Introduction:Women with spina bifida often experience neurological impairments leading to pelvic organ dysfunction, including difficulties with bladder and bowel emptying that necessitate frequent Valsalva manoeuvres. These factors, combined with pelvic floor weakness, may increase the risk of pelvic organ prolapse (POP). This study aimed to assess the prevalence of POP in women with spina bifida, identify associated risk factors and evaluate outcomes of surgical management. Methods:We retrospectively analysed a prospectively maintained database of women with spina bifida seen at a French referral centre from 2007 to 2024. Age under 18 and congenital perineal abnormality were exclusion criteria. The primary outcome was the presence of POP grade 2 or higher (Baden-Walker classification). Secondary outcomes included symptomatic POP requiring surgery, recurrence after surgery, use of vaginal pessaries and related symptoms. Results:POP grade ≥2 was present in 14.8% of patients. Women with POP were older (median 44 vs. 31 years; p < 0.0001) and more frequently parous (58.5% vs. 18.3%; p < 0.0001), although 41.5% of POP cases occurred in nulliparous women. Apical prolapse was predominant (64.3%). Among 11 patients who underwent POP surgery, 54.5% experienced recurrence. Multivariate analysis identified parity (OR 5.33; p = 0.005) and lower maximum urethral closure pressure (OR 0.97; p = 0.02) as independent risk factors. Conclusions:POP is highly prevalent in young adult women with spina bifida, including many nulliparous patients. The parity status and a low maximum urethral closure pressure could be associated with an increased risk of POP in this population. High recurrence after surgery highlights the need for information, routine screening and tailored management in this population.

BACKGROUND AND OBJECTIVE:Artificial urinary sphincter (AUS) is commonly used in France in female patients with stress urinary incontinence (SUI) due to intrinsic sphincter deficiency (ISD). However, it has never been assessed using patient-reported outcomes. This study aimed to evaluate the functional outcomes of robotic AUS implantation using validated questionnaires. METHODS:The data from female patients who underwent robotic AUS implantation at a single academic center between 2014 and 2023 were collected prospectively. Preoperatively, all patients filled out a Urinary Symptoms Profile (USP) questionnaire, and the International Consultation Incontinence Questionnaire Short Form (ICIQ-SF). These were repeated at 3 mo postoperatively and annually along with a Patient Global Impression of Improvement (PGII) score. Quality of life was assessed using question 5 of the ICIQ-SF. KEY FINDINGS AND LIMITATIONS:Over the study period, 101 robotic female AUS implantation cases were performed by three surgeons. The median patient age was 66 yr (interquartile range: 53-73), and 86.9% had a history of previous SUI surgery. In our cohort, 12 patients had neurogenic SUI (11.8%). In terms of complications, there were 16 intraoperative (15.8%) and 26 postoperative (25.7%) complications, all of Clavien grade 1 or 2 except seven of Clavien grade 3B (major complication rate: 6.8%). All patient-reported outcomes improved significantly at 3 mo. The USP SUI subscore decreased from 7.3 preoperatively to 0.8 at 3 mo (/9; p < 0.0001), the USP overactive bladder subscore decreased from 12.6 to 5.1 (/21; p < 0.0001), and the ICIQ-SF decreased from 16.5 to 3.1 (/21; p < 0.0001). Quality of life improved, with the ICIQ-QoL decreasing from 8.8 preoperatively to 0.9 at 3 mo (/10; p < 0.0001). The 3-mo PGII score was 1/7 (very much improved) in 79 patients (78.8%). CONCLUSIONS AND CLINICAL IMPLICATIONS:Robot-assisted AUS implantation in female patients has low morbidity and improves the patient-reported outcomes and quality of life of female patients with SUI due to ISD. PATIENT SUMMARY:This study represents the largest cohort of robotic female artificial urinary sphincter (AUS) implantation in the literature and is the first to report the patient-reported outcomes (PROMs) after female AUS implantation using validated questionnaires. We found significant improvement in all PROMs at 3 mo, except for voiding dysfunction symptoms. This study brings new robust data to help the widespread use of female AUS across the world, even if further studies with longer follow-up are needed to confirm that these results are maintained over time. We then compared the continence status reported by the patients with PROMs, finding a significant association. This highlights that the existing literature on female AUS, which lacks such PROMs, remains of interest.

