Papers by emmanuel chartier-kastler
Progres En Urologie, Jun 1, 2016
Resume Objectifs Determiner la prevalence de l’hyperactivite vesicale (HAV) en France et obtenir ... more Resume Objectifs Determiner la prevalence de l’hyperactivite vesicale (HAV) en France et obtenir des donnees sur le parcours de soin initial des patients atteints d’HAV. Materiels et methodes Un questionnaire comportant 41 questions a ete envoye a 12 000 patients representatifs de la population francaise, comportant des renseignements sur les donnees socio-demographiques, les antecedents medicaux, le score Profil de Symptomes Urinaires, la gene, l’historique des symptomes, les recours aux soins et les traitements recus. Le critere d’evaluation principal (definissant une HAV) etait la presence d’urgenturies au moins plusieurs fois par semaine, ou un traitement contre l’HAV. Les facteurs associes a l’HAV ont ete etudies par analyse uni- et multivariee. Resultats Sur les 8842 questionnaires analyses, 14,4 % des patients souffraient d’HAV. La prevalence de l’HAV etait plus marquee chez les femmes, et augmentait avec l’âge. Les facteurs associes etaient : obesite, colopathie fonctionnelle, infection urinaire, enuresie dans l’enfance, constipation, anxiete/depression, maladies neurologiques et pathologie rachidienne, apnee du sommeil, asthme, bronchite chronique, diabete et hypertension arterielle. Seuls 34,6 % des patients atteints d’HAV avaient consulte un medecin pour ce motif, principalement un medecin generaliste. Soixante-douze pour cent ont eu un examen complementaire qui etait le plus souvent un examen d’urine, et seuls 6 % des patients avaient eu un calendrier mictionnel. Le traitement recu le plus frequent (12,5 %) etait un anticholinergique. Une reeducation a ete prescrite dans 26 % des cas, des conseils hygieno-dietetiques dans 26 % des cas. Conclusions L’HAV est un symptome frequent dont la prevalence augmente avec l’âge, et qui concerne souvent des patients polypathologiques. Un ecart important entre la pratique clinique et les recommandations de prise en charge initiale a ete constate. Niveau de preuve 3.
Progres En Urologie, Nov 1, 2021
Spinal Cord, Mar 7, 2018
Objectives To report the long-term complications of non-continent cutaneous urinary diversion (NC... more Objectives To report the long-term complications of non-continent cutaneous urinary diversion (NCCUD) in adult patients with spinal cord injury (SCI). Setting Hospital in Paris, France. Methods A retrospective single center study included all adult patients with SCI who underwent an ileal conduit between 1997 and 2014. Early complications were reported according to Clavien-Dindo classification. Long-term complications and reoperation rates were recorded, as well as stoma management and autonomy improvement related to urinary function. Results One hundred and two patients were included. The surgical indications included failure of intermittent catheterization (n = 43), urethral fistulae due to skin ulcers (n = 50), renal failure (n = 8), recurrent urinary tract infections (n = 9), lithiasis (n = 3), and bladder tumors (n = 2). There were 67 early postoperative complications for 44 patients (43%) leading to an additional surgery in 15 cases: 30 grade I-II, 30 grade III, 6 grade IV, and 1 grade V. A total of 37 late complications were reported for 36 patients (35%): 17 ureteral anastomosis stenosis, 3 stoma hernia, 3 pyocystis (3/15 patients), 7 pyelonephritis, 2 renal failures, 2 ureteral lithiasis, 1 uterine prolapse, 1 incisional hernia, and 1 tumor recurrence. Renal function remained unchanged (p = 0.53). Autonomy related to urinary function was improved in 88% of patients. The correct fitting of the stoma was possible for 81% of the patients. Conclusions Despite a perioperative morbidity rate of 43% and a late complication rate of 35%, as a last resort procedure, NCCUD is an end-stage solution in patients with SCI to preserve renal function and achieve autonomy.
