Outcomes of robot-assisted urinary sphincter implantation for male neurogenic urinary incontinence

Objectives: To report the functional outcomes of robot-assisted laparoscopic artificial urinary sphincter implantation (R-AUS) in men with neurogenic stress urinary incontinence (SUI). Patients and Methods: A monocentric retrospective study included all consecutive adult male neuro-urological patients who underwent R-AUS for SUI between January 2011 and August 2018. The AUS was implanted via a transperitoneal robot-assisted laparoscopic approach. Intraoperative and early postoperative complications were reported (Clavien–Dindo classification). Continence was defined as no pad usage. Revision and explantation rates were also evaluated. Results: Overall, 19 men with a median (interquartile range [IQR]) age of 45 (37–54) years were included. No conversion to laparotomy was needed. Three minor (Clavien–Dindo Grade I–II) early postoperative complications occurring in three (15.8%) patients were reported. The median (IQR) follow-up was 58 (36–70) months. At the end of the follow-up, the continence rate was 89.5%. The AUS revision and explantation rates were 5.3% and 0%, respectively. Conclusion: A R-AUS is a safe and efficient procedure for AUS implantation in adult male neuro-urological patients, referring to the challenging open technique

Évaluation médico-économique des traitements urologiques chez les patients blessés médullaires : revue de la littérature

International audienceIntroductionTo provide an overview of the urological management of spinal cord injured patients based on an economic analysis.Materials and methodsA literature search from January 1994 to December 2014 was performed using Medline and Embase database using the following keywords: cost-effectiveness; cost-benefit; cost-utility; spinal cord injury; neurogenic bladder; intermittent catheterization; antimuscarinics; botulinum toxin; sacral neuromodulation; tibial nerve; Brindley; sphincterotomy. The tool used for comparison was the QALY (“quality adjusted life years”); an indicator between 0 and 1 allowing the comparison between two medical treatments using cost per QALY.ResultsSolifenacin (5 to 10 mg) is the most cost-effective treatment with an incremental cost-effectiveness ratio (ICER) of 19,893 €/QALY compared to trospium 40 mg, of 16,657 €/QALY compared to trospium 60 mg, of 12,309 £/QALY compared to oxybutinin. Botulinum toxin A is also cost-effective with an ICER of 24,720 $/QALY compared to best supportive cares for anticholinergic-refractory neurogenic detrusor overactivity.ConclusionSolifenacin and botulinum toxin A appears to be the most cost-effective treatments for spinal injured urological cares. There is a pressing need to both increase and improve data collection and research on spinal cord injury.IntroductionÉvaluer les traitements urologiques accessibles aux patients blessés médullaires en s’appuyant sur des données médico-économiques.Matériel et méthodesUne revue de la littérature de janvier 1994 à décembre 2014 a été réalisée à partir des bases de données Medline et Embase en utilisant les mots clés suivants : cost-effectiveness ; cost-benefit ; cost-utility ; spinal cord injury ; neurogenic bladder ; intermittent catheterization ; antimuscarinics ; botulinum toxin ; sacral neuromodulation ; tibial nerve ; Brindley ; sphincterotomy. L’outils de comparaison utilisé était le QALY (« Quality Adjusted Life Years »), un indicateur synthétique d’utilité compris entre 0 et 1 permettant de comparer deux actions médicales sur une même pathologie.RésultatsParmi les traitements parasympatholytiques, la solifénacine (5 à 10 mg) était le traitement le plus efficace du point de vue pharmaco-économique, avec un ratio incrémental coût-efficacité (ICER) de 19 893 €/QALY en comparaison au trospium 40 mg, de 16 657 €/QALY au trospium 60 mg, de 12 309 £/QALY à l’oxybutinine. Les injections de toxine botulique étaient également coûts-efficaces avec un ICER de 24 720$/QALY comparativement au traitement médical.ConclusionDans notre revue, la solifénacine et la toxine botulique A étaient les traitements les plus coûts-utiles. L’amélioration de la collecte de données sur les coûts et les dépenses des soins urologiques est un enjeu médico-économiqu

Incidence of bladder cancer in neuro-urological patients in France. a nationwide study

Purpose: The purpose of this study was to evaluate the incidence of bladder cancer (BCa) in patients with the main neurological diseases that induce neurogenic lower urinary tract dysfunction, namely, multiple sclerosis (MS), spinal cord injury (SCI) and spina bifida (SB). Methods: We conducted a retrospective analysis of nationwide data from the French Hospital Discharge Database (PMSI) from January 2010 to December 2018. The incidence of BCa was calculated in patients with MS, SCI and SB. Incidence, sex, age, radical cystectomy after BCa diagnosis and in-hospital deaths were compared between the three groups. The Chi2 and Kruskal–Wallis tests were used for qualitative and quantitative data comparisons, respectively. Results: Overall, 2015 neuro-urological patients (mean (± SD) age: 65.4 ± 12.3 years) were hospitalized in France between 2010 and 2018 with a new diagnosis of BCa. In neuro-urological patients, BCa was more frequent in men than in women (sex ratio: 3.08). The incidence of BCa in neuro-urological patients was 174.9/100,000 persons/year. The incidence of BCa was 791.1/100,000 persons/year in SCI compared to 56.6 in MS and 113.8 in SB (p < 0.0001). After the initial diagnosis of BCa, 551 (27.3%) patients underwent a radical cystectomy and 613 (30.4%) died in hospital after BCa diagnosis. Conclusions: The incidence of BCa in France between 2010 and 2018 was 174.9/100 000 persons/year, and was particularly high in patients with SCI