Introduction: In recent years, several preliminary reports have suggested that the robot-assisted approach may decrease the surgical morbidity of artificial urinary sphincter (AUS) implantation in female patients with stress urinary incontinence (SUI). However, for now, only short-term outcomes have been reported. The present study aimed to report the 5-year outcomes of robot-assisted AUS implantation in female patients. Patients and methods: All female patients who underwent a robot-assisted AUS implantation between January 2014 and September 2019 at a single academic center were included in a retrospective study. All robot-assisted female AUS implantations performed after September 2019 were excluded to ensure a 5-year minimum follow-up duration. The indication for AUS implantation was SUI due to intrinsic sphincter deficiency. The primary endpoint was the explantation-free survival and revision-free survival. Results: Forty-two patients were included. The median age was 66 years (28–84), and 83.8% of the patients had a history of previous anti-incontinence procedure. After a median follow-up of 64 months (16–110), 8 patients were lost to follow-up before the 5-year time point. The 5-year estimated revision-free survival was 89.2 and the 5-year estimated explantation-free survival was 88%. Five AUS explantations were needed (11.9%), and six revisions were required (14.3%). The median time to explantation was 14 months. Four explantations (80%) occurred within the first 18 months, and all of them within the first 27 months. Thirty patients (71.42%) had a complete or improved continence with a complete continence rate of 59.52% and an improved continence rate of 11.9%. There were 10 intraoperative complications (23.8%): 5 bladder injuries and 5 vaginal injuries. Thirteen patients had postoperative complications (30.9%), but only two were Clavien grade ⩾3. Conclusion: The 5-year outcomes of robot-assisted AUS implantation seem to confirm the promising short-term outcomes that have been reported so far, although revision rates increased with time, which warrants further investigation.

Background: The artificial urinary sphincter has been an effective treatment for stress urinary incontinence caused by intrinsic sphincter deficiency in women. However, the use of this device has been limited by the technical difficulties and risks associated with the open implantation procedure. Preliminary studies using robotic techniques have shown promising results, but only one small study has compared robotic to open procedures. This study aims to compare the outcomes of robotic and open artificial urinary sphincter implantation in women with stress urinary incontinence due to intrinsic sphincter deficiency in a large multicenter cohort. Methods: Data were collected retrospectively from female patients who underwent open or robot-assisted artificial urinary sphincter implantation from 2006 to 2020 at 12 urology departments. The primary outcome was the rate of complications within 30 days after surgery, graded using the Clavien-Dindo Classification. Perioperative and functional outcomes were compared between the two groups. Results: A total of 135 patients were included, with 71 in the robotic group and 64 in the open group. The open group had a higher rate of intraoperative complications (27.4% vs. 12.7%; p = 0.03) and postoperative complications (46.8% vs. 15.5%; p < 0.0001). More patients in the robotic group achieved full continence (83.3% vs. 62.3%; p = 0.01). The open group had higher explantation (27.4% vs. 1.4%; p < 0.0001) and revision rates (17.5% vs. 5.6%; p = 0.02). The estimated 1-year explantation-free survival rate was higher in the robotic group. (98.6% vs. 78.3%; p = 0.001). Conclusions: Robot-assisted implantation may reduce perioperative morbidity and improve functional outcomes compared to open implantation in women with stress urinary incontinence.

