women (non-significant despite the difference in the origin of disease). CONCLUSION: VBN computer analysis of urodynamic tracings allows to propose a description of the detrusor nervous control: (1) an on-off nervous order rules the "standard" detrusor activity, and (2) a feedback, which probably starts at the urethral level, acts to switch an on-off reduction of the detrusor activity in the other cases.

Objectives : To measure the strength at tearing of pelvic ligaments used in the cure of prolapse and urinary incontinence. Material and methods : We performed our measurements on pelvis ligaments from cadaveric specimens. We dissected 29 human female pelvis cadavers of which storage conditions differed. Ten were frozen, 10 fresh and 9 were stored in formalin. In each cadaver we dissected pre-vertebral ligaments at promontory and right and left symmetrical ligaments. These were the iliopectineal, sacrospinous and arcus tendineus of pelvic fascia. A subjective clinical evaluation of the ligament properties was performed by visual observation as well as finger palpation. Ligaments were classified into three groups. Group A contained high quality ligaments, in terms of thickness and apparent strength following finger palpation. Ligaments of doubtful quality were classified in group B and low apparent quality ligaments in group C. Then the ligaments were stitched by a suture taking the entire ligament and a force was applied on the vagina axis until tearing. The device used for strength measurement during traction was a SAMSON type force gauge, model EASY, serial number SMS-R-ES 300N manufactured by Andilog that was developed for the purpose of our study. Measurements were given in Newton (N). Results : There was a great variability in the values obtained at tearing with minimal values at around 20 N and maximal values at 200 N. Individually measured, ligament strength varied between individuals, and for the same patient between the type of ligaments and the side. The pre-vertebral ligament was on average the strongest. There was no significant difference according to the storage condition except for the pre-vertebral ligament in formalin cadavers. For bilateral ligaments, there was no difference between the left and right side. The iliopectineal ligament was statistically significantly stronger than the sacrospinous and arcus tendineus of pelvic fascia. There was a correlation between subjective evaluation and objective strength measurements. Discussion : No papers have been published on the strength of pelvic ligaments at tearing. These are however routinely used in the cure of prolapse and urinary incontinence. Our results show that there is a great variability in strength between individuals, and for a same patient between the types of ligaments and side. These observations could explain some of the surgical intervention failures and demonstrate the importance of per-operative strength evaluation. Per-operative subjective evaluation of strength is related to objective measurements and could be used to determine the type of ligaments to be used for surgical suspension. Freezing does not damage pre-vertebral ligament strength and further studies are required to evaluate elasticity of pelvic ligaments.

OBJECTIVE: To validate 5 language versions (French, Dutch, German, English and Danish) of CONTILIFE, a urinary incontinence-specific measure of Quality of Life (QoL). METHODS: CONTILIFE was administered to Belgian, Danish, English, French, German, and Dutch women with genuine stress incontinence. The internal consistency, the construct and clinical validity, and the responsiveness to change over time were assessed using standardised procedures. RESULTS: 505 women filled in the CONTILIFE at baseline. Quality of completion was good. The mean number of missing data varied between 0.33 (1.17%) and 0.94 (3.36%) according to the country. Internal consistency was good for all dimensions except for the Effort Activities dimension. Construct validity was good for the Danish, French and pooled sample, and acceptable for English, German and Dutch samples. The distribution of QoL scores differed according to the number of urinary leaks (p or =0.50) except for the Sexuality and Well-Being dimensions. CONCLUSION: In this international European study, CONTILIFE matched the psychometric requirements to be used as a valid, reliable, and sensitive measure of the QoL of the patients. The Daily Activities, Effort Activities, Self-Image and Emotional Consequences dimensions are the most relevant and valid dimensions for purposes of comparison.