Neurourology and Urodynamics, Oct 2, 2022
Purpose: Artificial urinary sphincter is the reference treatment for stress urinary incontinence ... more Purpose: Artificial urinary sphincter is the reference treatment for stress urinary incontinence in men, but it remains rarely used in women. This study aimed to compare long-term device survival between women and men, after the first implantation of an AMS 800 TM artificial urinary sphincter (Boston Scientific, USA) for the treatment of a non-neurogenic stress urinary incontinence. Materials and methods: This retrospective cohort study included all patients with nonneurogenic stress urinary incontinence who underwent surgery in a large-volume university hospital between 2000 and 2013. The primary outcome was the overall survival of the device, defined as the absence of any repeated surgery (revision or explantation) during follow-up. Men and women were matched 3:1 according to age and year of implantation. Differences were analyzed using a Cox model accounting for matching and applying time intervals because hazards were not proportional over time. Sensitivity analyzes were performed, excluding firstly population with history of radiotherapy and secondly population with more than one previous surgery for urinary incontinence. Results: A total of 107 women were matched to 316 men. Median follow-up was 6.0 years (Q1-Q3 1.8 -9.4): 7.0 years (Q1-Q3 3.1 -10.3) for women and 5.1 years (Q1-Q3 1.3 -9.1) for men. During the follow-up, 56 patients had an explantation of the device: 44 men (13.9%) and 12 women (11.2%) and 113 had a revision: 85 men (26.9%) and 28 women (26.1%). Men have a significantly higher risk of explantation or revision than women between 6 months and 8 years after implantation (HR 2.12 (1.29-3.48)). Before 6 months and after 8 years, there were not significant differences. Both sensitivity analyses found consistent results. Conclusions: This study suggests that device survival seems better in women after the first 6 months.
World Journal of Urology, Apr 28, 2022
To perform a dynamic evaluation of the prostate cancer (PCa) detection rate according to the biop... more To perform a dynamic evaluation of the prostate cancer (PCa) detection rate according to the biopsy strategy over 10 years of practice in a single institution that pioneered MRI-targeted fusion biopsy (MRI-TB). This stage 4 IDEAL study prospectively included all consecutive patients who underwent transrectal prostate biopsy for clinically suspected PCa between January 2010 and November 2020. Patients with positive MRI (PIRADS score ≥3) underwent both MRI-TB and systematic biopsy (SB) while those with negative MRI (PIRADS score <3) underwent SB only. The main outcome was the evolution of the detection rate of clinically relevant PCa (csPCa ; grade ≥2). The secondary outcome was the change in PCa detection rate according to the biopsy method. Results: A total of 2942 men underwent prostate MRI and a prostate biopsy: 2322 underwent MRI-TB and 620 had SB only. The detection rate of csPCa increased 2.5-fold from 23% to 58%. The detection rate of PCa and csPCa was significantly higher in patients who underwent MRI-TB compared to those who underwent SB only (67% vs. 52 % and 40% vs. 32%, respectively (P<0.001 for both comparisons)). The number of csPCa diagnosed by MRI-TB increased linearly over the study period and represented the majority of PCa diagnoses after 2016. Implementation of MRI-TB in patients with positive MRI led to improved detection of csPCa.
The Journal of Urology, May 1, 2022
The ATOMS has recently gained popularity in the post-prostatectomy incontinence (PPI) scene, tout... more The ATOMS has recently gained popularity in the post-prostatectomy incontinence (PPI) scene, touting advantages such as surgical simplicity and post-operative adjustability. The present study explores the device as a potential treatment option for PPI. Primary outcome was dryness rate, 24-hour pad-count change compared to baseline and results from the patient global impression of improvement (PGI-I) questionnaire. Secondary outcome was the frequency of postoperative adverse events. METHODS: A retrospective medical record study was conducted on 91 patients who underwent ATOMS implantation between February 2016 and September 2020 at our institution. Preoperative incontinence severity was defined as <2 pads per day (PPD), 2-4 PPD, and >4 PPD with regards to 24-h pad-count or/and <200g, 200-400g and >400g regarding 24-h pad-test (24h-PT) to classify mild, moderate, and severe incontinence, respectively. Dryness was defined as requiring 0 or 1 PPD postoperatively. Patients considered "improved" or "very much improved" were defined as having a diminution of PPD of ! 50% or ! 75%, respectively. Positive patient satisfaction was defined by "Much better", and "Very much better" PGI-I results. RESULTS: Out of the 91 patients identified, 65 were included in the study (26 were excluded due to a follow-up <12 months). Mean patient age was 71 years, with a mean follow-up of 29.9 months (SE 1.8; range 12-67). Median preoperative PPD and 24h-PT were 4 (IQR 6-3; range 1-10) and 358 g (IQR 607-256; range 34-1592) respectively, classifying most patients as moderate (n[24; 36.9%) or severe (n[40; 61.5%) incontinence. Median PPD at final follow-up was 1.0 (IQR 2-0; range 0-5; p < 0.001). 59 (90.7%) patients required adjustment postoperatively, with a mean of 2.4 adjustments (SE 0.25; range 1-8) and a mean total instilled volume of 14.8mL (SE 0.76; range 6-31). Overall improvement was noted in 56 (86.2%) patients, with 43 (76.7%) being "very much improved" and 42 (75.0%) being dry. Patient satisfaction rate was 87. 7% (n[57). 8 (12.3%) patients experienced complications of any Clavien-Dindo grade, of which 4 were a grade III due to 1 device migration (1.5%), and 3 explantations due to leakage (4.6%). CONCLUSIONS: The present study vouches ATOMS as a safe and effective device in the treatment of PPI. More robust studies may allow integration of the ATOMS device among treatments options in North American urological practices.