INTRODUCTION:Ureteroenteric anastomotic stricture (UES) is one of the main complications after radical cystectomy (RC) with urinary diversion, regardless of the surgical approach. The standard surgical treatment for these strictures is usually an open ureteroenteric repair. The use of robotic-assisted surgery is developing as a less invasive alternative. The aim of this study was to compare the results of open and robotic approaches for UES repair. METHODS:A retrospective single-center study was conducted including all patients who underwent ureteroenteric repair for stricture after RC from 2015 to 2024. The primary endpoint was surgical success, defined as the absence of clinical or radiological stricture recurrence at the last follow-up. Complication and stricture recurrence rates were compared between both groups. RESULTS:Twenty-six patients were included: 11 underwent robotic-assisted repair and 15 underwent open repair. No differences between both groups were observed except for the indication of the cystectomy which was more often for oncologic reasons in the open group (80 vs. 36.4%; P=0.04). The median time to UES occurrence was 101 days. The anastomosis used for surgical repair differed significantly in both groups with Bricker being prevalent in the open group (73.3 vs. 9.1%) and side-to-side anastomosis being used only in the robotic group (45.5 vs. 0%; P=0.001). The mean operative time tended to be shorter in the open group but without statistical significance (151.3 vs. 191.8; P=0.15). Conversely the median length of hospital stay tended to be shorter in the robotic group (8 vs. 7 days; P=0.21). The median time to return of bowel function was significantly shorter in the robotic group (3 vs. 2 days; P=0.03). No significant differences were observed in terms of 30-day complication rate (13.3 vs. 27.3%; P=0.62). The success rate of ureteroenteric repair was 100% (P=0.99) in both groups, with a median follow-up of 18.5 months. CONCLUSION:Open and robotic ureteroenteric repair for strictures have a comparable success rate and appears to provide excellent functional results with low morbidity. These results suggest that minimally invasive surgery is a promising alternative, even in patients primary operated in open approach. Larger studies are required to confirm these results. LEVEL OF EVIDENCE: 4:

INTRODUCTION:The aim of this study was to report the outcomes of synthetic mid-urethral slings (MUS) in female patients with spina bifida and stress urinary incontinence (SUI). METHODS:All female patients with spina bifida who were seen at a national referral center between 2007 and 2021 and who had a history of MUS for SUI were included in a retrospective study. The primary outcome of interest was the continence status at 1year as per patients' subjective perception categorized as complete continence, improved continence, unchanged or worsened SUI. RESULTS:Out of 339 female spina bifida patients; 11 patients had undergone a MUS insertion and were included for analysis (3.2%). The median age was 30years (range: 19-52years). There were four postoperative complications (36.4%). The three patients fully continent at three months were still fully continent at one year (27.3%) while three had improved continence (27.3%) and five had unchanged continence (45.5%). After a median follow-up of 102months, only one patient was still fully continent (9.1%) and three patients had still improved continence (27.3%). Five patients (45.5%) underwent a subsequent anti-incontinence procedure. The only adverse predictor of improved/complete continence at 1year was a sacral neurological level (OR=0.05; p=0.03). CONCLUSION:MUS in women with spina bifida and SUI appears to be safe but less effective than in the non-neurogenic population which may be explained by different underlying pathophysiological mechanisms. These findings question the relevance of this treatment option in these complex population, especially in the current mesh controversy era. LEVEL OF EVIDENCE: 4:

We aim to explore the feasibility of robot-assisted supratrigonal cystectomy and augmentation cystoplasty (RA-SCAC) for the management of adult neurogenic lower urinary tract dysfunction and to compare the functional and surgical outcomes of an intracorporeal and extracorporeal approach. A retrospective review of all patients who underwent robot-assisted supratrigonal cystectomy and augmentation cystoplasty was performed. Data was collected on age, body mass index, American Society of Anaesthesiologists (ASA) score, type and duration of neurological disease, previous abdominal surgery and renal function. Bladder diary, urodynamics and validated symptom score results were recorded at baseline and repeated postoperatively. Intraoperative details included type of diversion, concomitant surgery, duration of surgery, blood loss and conversion to open. Postoperative surgical recovery was also reviewed. The primary endpoint was the rate of major postoperative complications defined as any complication Clavien-Dindo grade ≥3 occurring within the first 90 days postoperatively. There were 26 patients in total; 7 performed extracorporeally and 19 intracorporeally. Mean age was 41.5, mean BMI 24.4 and majority were ASA score 2 (61.5%). Twelve (46.1%) patients had spinal cord injury and 6 (23.1%) spina bifida. Seven (26.9%) had a concomitant procedure including bladder neck artificial urinary sphincter (AUS) insertion, bladder neck fascial sling or creation of a continent catheterisable channel. The surgical outcomes were analysed separately for those that had RA-SCAC only versus RA-SCAC with a concomitant procedure. The operative time was shorter in the intracorporeal group, and the length of stay was similar in both groups. The total number of major postoperative complications was low (n = 3; 11.5%). All urodynamic parameters significantly improved at 6 months in the intracorporeal group. Median number of urinary incontinence episodes per 24 h decreased significantly in both groups at 3 months but the continence status and ICIQ-UI SF demonstrated statistical significance in the intracorporeal group only. In conclusion, robot-assisted supratrigonal cystectomy and augmentation cystoplasty is feasible in adult neurological patients, favouring an intracorporeal approach.

