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See detailVers une approche moins invasive de la voie transoburatrice de dedans en dehors (TVT-O) pour le traitement de l’incontinence urinaire féminine: dissection réduite et bandelette plus courte
Waltregny, David ULg; Thomas, Alexandre ULg; de Leval, Jean ULg

in Andrologic (2010), 6

Plusieurs essais randomisés et méta-analyses récentes ont montré que la voie transobturatrice est, à moyen terme, aussi efficace et plus sécurisante que la voie rétropubienne pour la mise en place d’une ... [more ▼]

Plusieurs essais randomisés et méta-analyses récentes ont montré que la voie transobturatrice est, à moyen terme, aussi efficace et plus sécurisante que la voie rétropubienne pour la mise en place d’une bandelette sous-urétrale pour traiter l’incontinence urinaire d’effort (IUE) féminine. En effet, la voie transobturatrice est associée à des taux de guérison subjective de l’IUE similaires (±85-90%) mais à un risque moindre de de saignement, de perforation vésicale et de troubles mictionnels postopératoires. La voie transobturatrice de dedans en dehors (‘Tension-free Vaginal Tape - Obturator’, TVT-O) a été développée en 2003 par Jean de Leval dans le but de réduire le risque de perforation de la vessie et de l’urètre tout en minimisant la dissection chirurgicale nécessaire pour insérer la bandelette. A ce jour, plus de 50 études cliniques, incluant 18 essais randomisés et 3 registres nationaux réalisés en France, Autriche, et Norvège, ont largement démontré les excellents résultats à moyen terme (2 à 5 ans de suivi) de la technique TVT-O. Plus récemment, nous avons apporté deux modifications à la procédure TVT-O, à savoir l’utilisation d’une bandelette plus courte, de 12 cm de long, insérée sans perforer la membrane obturatrice par les ciseaux ou le guide. Nos travaux anatomiques sur cadavres ont montré que cette bandelette plus courte est ancrée dans les muscles obturateurs et la membrane obturatrice mais évite dans une large mesure les muscles adducteurs. D’un point de vue clinique, nous avons comparé l’approche TVT-O originale à la version modifiée, potentiellement moins invasive, au travers d’un essai clinique prospectif randomisé. Les résultats de cet essai, présentés au congrès conjoint de l’International Continence Society (ICS) et de l’International Urogynecology Association (IUGA) à Toronto, ont montré qu’après suivi minimal d’1 an, les 2 approches génèrent des taux de guérison de l’IUE élevés et des taux de complications postopératoires très faibles, similaires pour les 2 procédures, la procédure modifiée étant néanmoins associée à une incidence et à une sévérité de douleurs de cuisse postopératoires immédiates significativement moindres. [less ▲]

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See detailVersican overexpression in human breast cancer lesions: Known and new isoforms for stromal tumor targeting.
Kischel, Philippe ULg; Waltregny, David ULg; Dumont, Bruno ULg et al

in International Journal of Cancer = Journal International du Cancer (2010), 126(3), 640-50

Proteoglycans play a key role in cancer development and progression by participating in the constitution of a specific fertile tumor microenvironment. As they are largely overexpressed in the malignant ... [more ▼]

Proteoglycans play a key role in cancer development and progression by participating in the constitution of a specific fertile tumor microenvironment. As they are largely overexpressed in the malignant stroma, proteoglycans provide a reservoir of potential new targets for anticancer therapies, because they can serve to convey toxic payloads in the close proximity of cancer cells and subsequently destroy them. In this context, versican, a proteoglycan largely overexpressed in several solid cancers, bears the potential to be such an ideal target. As 4 main versican isoforms have been characterized, we sought to determine which isoform could represent the best target in human breast cancer. We used a series of 10 primary breast cancer lesions that were characterized as overexpressing the versican protein, when compared with matched normal breast tissues, using shotgun mass spectrometry and immunohistochemistry experiments. Quantitative polymerase chain reaction and western-blotting experiments were used to evaluate versican isoform expression in breast cancer/normal tissue pairs for which ARN quality was excellent. All known isoforms were significantly overexpressed in the malignant lesions, both at the mRNA and at the protein levels. In the course of this study, we also identified and cloned a new alternatively spliced versican isoform, referred to as V4, which was also found to be upregulated in human breast cancer. This study provides for the first time a comprehensive mRNA and protein analysis of versican isoforms expression in human breast tissues, and offers insights into which therapeutic strategy would be best suited to target versican in human breast cancer lesions. [less ▲]

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See detailIdentification and Validation of the Methylated TWIST1 and NID2 Genes through Real-Time Methylation-Specific Polymerase Chain Reaction Assays for the Noninvasive Detection of Primary Bladder Cancer in Urine Samples.
Renard, Isabelle; Joniau, Steven; van Cleynenbreugel, Ben et al

in European urology (2010)

BACKGROUND: Accumulating evidence suggests that DNA methylation markers could serve as sensitive and specific cancer biomarkers. OBJECTIVE: To determine whether a panel of methylated genes would have the ... [more ▼]