The Journal of Urology, Sep 1, 2021
The Journal of Urology, Apr 1, 2020
INTRODUCTION AND OBJECTIVE:The manufacturer recommends filling the pressure-regulating balloon (P... more INTRODUCTION AND OBJECTIVE:The manufacturer recommends filling the pressure-regulating balloon (PRB) with 22 cc of isotonic solution at the time of implantation, whilst the occlusive cuff (OC) is e...
Progres En Urologie, Nov 1, 2017
Annals of physical and rehabilitation medicine, May 1, 2014
Pathologies du système génito-urinaire / Annals of Physical and Rehabilitation Medicine 57S (2014... more Pathologies du système génito-urinaire / Annals of Physical and Rehabilitation Medicine 57S (2014) e93-e95 Méthode.-Entre juillet 2001 et janvier 2012, les patients ayant une vessie neurologique et opérés d'une DUCC selon la technique de Mitrofanoff/Monti/Casale ont été inclus. La continence par la stomie et l'urètre, la fonction rénale, les paramètres urodynamiques et les complications ont été évalués. Résultats.-Un total de 84 patients ont été inclus, d'âge médian 40 ans(IQR17-76). Le suivi médian était de 55 mois(IQR35-95). Parmi, 95 % des patients ont eu une entérocystoplastie d'agrandissement, 51 patients ont eu une chirurgie de la continence. Deux complications postopératoires sévères(grade III-IV) ont été rapportées. Sept patients ont eu une sténose du tube ou de la stomie traitées par dilatation(n = 6) et chirurgie(n = 1). Huit patients ont eu des calculs vésicaux traités par endoscopie. Sept patients ont eu une incontinence urinaire urétrale persistante traitée par ballons péri-urétraux(n = 4), bandelette aponévrotique(n = 2), bandelette sous-uréthrale(n = 1). La clairance de la créatinine était améliorée chez tous les patients. Au terme du suivi, 100 % des patients avaient une stomie fonctionnelle et continente, 91 % des patients avaient une continence urétrale. Discussion.-La DUCC a permis aux patients de réaliser des auto-sondages intermittents et d'être continents. Le haut appareil urinaire était protégé.
Spinal Cord, Sep 27, 2016
Study design: A retrospective observational study. Objective: To describe specificities of pregna... more Study design: A retrospective observational study. Objective: To describe specificities of pregnancy in a traumatic spinal cord-injured (SCI) population managed by a coordinated medical care team involving physical medicine and rehabilitation (PMR) physicians, urologists, infectious diseases' physicians, obstetricians and anaesthesiologists.
Neurourology and Urodynamics, 2020
Progrès en Urologie, 2020
Introduction. -Our objective was to provide guidelines covering all aspects of intermittent cathe... more Introduction. -Our objective was to provide guidelines covering all aspects of intermittent catheterisation (intermittent self-catheterisation and third-party intermittent catheterisation). Materials and methods. -A systematic review of the literature based on Pubmed, Embase, Google scholar was initiated in December 2014 and updated in April 2019. Given the lack of robust data and the numerous unresolved controversial issues, guidelines were established based on the formal consensus of experts from steering, scoring and review panels. Results. -This allowed the formulation of 78 guidelines, extending from guidelines on indications for intermittent catheterisation, modalities for training and implementation, choice of equipment, management of bacteriuria and urinary tract infections, to the implementation of intermittent catheterisation in paediatric, geriatric populations, benign prostatic hyperplasia patients and continent urinary diversion patients with a cutaneous reservoir as well as other complications. These guidelines are pertinent to both intermittent self-catheterisation and third-party intermittent catheterisation. Conclusion. -These are the first comprehensive guidelines specifically aimed at intermittent catheterisation and extend to all aspects of intermittent catheterisation. They assist in the clinical decision-making process, specifically in relation to indications and modalities of intermittent catheterisation options. These guidelines are intended for urologists, gynaecologists, geriatricians, paediatricians, neurologists, physical and rehabilitation physicians, general practitioners and other health professionals including nurses, carers. . .