Folic acid insufficiency is an important risk factor for congenital neural tube defects. Despite recommendations and national campaigns, the proportion of women taking folic acid in the peri-conceptional period remains insufficient worldwide. We describe in this study the proportion of peri-conceptional folic acid supplementation use and its determinants among a population of hospital workers during the course of a prevention campaign. We performed a single-center cross sectional study in a university hospital in France. Data were collected during 2 months in 2019 by an online questionnaire sent to all professionals. We collected information about folic acid supplementation use, its modalities (form, period, frequency and dosage) and reason for initiating or not supplementation. Response rate was 11.4 % (n = 1,075/9,447). Among the 748 women who reported at least one pregnancy, 72.7 % (95 % CI: 69.4–76.0 %) reported taking folic acid during their last pregnancy. Main reason for initiating supplementation was information given by a health professional (87.8 %), especially by gynaecologists-obstetricians. Principal factors associated with folic acid supplementation use were age between 25 and 35 years, high level of education and recent pregnancy. Folic acid supplementation use is still not systematic before and during pregnancy, even among health professionals. There is a case for mandatory folic acid fortification for the French general population.

Introduction Deux séries historiques ont suggéré de meilleurs résultats fonctionnels et une survie plus longue pour l’implantation d’un sphincter artificiel urinaire (SAU) chez la femme vs chez l’homme. On peut supposer que l’approche robotique de l’implantation chez la femme a pu modifier cette comparaison. L’objectif de cette étude était de comparer les résultats de l’implantation robotique du SAU chez la femme et l’implantation bulbaire du SUA chez l’homme pour l’incontinence urinaire d’effort non neurogène. Méthodes Les dossiers de tous les patients de sexe masculin ayant eu une implantation bulbaire de SUA et de tous les patients de sexe féminin ayant eu une implantation robotique de SUA entre 2010 et 2022 pour une IUE non neurogène dans un centre ont été revus rétrospectivement. Les patient(e)s ayant déjà eu un SUA étaient exclus. Toutes les implantations chez la femme ont été réalisées par une approche transpéritonéale robotique « antérieure ». Le critère d’évaluation principal était la continence à 3 mois, classé comme suit : résolution complète de l’incontinence amélioration ou inchangé. Résultats Après exclusion de 79 patients, 171 patients ont été inclus : 70 femmes et 101 hommes. Les caractéristiques des patient(e)s différaient significativement sur de nombreux points (Figure 1). La durée opératoire était significativement plus courte pour les hommes (126,9 vs 165,5min). Le taux de complications postopératoires était similaire(17,3 vs 22,9 % ; p=0,38) ainsi que la durée médiane d’hospitalisation (2 vs 2jours ; p=0,96). La continence à 3 mois et lors du dernier suivi était en faveur du groupe féminin. La diminution de l’ICIQ-SF à 3 mois était significativement plus importante dans le groupe des femmes (–6,7 vs –4,6) La survie sans explantation à 5ans était similaire dans les deux groupes ainsi que la survie sans révision à 5ans (84,6 vs 83,9 % ; p=0,89) et la survie sans réoperation à 5ans (67,4 vs 61,7 % ; p=0,89). En analyse multivariée, le genre féminin était le seul facteur significativement associée à la continence complète au dernier suivi (OR=4,3 ; p=0,03) (Figure 2). Conclusion L’implantation robotisée de sphincter artificiel urinaire chez la femme donne de meilleurs résultats fonctionnels que l’implantation bulbaire chez l’homme tout en ayant une morbidité et des taux de survie similaires (Figure 3).