BACKGROUND: Accumulating evidence suggests that DNA methylation markers could serve as sensitive and specific cancer biomarkers. OBJECTIVE: To determine whether a panel of methylated genes would have the potential to identify primary bladder cancer (BCa) in voided urine samples. DESIGN, SETTING, AND PARTICIPANTS: A pharmacologic unmasking reexpression analysis in BCa cell lines was initially undertaken to unveil candidate methylated genes, which were then evaluated in methylation-specific polymerase chain reaction (MSP) assays performed on DNA extracted from noncancerous and cancerous bladder tissues. The most frequently methylated genes in cancerous tissues, with 100% specificity, were retained for subsequent MSP analysis in DNA extracted from urine samples to build and validate a panel of potential methylated gene markers. Urine samples were prospectively collected at three urologic centres from patients with histologically proven BCa and processed for use in real-time MSP and cytologic analysis. Patients with nonmalignant urologic disorders were included as controls. MEASUREMENTS: A urine sample was classified as valid when >/=10 copies of the gene encoding ss-actin were measured in the urine sediment genomic DNA. Sensitivity, specificity, and predictive values of the MSP and cytology tests were assessed and compared. RESULTS AND LIMITATIONS: MSP assays performed on 466 of the 496 (94%) valid urine samples identified two genes, TWIST1 and NID2, that were frequently methylated in urine samples collected from BCa patients, including those with early-stage and low-grade disease. The sensitivity of this two-gene panel (90%) was significantly better than that of cytology (48%), with comparable specificity (93% and 96%, respectively). The positive predictive value and negative predictive value of the two-gene panel was 86% and 95%, respectively. CONCLUSIONS: Detection of the methylated TWIST1 and NID2 genes in urine sediments using MSP provides a highly (>/=90%) sensitive and specific, noninvasive approach for detecting primary BCa. TRIAL REGISTRATION: BlCa-001 study - EudraCt 2006-003303-40. [less ▲]

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See detailUpdated Systematic Review and Meta-Analysis of the Comparative Data on Colposuspensions, Pubovaginal Slings, and Midurethral Tapes in the Surgical Treatment of Female Stress Urinary Incontinence.
Novara, G.; Artibani, W.; Barber, M. D. et al

in European Urology (2010)

CONTEXT: Burch colposuspension, pubovaginal sling, and midurethral retropubic tape (RT) and transobturator tape (TOT) have been the most popular surgical treatments for female stress urinary incontinence ... [more ▼]

CONTEXT: Burch colposuspension, pubovaginal sling, and midurethral retropubic tape (RT) and transobturator tape (TOT) have been the most popular surgical treatments for female stress urinary incontinence (SUI). Several randomized controlled trials (RCTs) have been published comparing the different techniques, with conflicting results. OBJECTIVE: Our aim was to evaluate the efficacy, complication, and reoperation rates of midurethral tapes compared with other surgical treatments for female SUI. EVIDENCE ACQUISITION: A systematic review of the literature was performed using the Medline, Embase, Scopus, Web of Science databases, and Cochrane Database of Systematic Reviews. EVIDENCE SYNTHESIS: Thirty-nine RCTs were identified. Patients receiving midurethral tapes had significantly higher overall (odds ratio [OR]: 0.61; confidence interval [CI]: 0.46-0.82; p=0.00009) and objective (OR: 0.38; CI: 0.25-0.57; p<0.0001) cure rates than those receiving Burch colposuspension, although they had a higher risk of bladder perforations (OR: 4.94; CI: 2.09-11.68; p=0.00003). Patients undergoing midurethral tapes and pubovaginal slings had similar cure rates, although the latter were slightly more likely to experience storage lower urinary tract symptoms (LUTS) (OR: 0.31; CI: 0.10-0.94; p=0.04) and had a higher reoperation rate (OR: 0.31; CI: 0.12-0.82; p=0.02). Patients treated with RT had slightly higher objective cure rates (OR: 0.8;CI: 0.65-0.99; p=0.04) than those treated with TOT; however, subjective cure rates were similar, and patients treated with TOT had a much lower risk of bladder and vaginal perforations (OR: 2.5; CI: 1.75-3.57; p<0.00001), hematoma (OR: 2.62; CI: 1.35-5.08; p=0.005), and storage LUTS (OR: 1.35; CI: 1.05-1.72; p=0.02). Meta-analysis demonstrated similar outcomes for TVT-O (University of Liege, Liege, Wallonia, Belgium) and Monarc (AMS, Minnetonka, MN, USA). CONCLUSIONS: Patients treated with RT experienced slightly higher continence rates than those treated with Burch colposuspension, but they faced a much higher risk of intraoperative complications. RT and pubovaginal slings were similarly effective, although patients with pubovaginal slings were more likely to experience storage LUTS. The use of RT was followed by objective cure rates slightly higher than TOT, but subjective cure rates were similar. TOT had a lower risk of bladder and vaginal perforations and storage LUTS than RT. The strength of these findings is limited by the heterogeneity of the outcome measures and the short length of follow-up. [less ▲]

