Objectives. - A retrospective evaluation of artificial urinary sphincter (AUS) implantation in women with previous pelvic radiotherapy (PR).Population and methods. - From May 1987 to December 2009, on the 215 women implanted with AUS, nine (4.2%) had previous PR. We compared two groups of women, the first one without PR (group 1; n = 206) and the other group with PR (group 2; n = 9). Previous preop. urodynamics were realized. Patients using more than one pad per day at the end of follow-up were considered in failure.Results. - Mean follow-up for these two groups was 6 years (SD: 5.6 years), with a mean age of 62.8 years. Mean delay between PR and surgery was 14 years. PR was indicated for cervix cancer in 78% (7/9), endometrial cancer and ovarian cancer in 9% (1/9) each. PR was responsible of an increased rate of AUS erosion and explantation (P < 0.001). In group 2, more than half of women had AUS failure and 60% for AUS erosion, versus 22% and 26% respectively in group 1. In group 2, all the AUS eroded were explanted, one third of women, with a mean delay of 59.8 months (4-140) with AUS implantation.Conclusion. - AUS implantation in a female population with previous PR is not necessary inconsistent, but the failure rate is high. This difficult surgery should be reserved for specialized centres. (C) 2012 Elsevier Masson SAS. All rights reserved.

Background: The artificial urinary sphincter (AUS) has become a commonly used therapy for severeurinary incontinence (UI) due to intrinsic sphincter deficiency (ISD).Objective: To evaluate retrospectively the efficacy and risk factors for failure and complications of AUS implantation in women with nonneurologic UI.Design, setting, and participants: From May 1987 to December 2009, 215 women with ISD were treated by AUS implantation, with a mean age of 62.8 yr and a mean follow-up of 6 yr (standard deviation: 5.6 yr). Previous surgical procedures to treat incontinence had been performed in 88.8% of the patients. Urodynamic assessment was required. Patients using only 0 or 1 pad at the end of follow-up were considered continent. The patient's level of satisfaction was evaluated by a global analogue scale and clinical interview.Intervention: All women had AUS implantation.Measurements: Patients were evaluated for continence rate, risk factors for failures, and complications.Results and limitations: At the end of follow-up, 158 patients (73.5%) were continent, and 170 (79%) were satisfied. The redo rate was 15.3% after a mean interval of 8.47 yr for the first redo procedure. Fifteen explantations (7%) were performed. The only risk factor for intraoperative complications (10.7%) was smoking (p < 0.004). Six patients (2.8%) were lost to follow-up. AUS failed to treat incontinence in 51 patients (23.7%) due to defective manipulation in 27.4% of the cases. On multivariate analysis, risk factors for failure were age > 70 yr (odds ratio [OR]: 2.46), a history of the Burch procedure (OR: 2.28), or pelvic radiotherapy (OR: 4.37) (p < 0.05).Conclusions: The place for this safe and long-lasting effective technique in the treatment of UI due to recurrent sphincter deficiency is confirmed. Screening for these risk factors should allow better patient selection. (C) 2011 European Association of Urology. Published by Elsevier B. V. All rights reserved.

Évaluation rétrospective des résultats de ballonnets périurétraux chez la femme et description d’un geste opératoire complémentaire : la rétrovision du col vésical par cystoscopie souple.

Objectives: A retrospective evaluation of the results of Adjustable Continence Therapy® (ACT®) in women by a study center and the description of a technique: bladder neck retrovision.

Analyser les résultats de l’implantation de ballonnets périurétraux (Pro-ACT®) dans la cure d’incontinence urinaire par insuffisance sphinctérienne (IU/IS) de l’homme, par une étude monocentrique rétrospective portant sur 60 patients consécutifs traités entre 2006 et 2009.

Objectives. - Evaluation of the results of Adjustable Continence Therapy (R) (ACT (R)) in women by a retrospective one-center study and exposure of a technique: bladder neck retrovision.Patients and methods. - Between January 2001 and February 2009, 67 women had ACT (R) implantation by the same surgeon for the indication of urinary incontinence by intrinsic sphincter deficiency, with mean age of 70.2 years. Mean follow-up was 24.8 months (1 to 89 months). Evaluation of functional results was realized with the research of urinary leakage when coughing or during abdominal thrust in the clinical exam, with the Urinary Symptom Profile (R) (USP (R)) questionnaire (since 2007), and with an analogical global satisfaction evaluation.Results. - More than 90% of women (n = 67) have been improved at least at one medical consultation, and 60% (40/67) at last follow-up with a satisfaction index superior to 80% in 25 patients. Urinary leakage when coughing or doing abdominal thrust disappeared in 58% (36/62). An improvement of USP (R) score was observed in 76% (19/25). Postoperative complications occurred in 37.3% (25 patients) with a mean period of 10.8 months after surgery.Conclusion. - The ACT (R), indicated in stress urinary incontinence, is attractive because of the benefit risk ratio. It could represent an alternative treatment when the artificial urinary sphincter is not technically possible, not accepted or when a reversibility is required. The bladder neck retrovision would improve the ACT (R) surgery by precision and safety. (C) 2010 Elsevier Masson SAS. All rights reserved.