Introduction: The Operated Male-to-Female Sexual Function Index (oMtFSFI) questionnaire is the first scoring system developed to assess sexual function after gender-affirming vulvo-vaginoplasty, and was initially developed and validated in Italian. The aim of this study was to provide linguistic validation of the questionnaire in French through several steps including use of the questionnaires across a series of patients who had undergone gender-affirming vulvo-vaginoplasty between 2020 and 2022 at two French academic centers. Method: The French version of the oMtFSFI questionnaire was obtained through a double translation (Italian to French) and a back-translation (French to Italian), validated by a scientific committee, and cognitively assessed by a panel of expert patients. The questionnaire was then distributed to transgender male to female patients who had undergone genital gender affirming surgery at two French academic centers. Results: The oMtFSFI score consists of 18 questions exploring 7 domains (genital self-image, desire, arousal, lubrication, orgasm, satisfaction, sexual pain). Among the sixty-four patients who responded to the questionnaire, 16 patients (25%) reported abstaining from sexual activity involving vaginal penetration at the time of the study were excluded. The mean total score was 37, corresponding to mild to moderate sexual dysfunction and 60.4% of the patients reported normal overall sexual function. The level of sexual satisfaction was normal for 68.8% of the patients and the genital self-image was normal for 52.1%. Most of the patients (79.2%) reported at least mild dyspareunia and 10.4% had critical sexual dysfunction. Surgery improved gender dysphoria in 96.7% of patients. There was a strong correlation between the overall oMtFSFI score and the happiness Visual Analog Scale (VAS) (P P < 0.001) as well as with the quality of life VAS (P P < 0.001). Conclusion: The French version of the oMtFSFI questionnaire is the only scoring system specifically developed to assess sexual function after vulvo-vaginoplasty in transgender women linguistically validated in French. Its validation in French language makes it an interesting tool for research and clinical practice. (c) 2024 Elsevier Masson SAS. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

Previous studies suggested better functional outcomes and longer device survival for female artificial urinary sphincter (AUS) implantation compared to male AUS implantation. We hypothesized that the adoption of robotic approaches for female implantation might have influenced these comparisons. This study aimed to compare the outcomes of robotic female AUS and male AUS implantation for non-neurogenic stress urinary incontinence (SUI). We retrospectively reviewed charts of male patients who had AUS implantation and female patients who underwent robotic AUS implantation for non-neurogenic SUI between 2010 and 2022 at a single center. Prior AUS implantations were exclusion criteria. The primary endpoint was continence status at 3 months, categorized as complete resolution of SUI (0 pad), improved SUI (1pad), or unchanged SUI (>1pad). After excluding 79 patients, 171 were included: 70 women and 101 men. Operative time was shorter in males (126.9 vs. 165.5 min; p < 0.0001). Postoperative complication rates were similar (17.3

Purpose: While pump manipulation is rarely problematic in male patients with artificial urinary sphincters (AUSs), the situation may differ in female patients due to anatomical or cultural factors. This study aimed to evaluate the prevalence of difficulties in pump manipulation among female AUS patients, identify associated risk factors, and explore management strategies for this challenging issue.Methods: Data were collected from all female patients who underwent a robotic AUS implantation at a single academic center between 2014 and 2022. The primary endpoint was temporary difficulties, defined by at least one other short hospitalization to learn pump manipulation.Results: Out of the 88 female AUS patients included in the study, 20 experienced initial difficulties manipulating the pump, accounting for 22.7% of the group. Temporary difficulties were reported by 16 patients (18.2%), while 4 patients (4.5%) had their devices permanently deactivated. Surgical reoperations to reposition the pump were necessary for 5 patients, representing 5.6% of the sample. The only variables significantly associated with temporary difficulties were longer operative time (183.4 minutes vs. 159.1 minutes, P=0.04) and the overall experience of the center (32 vs. 50, P=0.04). The sole variable significantly linked to serious difficulties was the overall experience of the center (11 vs. 47, P=0.004). Although the median age and body mass index were higher in the group with temporary difficulties, these differences were not statistically significant.Conclusions: Difficulties in manipulating the pump are relatively common among female AUS patients. Most of these difficulties can be resolved through repeated patient education and careful follow-up. However, some may lead to serious complications. Raising awareness of this issue, along with ongoing patient education and meticulous follow-up, may help to minimize these consequences.

