Prevention of urinary tract infection in spinal cord-injured patients: safety and efficacy of a weekly oral cyclic antibiotic (WOCA) programme with a 2 year follow-up--an observational prospective study.

POPULATION: Spinal cord injury (SCI) patients with neurogenic bladder have an increased risk for symptomatic urinary tract infection (UTI). Recurrent UTI requires multiple courses of antibiotic therapy, markedly increasing the incidence of multidrug-resistant (MDR) bacteria. METHODS: During an observational prospective study, we determined the safety and efficacy of a weekly oral cyclic antibiotic (WOCA) regimen to prevent UTI in SCI adult patients with neurogenic bladder undergoing clean intermittent catheterization. The WOCA regimen consisted of the alternate administration of an antibiotic once per week over a period of at least 2 years. The antibiotics chosen were efficient for UTI, well tolerated and with low selection pressure. RESULTS: There was a significant decrease in antimicrobial consumption linked to the dramatic decrease in the incidence of UTI. Before intervention, there were 9.4 symptomatic UTIs per patient-year, including 197 episodes of febrile UTI responsible for 45 hospitalizations. Under the WOCA regimen there were 1.8 symptomatic UTIs per patient-year, including 19 episodes of febrile UTI. No severe adverse events and no new cases of colonization with MDR bacteria were reported. CONCLUSIONS: In this prospective, observational pilot study a novel approach to the prevention and treatment of UTI in SCI was investigated. Our study shows the benefit of WOCA in preventing UTI in SCI patients

Urogenital dysfunction in male patients with Charcot-Marie-Tooth: a systematic review

Aims Purposes of this study were to describe lower urinary tract symptoms (LUTS) and related urodynamic patterns in patients with hereditary spastic paraplegia (HSP), and to characterize LUTS management and associated uronephrological complications. Methods We retrospectively reviewed medical files of HSP patients, consecutively followed in our Physical and Rehabilitation Medicine Department between 1999 and 2016. Clinical, urodynamic, and radiological data were collected and analyzed. Different treatments which have been prescribed and uronephrological complications were also recorded. Patients with other neurological or urological diseases were excluded. Results Thirty-three patients with HSP were included. Mean duration of follow-up was 8.1 ± 5 years, mean age 62 ± 14 years, and 70% were men. The most frequent LUTS was urgency and voiding dysfunction (both 69.7%). Incontinence and retention with a significant postvoid residue above 100 mL accounted for 66.7% and 57.6% of initial symptoms respectively. Neurogenic detrusor overactivity was diagnosed in 80.7% of patients. Two-thirds of our cohort were treated with anticholinergics and 9.1% required intradetrusor botulinum-toxin injections. Only 27.3% of patients performed clean intermittent self-catheterization. Febrile urinary tract infections (21.2%), urolithiasis (15,1%), hydronephrosis (6%), and chronic renal failure (9.1%) were found. Conclusion Given their high prevalence and the risk of uronephrological complications, LUTS should be systematically assessed in HSP patients. The systematic screening of urological dysfunction in this population would improve its management, decrease the incidence of uronephrological complications, and increase the quality of life

Aid to Percutaneous Renal Access by Virtual Projection of the Ultrasound Puncture Tract onto Fluoroscopic Images

Background and Purpose: Percutaneous renal access in the context of percutaneous nephrolithotomy (PCNL) is a difficult technique, requiring rapid and precise access to a particular calix. We present a computerized system designed to improve percutaneous renal access by projecting the ultrasound puncture tract onto fluoroscopic images. Materials and Methods: The system consists of a computer and a localizer allowing spatial localization of the position of the various instruments. Without any human intervention, the ultrasound nephrostomy tract is superimposed in real time onto fluoroscopic images acquired in various views. Results: We tested our approach by laboratory experiments on a phantom. Also, after approval by our institution's Ethics Committee, we validated this technique in the operating room during PCNL in one patient. Conclusion: Our system is reliable, and the absence of image-processing procedures makes it robust. We have initiated a prospective study to validate this technique both for PCNL specialists and as a learning tool