Neurology, Jan 14, 2018
To evaluate the efficacy and safety of onabotulinumtoxinA 100 U in noncatheterizing patients with... more To evaluate the efficacy and safety of onabotulinumtoxinA 100 U in noncatheterizing patients with multiple sclerosis (MS) with urinary incontinence (UI) due to neurogenic detrusor overactivity (NDO). In this randomized, double-blind phase III study, patients received onabotulinumtoxinA 100 U (n = 66) or placebo (n = 78) as intradetrusor injections via cystoscopy. Assessments included changes from baseline in urinary symptoms, urodynamics, and Incontinence-Quality of Life (I-QOL) total score. Adverse events (AEs) were assessed, including initiation of clean intermittent catheterization (CIC) due to urinary retention. OnabotulinumtoxinA vs placebo significantly reduced UI at week 6 (-3.3 episodes/day vs -1.1 episodes/day, < 0.001; primary endpoint). Significantly greater proportions of onabotulinumtoxinA-treated patients achieved 100% UI reduction (53.0% vs 10.3%, < 0.001). Significant improvements in urodynamics ( < 0.01) were observed with onabotulinumtoxinA. Improvements i...
World journal of urology, Jan 21, 2018
This work represents the efforts of the SIU-ICUD workgroup on this topic and comprehensive litera... more This work represents the efforts of the SIU-ICUD workgroup on this topic and comprehensive literature search of English language manuscripts regarding urologic surgery in spinal cord injury using key words of urologic surgery and spinal cord injury. Articles were compiled, and recommendations in the chapter are based on group discussion and intensive communication. The purpose is to review what has been published during the last decades on urological surgery for neurogenic bladder after spinal cord injury. Surgical techniques applied in spinal cord injured patients for neurogenic bladder dysfunction have been reviewed and the published material evaluated. There are several techniques that can be used to treat neurogenic dysfunctions and symptoms in refractory cases where conservative treatment failed. The number of publications is small as are the number of patients with spinal cord injury in which they have been performed. The choice of techniques proposed to the patients depends o...
Progrès en Urologie, 2017
HAL is a multi-disciplinary open access archive for the deposit and dissemination of scientific r... more HAL is a multi-disciplinary open access archive for the deposit and dissemination of scientific research documents, whether they are published or not. The documents may come from teaching and research institutions in France or abroad, or from public or private research centers. L'archive ouverte pluridisciplinaire HAL, est destinée au dépôt et à la diffusion de documents scientifiques de niveau recherche, publiés ou non, émanant des établissements d'enseignement et de recherche français ou étrangers, des laboratoires publics ou privés.
Journal of Urology, 2012
PURPOSE: We evaluated the long-term safety and efficacy of an adjustable continence device (ACT® ... more PURPOSE: We evaluated the long-term safety and efficacy of an adjustable continence device (ACT® or ProACT™) in male and female patients with neurogenic stress urinary incontinence. MA-TERIALS AND METHODS: Data on patients consecutively treated with implantation of an adjustable continence device due to neurogenic stress urinary incontinence were reviewed from the start of our experience to the current 4-year followup. RESULTS: We reviewed data on 13 male and 24 female patients with neurogenic stress urinary incontinence due to different forms of pelvic nerve or spinal cord lesions. Mean ± SD age at implantation was 46.2 ± 17.4 years. Of the patients 92% performed clean intermittent self-catheterization. The device was implanted bilaterally using general and local anesthesia in 16.2% and 83.8% of cases, respectively. From before implantation to 48-month followup the mean number of urinary incontinence episodes decreased from 6.1 ± 2.4 to 2.8 ± 3.1 and the mean number of pads used per 24 hours decreased from 4.2 ± 2.7 to 2.2 ± 2.2. Of the patients 54.5% indicated more than 50% improvement of stress urinary incontinence symptoms after 48 months, of whom 38.9% indicated complete continence. Adverse events included erosion/migration, device infection or failure, implantation site pain, bladder stone formation and difficult clean intermittent self-catheterization. CONCLUSIONS: Implantation of the ProACT/ACT device in patients with neurogenic stress urinary incontinence is minimally invasive and safe. It can significantly improve neurogenic stress urinary incontinence in the long term. Thus, it might be a reasonable option for patients who are not willing, not suitable or not yet ready for more invasive surgery, such as artificial urinary sphincter or fascial suspension sling placement.
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Papers by emmanuel chartier-kastler