INTRODUCTION:Neurogenic detrusor overactivity (NDO) has a major impact on patients' quality of life and can lead to upper urinary tract complications. Intradetrusor botulinum toxin type A injections are administered as second-line treatment to these patients following the failure of anticholinergic agents. The aim of the DETOX 2 study is to propose a consensus definition of the failure of intradetrusor botulinum toxin injections for NDO in patients presenting spinal cord injury, spina bifida, or multiple sclerosis (MS) with self-catheterization. METHOD:This study followed the method adopted by the French National Authority for Health for recommendations by consensus. Based on a review of the literature and a preliminary survey, a steering committee compiled a questionnaire and selected a rating group comprising 16 experts from the Neuro-Urology Committee of the French Urology Association (cnuAFU) and Genulf. The experts were asked to complete the online questionnaire. At the end of the first round, all participants came together to discuss any disagreements and a second-round online questionnaire was completed to reach a consensus. RESULTS:Thirteen of the 16 experts approached completed both rounds of questionnaires. A strong consensus was reached for two proposals (median score = 9/10) which were therefore included in the definition from the first round: at least one repeat injection of the same botulinum toxin at the same dose must be given to rule out failure on technical grounds and a duration of efficacy <3 months must be considered a failure. At the end of round 2, a relative consensus was reached regarding the clinical criterion defining failure (median score = 7/10) and the urodynamic criterion of failure (median score = 8/10). An additional proposal was selected during this second round on the need for a voiding diary (median score = 8/10). CONCLUSION:The first consensus definition of failure of an intradetrusor injection of TB-A for NDO has been achieved with this study: persistence of detrusor overactivity with maximum detrusor pressures >40 cm H2O and/or a compliance issue and/or persistence of urinary incontinence and/or urgency and/or a number of daily self-catheterizations >8/day and/or efficacy <3 months. This study will help to standardize research on the failure of the intradetrusor botulinum toxin for NDO in clinical practice and clinical research.

You have accessJournal of UrologyLower Tract Reconstruction (including Transgender) II (V13)1 May 2024V13-08 ROBOT-ASSISTED TRANS-VESICAL ANTERIOR INLAY OF BUCCAL MUCOSAL GRAFT FOR RECURRENT BLADDER NECK CONTRACTURE Lucas Freton, Lee Zhao, Vivien Graffeille, Claire Richard, Juliette Hascoet, Antoine Jeanne-Julien, Andrea Manunta, Romain Mathieu, Karim Bensalah, and Benoit Peyronnet Lucas FretonLucas Freton , Lee ZhaoLee Zhao , Vivien GraffeilleVivien Graffeille , Claire RichardClaire Richard , Juliette HascoetJuliette Hascoet , Antoine Jeanne-JulienAntoine Jeanne-Julien , Andrea ManuntaAndrea Manunta , Romain MathieuRomain Mathieu , Karim BensalahKarim Bensalah , and Benoit PeyronnetBenoit Peyronnet View All Author Informationhttps://doi.org/10.1097/01.JU.0001009532.52598.9a.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There is no clear consensus regarding the management of recurrent bladder neck contracture (BNC) after endoscopic treatment. The purpose of this video was to describe a robotic transvesical buccal mucosal graft urethroplasty technique for recurrent BNC after a first robotic YV plasty. METHODS: The technique is described in the video. This is a 73-year-old man who had benign prostatic hypertrophy treated with monopolar transurethral resection of the prostate (TURP) in 2007 and then had 3 endoscopic treatments (monopolar RTUP, monopolar transurethral incision of BNC, and holmium laser urethrotomy) combined with self-dilations in 2019. He had a robotic YV plasty in March 2020 for a BNC recurrence. He had an urinary tract infection in the post-operative course and had worsening of symptoms 9 months after surgery with mixed symptoms and recurrence of post-void residual at 180cc. The fibroscopy showed a anterior recurrence. RESULTS: The operation was performed under general anesthesia in 23° Trendelenburg position. The Xi robot is docked and 5 ports are placed. A transperitoneal approach is used and the bladder is wide opened longitudinally. The edges are fixed to the abdominal wall. The contracture is incised anteriorly and the fibrosis is removed. A buccal mucosa graft is then fixed in a running fashion. The graft is fixed with fast-absorbing suture. The bladder is closed and a methylene blue test is performed. The patient was discharged at postoperative day 1. The urethral catheter was removed at day 14. There were no postoperative complications. At 12 months, there was no recurrence of stricture and the patient had 25cc PVR. CONCLUSIONS: Robotic trans-vesical buccal mucosa graft for recurrent cervical sclerosis is a feasible technique that seems provide satisfactory results as a revision procedure in patients with recurrent contracture after endoscopic treatment and YV plasty. Long-term follow-up will be necessary to evaluate functional results. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1158 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Lucas Freton More articles by this author Lee Zhao More articles by this author Vivien Graffeille More articles by this author Claire Richard More articles by this author Juliette Hascoet More articles by this author Antoine Jeanne-Julien More articles by this author Andrea Manunta More articles by this author Romain Mathieu More articles by this author Karim Bensalah More articles by this author Benoit Peyronnet More articles by this author Expand All Advertisement PDF downloadLoading ...