Systematic review exploring the relationship between sexual abuse and lower urinary tract symptoms

INTRODUCTION AND HYPOTHESIS: Patients presenting with lower urinary tract symptoms (LUTS) may report a history of sexual abuse (SA), and survivors of SA may report LUTS; however, the nature of the relationship is poorly understood. The aim of this review is to systematically evaluate studies that explore LUT dysfunction in survivors of SA. METHODS: A systematic literature search of six databases, Cochrane Database of Systematic Reviews, MEDLINE, EMBASE, CINAHL, AMED, and PsycINFO, was performed. The last search date was June 2021 (PROSPERO CRD42019122080). Studies reporting the prevalence and symptoms of LUTS in patients who have experienced SA were included. The literature was appraised according to the PRISMA statement. The quality of the studies was assessed. RESULTS: Out of 272 papers retrieved, 18 publications met the inclusion criteria: studies exploring LUTS in SA survivors (n=2), SA in patients attending clinics for their LUTs (n=8), and cross-sectional studies (n=8). SA prevalence ranged between 1.3% and 49.6%. A history of SA was associated with psychosocial stressors, depression, and anxiety. LUTS included urinary storage symptoms, voiding difficulties, voluntary holding of urine and urinary tract infections. Most studies were of moderate quality. Assessment of SA and LUTS lacked standardisation. CONCLUSIONS: The review highlights the need for a holistic assessment of patients presenting with LUTS. Although most of the studies were rated as being of 'moderate' quality, the evidence suggests the need to provide a "safe space" in clinic for patients to share sensitive information about trauma. Any such disclosure should be followed up with further assessment

Medical image computing and computer-aided medical interventions applied to soft tissues. Work in progress in urology

Until recently, Computer-Aided Medical Interventions (CAMI) and Medical Robotics have focused on rigid and non deformable anatomical structures. Nowadays, special attention is paid to soft tissues, raising complex issues due to their mobility and deformation. Mini-invasive digestive surgery was probably one of the first fields where soft tissues were handled through the development of simulators, tracking of anatomical structures and specific assistance robots. However, other clinical domains, for instance urology, are concerned. Indeed, laparoscopic surgery, new tumour destruction techniques (e.g. HIFU, radiofrequency, or cryoablation), increasingly early detection of cancer, and use of interventional and diagnostic imaging modalities, recently opened new challenges to the urologist and scientists involved in CAMI. This resulted in the last five years in a very significant increase of research and developments of computer-aided urology systems. In this paper, we propose a description of the main problems related to computer-aided diagnostic and therapy of soft tissues and give a survey of the different types of assistance offered to the urologist: robotization, image fusion, surgical navigation. Both research projects and operational industrial systems are discussed

Mapping of transrectal ultrasonographic prostate biopsies: quality control and learning curve assessment by image processing

Objective: Mapping of transrectal ultrasonographic (TRUS) prostate biopsies is of fundamental importance for either diagnostic purposes or the management and treatment of prostate cancer, but the localization of the cores seems inaccurate. Our objective was to evaluate the capacities of an operator to plan transrectal prostate biopsies under 2-dimensional TRUS guidance using a registration algorithm to represent the localization of biopsies in a reference 3-dimensional ultrasonographic volume. Methods: Thirty-two patients underwent a series of 12 prostate biopsies under local anesthesia performed by 1 operator using a TRUS probe combined with specific third-party software to verify that the biopsies were indeed conducted within the planned targets. RESULTS: The operator reached 71% of the planned targets with substantial variability that depended on their localization (100% success rate for targets in the middle and right parasagittal parts versus 53% for targets in the left lateral base). Feedback from this system after each series of biopsies enabled the operator to significantly improve his dexterity over the course of time (first 16 patients: median score, 7 of 10 and cumulated median biopsy length in targets of 90 mm; last 16 patients, median score, 9 of 10 and a cumulated median length of 121 mm; P = .046). Conclusions: In addition to being a useful tool to improve the distribution of prostate biopsies, the potential of this system is above all the preparation of a detailed "map" of each patient showing biopsy zones without substantial changes in routine clinical practices

