Las estenosis uretrales femeninas son difíciles de diagnosticar y de tratar. Después de los tratamientos endouretrales, que son poco eficaces, debe plantearse una uretroplastia. Se han descrito varias técnicas, en función del colgajo utilizado y del lado de la uretra donde se realiza el acceso: anterior o posterior. En este artículo se describe una técnica de uretroplastia de la cara anterior de la uretra por injerto de la mucosa bucal. La técnica quirúrgica consta de un tiempo de preparación uretral por vía vaginal, la movilización del injerto de mucosa bucal y, después, la anastomosis del injerto en la cara anterior de la uretra. La uretroplastia en la mujer es una técnica eficaz, con tasas bajas de complicaciones, que debería realizarse de forma sistemática como segunda elección en el tratamiento de las estenosis uretrales femeninas complejas y recidivantes.

Objective and method. - To focus on indications and results of ablative treatments (cyoablation, radiofrequency) for small renal masses, a bibliographic research was conducted in MedLine database using terms of "ablative treatment", "cryotherapy", "radiofrequency", "kidney cancer", "renal cell carcinoma". Sixty-four articles were selected.Results. - Carcinologic outcomes seem to be better with cryoablation than with radiofrequency. Available results have to be balanced according to surgical approach, teams' experience and duration of follow-up. Tumour's size and central localization are the main factors of failure. The size of 3 cm is the most generally validated. Hospital stay and complications seem to be better with ablative therapies than with surgical approach, especially with percutaneous approach. The renal function preservation appears to be better with ablative therapies. It could be an interesting alternative to partial nephrectomy for small masses, in particular for fragile patients or in particular indications (multifocal tumors, in case of solitary kidney or transplanted kidney). The indications in elderly people must be proposed with care after the comorbidities have been evaluated.Conclusion. - Indications of ablative treatment for small renal masses improve, but the gold standard treatment remains partial nephrectomy and indications must be individually discussed. Other ablative treatments are under-development, needing further studies. (C) 2015 Elsevier Masson SAS. All rights reserved.

Afin de faire le point sur la place des traitement focaux (cryoablation, radiofréquence) dans le traitement des petites tumeurs rénales, une recherche bibliographique a été réalisée dans la base de données MedLine en juillet 2014 en utilisant les termes ablative treatment, cryotherapy, radiofrequency, kidney cancer, renal cell carninoma. Soixante-quatre articles ont été sélectionnés. Les résultats carcinologiques semblent meilleurs avec la cryoablation qu’avec la radiofréquence. Les résultats disponibles sont à modérer avec la voie d’abord, l’expérience des équipes et la durée de suivi. La taille tumorale est le principal facteur d’échec. La taille de 3 cm est la plus généralement admise. La durée d’hospitalisation ainsi que les complications semblent meilleures avec les thérapies thermo-ablatives en comparaison avec la chirurgie, surtout lors de procédures percutanées. La préservation de la fonction rénale semble meilleure avec les traitements ablatifs, qui sont une alternative séduisante à la néphrectomie partielle sur les tumeurs de petites tailles, en particulier chez les patients fragiles ou âgés ou dans certaines indications (tumeurs multifocales, rein unique ou transplanté). L’extension des indications aux personnes âgées est à prendre avec prudence après évaluation de la morbidité compétitive. La place des traitements ablatifs pour les petites tumeurs du rein grandit, mais le gold standard reste la néphrectomie partielle et les indications doivent être discutées au cas par cas. D’autres thérapies ablatives sont en cours de développement, nécessitant des études plus approfondies. To focus on indications and results of ablative treatments (cyoablation, radiofrequency) for small renal masses, a bibliographic research was conducted in MedLine database using terms of “ablative treatment”, “cryotherapy”, “radiofrequency”, “kidney cancer”, “renal cell carcinoma”. Sixty-four articles were selected. Carcinologic outcomes seem to be better with cryoablation than with radiofrequency. Available results have to be balanced according to surgical approach, teams’ experience and duration of follow-up. Tumour's size and central localization are the main factors of failure. The size of 3 cm is the most generally validated. Hospital stay and complications seem to be better with ablative therapies than with surgical approach, especially with percutaneous approach. The renal function preservation appears to be better with ablative therapies. It could be an interesting alternative to partial nephrectomy for small masses, in particular for fragile patients or in particular indications (multifocal tumors, in case of solitary kidney or transplanted kidney). The indications in elderly people must be proposed with care after the comorbidities have been evaluated. Indications of ablative treatment for small renal masses improve, but the gold standard treatment remains partial nephrectomy and indications must be individually discussed. Other ablative treatments are under-development, needing further studies.