Introduction Le sphincter urinaire artificiel (SUA) est une option thérapeutique chez les femmes ayant une incontinence urinaire d’effort par insuffisance sphinctérienne.Il semble exister une part plus importante de difficultés chez la femme que chez les hommes.L’objectif est d’évaluer la prévalence, les facteurs de risques et la gestion de ses difficultés de manipulation de la pompe chez les SUA de la femme. Méthodes Les données de toutes les implantations d’un SUA par voie robotique dans un seul centre universitaire entre 2014 et 2022, ont été collecté.Chaque chirurgie est numérotée par ordre chronologique pour définir l’expérience du centre.Le SUA est activité à 6 semaines postopératoire lors d’une hospitalisation de jour (HDJ).Le critère de jugement principal est représenté par les difficultés de manipulation de la pompe, définit par au moins une autre hospitalisation de jour.Les critères de jugements secondaires étaient (1) difficultés initiales de manipulation définient par mention dans un courrier de difficultés de manipulation, (2) difficultés permanentes définient par la nécessité de désactiver le dispositif définitivement, (3) complications suites aux difficultés de manipulation de la pompe (4) difficultés complexes nécessitant désactivation ou reprise chirurgicale. Résultats Parmi les 88 femmes, 20 ont présenté des difficultés initiales de manipulation, 16 ont eu des difficultés temporaires (18,2 %) et 4 ont une des difficultés permanantes (4,5 %)Une reprise chirurgicale pour repositionnement a été nécessaire chez 4 patientes.Cinq patientes ont eu des complications à type de rétentions aiguës d’urines.Le nombre médian de réhospitalisation pour apprentissage est de 1 (1–3). Le temps médian pour résoudre ses difficultés étaient de 3 mois (2–5).Les 2 seules variables significatives associées aux difficultés temporaires étaient une durée opératoire plus longue (183,4 vs 159,1min, p=0,04) et l’expérience du centre (32 vs 50 ; p=0,04).La seule variable significativement associée à des difficultés complexes de manipulation étaient l’expérience du centre (11 vs 47 ; p=0,004) (Fig. 1, Fig. 2, Fig. 3). Conclusion Les difficultés de manipulations sont courantes chez les femmes bénéficiant d’un SUA. La plupart sont résolues rapidement mais parfois ces difficultés amènent à des complications graves comme un choc septique ou à une reprise chirurgicale. Une sélection attentive, un suivi rapproché pourraient aider à minimiser les conséquences de ces difficultés.

Neurogenic bladder associated with spina bifida disease remains a major cause for mortality or morbidity due to kidney damages. However, we currently do not know which urodynamic findings are associated with an higher risk of upper tract damages in spina bifida patients. The objective of the present study was to evaluate urodynamic findings associated with functional kidney failure and/or with morphological kidney damages. A large single-center restrospective study was conducted in our national referral center for spina bifida patients using our patients’ files. All urodynamics curves were assessed by the same examinator. Functional and/or morphological evaluation of the upper urinary tract were done at the same moment as the urodynamic exam (between 1 week before and 1 month after). Kidney function was assessed using creatinine serum levels or 24 h urinary creatinine levels (creatinine clearance) for walking patients, or with the 24 h urinary creatinine level for wheelchair‐users. We included 262 spina bifida patients in this study. Fifty-five patients had a poor bladder compliance (21.4