Activité contractile spontanée des fragments isolés de vessies neurologiques humaines (tentative de corrélation clinique, urodynamique et anatomo-pathologique)

Les troubles vésico-sphinctériens sont des éléments symptomatiques séquellaires d un grand nombre d affections neurologiques. Ils sont à l origine de complications organiques grevant le pronostic vital et d une altération notable de la qualité de vie. La physiopathologie des troubles, notamment de l hyperactivité détrusorienne, est incomplètement élucidée. Elle ferait intervenir des mécanismes à la fois neurogéniques et myogéniques. Les données issues de l expérimentation animale et humaine ont permis de mettre en évidence une activité contractile spontanée (ACS) développée par des fragments de vessie qui pourrait être impliquée dans la physiopathologie de l hyperactivité détrusorienne neurogène mais dont la signification demeure inconnue. De plus, l analyse histologique des vessies neurologiques pourrait fournir des éléments complémentaires de compréhension.1/Rechercher une corrélation entre l ACS observée in vitro de fragments de vessie à l état frais issus de patients neurologiques et des facteurs pronostiques cliniques, urodynamiques et anatomopathologiques.2/Rechercher une corrélation entre les modifications histologiques observées dans les vessies neurologiques et des facteurs cliniques et urodynamiques. Des prélèvements de vessie à l état frais ont été obtenus après cystectomies chez 34 patients neurologiques. Des fragments de vessie avec et sans muqueuse ont été étudiés en bain d organes isolés (5mL) contenant une solution tampon Krebs (pH=7.4; 37C; 95%O2-5%CO2). L ACS des fragments de vessies a été enregistrée et l aire sous la courbe (AUC) des contractions spontanées a été quantifiée de manière standardisée. Une corrélation entre l AUC des contractions spontanées des fragments de vessie avec et sans muqueuse et les facteurs pronostiques cliniques, urodynamiques et anatomopathologiques a été recherchée. Une corrélation entre ces mêmes facteurs cliniques et urodynamiques d une part, et l inflammation, l œdème et la fibrose vésicale d autre part a été recherchée.Une corrélation significative a été mise en évidence entre l âge et l AUC des contractions spontanées des fragments de vessie (p=0,006) mais pas avec l AUC des contractions spontanée des fragments de vessie sans muqueuse. Une corrélation significative a été mise en évidence entre l échec d un traitement antérieur par parasympatholytiques et l AUC des contractions spontanées des fragments de vessie (p=0,02).Aucune corrélation significative entre l AUC et les données urodynamiques et histologiques n a été mise en évidence. Seul l âge était significativement corrélé au degré de fibrose observé dans les vessies (p=0,02).Alors que la physiopathologie des anomalies du comportement vésical chez les patients atteints de lésions neurologiques reste encore aujourd hui mal comprise, la corrélation entre l ACS des fragments de vessie avec divers facteurs pronostiques cliniques, urodynamiques et anatomopathologiques n est pas évidente dans ce tout premier travail. L ACS des fragments de vessies neurologiques analysées n en reste pas moins particulièrement anormale, conséquence d une chaîne de troubles neurogènes et myogènes. Si la prise en charge clinique de ces patients est aujourd hui bien codifiée et a permis d en transformer le pronostic rénal et fonctionnel, la recherche de biomarqueurs et l étude du rôle de la muqueuse vésicale doit se poursuivre. Ce type d étude sur vessies humaines à l état frais est dans sa phase balbutiante et prometteuse. La compréhension de l origine et de la signification de l ACS vésicale pourrait être déterminante dans l identification de nouvelles voies thérapeutiques de l hyperactivité détrusorienne .PARIS6-Bibl.Pitié-Salpêtrie (751132101) / SudocSudocFranceF