Faecal incontinence and urinary incontinence are common and often associated. Sacral neurostimulation is a validated technique for treating each of these two types of incontinence, taken separately. The purpose of this study was to review the literature on the results of this treatment for double incontinence. A literature search was conducted using MEDLINE, PubMed, EMBASE and the Cochrane Library using the keywords "faecal incontinence", "anal incontinence", "urinary incontinence", "urgency", "urinary disorder", "neurostimulation", "sacral nerve stimulation" and "electric nerve stimulation". We limited the search to English-language articles on faecal and urinary incontinence in adults published from 1995 to the present. We identified six articles, comprising 113 patients who were followed for 3-62 months. Improved faecal incontinence was observed in 44-100 % of cases, while improved urinary incontinence was observed in 20-100 % of cases. Patient satisfaction with the correction of double incontinence, both anal and urinary, was highly variable, ranging from 20 to 100 %. As anal incontinence and urinary incontinence are often associated and are sometimes responsive to sacral neuromodulation, it seems attractive to provide such treatment for double incontinence, to improve both digestive and urinary symptoms.

De janvier 2013 à mai 2014, un auto-questionnaire simple a été proposé aux patients atteints de SEP lors de leur consultation chez leur neurologue dans le but d'améliorer le dépistage les troubles mictionnels. Il regroupait 5 questions pertinentes, réponse par « OUI » ou « NON », définies par des experts (2 neurologues, 3 urologues spécialisés en neuro-urologie). Dès 3 « OUI » cochés, un rendez-vous était proposé au patient. Dans le cadre d'une consultation longue, le patient apportait un calendrier mictionnel sur 72H, une échographie, et clairance/créatinine. Il réalisait à son arrivée une débimétrie/mesure de résidu post-mictionnel. Après 18 mois d'utilisation, un questionnaire d'évaluation comportant 5 questions (réponse de 1 à 10, aucun intérêt à très satisfait) a été envoyé, aux neurologues. Au total, 52 consultations ont été réalisées (âge moyen : 43 ans, 69 % de femmes). Chez 62 % des patients cela a conduit à la prescription d'anti-cholinergiques, 19 % aux autosondages, 16 % a des injections intradétruoriennes de toxine, 15 % de stimulation tibiale, 4 % de neuromodulation S3, 8 % de dérivation urinaire incontinente. Tous ont été intégrés au réseau avec une surveillance. Pour les neurologues, l'auto-questionnaire améliorait le dépistage avec une moyenne de 8/10 (extrêmes [6–9]) ; il procurait en moyenne un de gain de temps : 6/10 [4–7] ; la procédure d'adressage des patients était simple et efficiente : 10/10 ; le retour/satisfaction des patients était très positif : 9/10 [8–10]. Tous les neurologues proposeraient l'utilisation plus large pour d'autres pathologies neurologiques et conseilleraient ce questionnaire à des confrères. Cet auto-questionnaire a permis de faciliter le dépistage des troubles sphinctériens chez les patients souffrant de SEP et de les intégrer le plus tôt possible au réseau local, bénéficiant ainsi des avis spécialisés et pluridisciplinaires. Le retour des neurologues et des patients a été très positif. L'observance aux projets thérapeutiques proposés restera à montrer sur le plus long terme.

BACKGROUND: Sacral nerve stimulation is a recognized treatment for fecal and urinary incontinence. Few articles have been published about patients presenting with both types of incontinence.OBJECTIVE: The aim of this study was to report the functional results in patients operated on for simultaneous fecal and urinary incontinence by the use of sacral nerve stimulation.DESIGN: This study is a retrospective analysis of prospectively collected data.SETTINGS: The investigation was conducted in the academic departments of colorectal surgery and urology.PATIENTS: Between January 2001 and March 2010, 57 consecutive patients (54 women) with a mean age of 58 years (range, 16-76) were included.INTERVENTIONS: Two-stage sacral nerve modulation (test and implant) was performed.MAIN OUTCOME MEASURES: Functional study before testing, at 6 months, and at the end of follow-up after implantation included the use of the Cleveland Clinic incontinence score, Urinary Symptoms Profile, Fecal Incontinence Quality of Life score, and the Ditrovie score. Patient satisfaction with the technique was evaluated at a median follow-up of 62.8 months.RESULTS: Fecal incontinence improved from 14.1/20 to 7.2/20 at 6 months and 6.9/20 at the end of follow-up. Urinary incontinence, mainly urge incontinence (47% of patients), and urgency frequency (34% of patients) improved at 6 months and end of follow-up, but not retention and dysuria. Specific quality of life was improved for fecal and urinary incontinence at 6 months and end of follow-up. At the end of follow-up, 73% patients were highly satisfied with the technique, but 9% felt their condition had deteriorated. The reoperation rate was 29%, of which 12% were indicated because of a complication.LIMITATIONS: This study was limited by its retrospective nature and the multiple causes of incontinence.CONCLUSION: Fecal and urinary incontinence, studied by symptoms scores and specific quality-of-life scores, are improved in patients receiving sacral nerve stimulation for double incontinence.