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See detailAn anatomic comparison of the traditional TVT-O versus a modified TVT-O procedure
Hinoul, Piet; Bonnet, Pierre ULg; De Roover, CHRISTOPHE ULg et al

in Gynecological Surgery (2010), 7(Suppl 1), 121

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See detailLe ciblage therapeutique: vers une guerre propre et efficace contre le cancer
Castronovo, Vincenzo ULg; Waltregny, David ULg; Detry, Olivier ULg et al

Scientific conference (2009, October)

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See detailDétecter le cancer de la vessie à partir d’échantillons d’urine
Waltregny, David ULg; Joniau, Steven; Bierau, Katia et al

Scientific conference (2009, October)

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See detailAndrogen receptor controls EGFR and ERBB2 gene expression at different levels in prostate cancer cell lines.
Pignon, Jean-Christophe ULg; Koopmansch, Benjamin ULg; Nolens, Grégory ULg et al

in Cancer Research (2009), 69(7), 2941-2949

EGFR or ERBB2 contributes to prostate cancer (PCa) progression by activating the androgen receptor (AR) in hormone-poor conditions. Here, we investigated the mechanisms by which androgens regulate EGFR ... [more ▼]

EGFR or ERBB2 contributes to prostate cancer (PCa) progression by activating the androgen receptor (AR) in hormone-poor conditions. Here, we investigated the mechanisms by which androgens regulate EGFR and ERBB2 expression in PCa cells. In steroid-depleted medium (SDM), EGFR protein was less abundant in androgen-sensitive LNCaP than in androgen ablation-resistant 22Rv1 cells, whereas transcript levels were similar. Dihydrotestosterone (DHT) treatment increased both EGFR mRNA and protein levels and stimulated RNA polymerase II recruitment to the EGFR gene promoter, whereas it decreased ERBB2 transcript and protein levels in LNCaP cells. DHT altered neither EGFR or ERBB2 levels nor the abundance of prostate-specific antigen (PSA), TMEPA1, or TMPRSS2 mRNAs in 22Rv1 cells, which express the full-length and a shorter AR isoform deleted from the COOH-terminal domain (ARDeltaCTD). The contribution of both AR isoforms to the expression of these genes was assessed by small interfering RNAs targeting only the full-length or both AR isoforms. Silencing of both isoforms strongly reduced PSA, TMEPA1, and TMPRSS2 transcript levels. Inhibition of both AR isoforms did not affect EGFR and ERBB2 transcript levels but decreased EGFR and increased ERBB2 protein levels. Proliferation of 22Rv1 cells in SDM was inhibited in the absence of AR and ARDeltaCTD. A further decrease was obtained with PKI166, an EGFR/ERBB2 kinase inhibitor. Overall, we showed that ARDeltaCTD is responsible for constitutive EGFR expression and ERBB2 repression in 22Rv1 cells and that ARDeltaCTD and tyrosine kinase receptors are necessary for sustained 22Rv1 cell growth. [less ▲]

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See detailLe ciblage thérapeutique : vers une guerre propre et efficace contre le cancer
Castronovo, Vincenzo ULg; Waltregny, David ULg; Detry, Olivier ULg et al

in Revue Médicale de Liège (2009), 64

One promising avenue towards the development of more selective, better anticancer drugs consists in the targeted delivery of bioactive compounds to the tumor environment by means of binding molecules ... [more ▼]

One promising avenue towards the development of more selective, better anticancer drugs consists in the targeted delivery of bioactive compounds to the tumor environment by means of binding molecules specific for tumor-associated biomarkers. Eligibility of such markers for therapeutic use implies ideally three criteria : (i) accessibility from the bloodstream, (ii) expression at sufficient level and (iii) no (or much lower) expression in normal tissues. Most current discovery strategies (such as biomarker searching into body fluids) provide no clue as to whether proteins of interest are accessible, in human tissues, to suitable high-affinity ligands, such as systemically delivered monoclonal antibodies. Innovative proteomic technologies are able to identify such accessible biomarkers and represent a key step in the clinical development of such target therapies. [less ▲]

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See detailDétection du cancer de la vessie à partir d'échantillons d'urine
Thomas, Alexandre ULg; Renard, Isabelle; Waltregny, David ULg

in Revue Médicale de Liège (2009), 64

Bladder cancer mainly affects patients aged 50 years or more and requires close and repeated surveillance. Flexible cystoscopy associated with urinary cytology are the currently recommended diagnostic and ... [more ▼]

Bladder cancer mainly affects patients aged 50 years or more and requires close and repeated surveillance. Flexible cystoscopy associated with urinary cytology are the currently recommended diagnostic and follow-up methods. Because medical imaging techniques remain rather unsatisfying for bladder carcinoma detection, research efforts have focused on urinary markers of the disease. Various approaches were tested with results generally too unconsistant to replace cystoscopy. Recently, the department of Urology at the University of Liège together with the Biotechnology Company OncoMethylome Sciences have been interested in testing whether the detection of hypermethylated genes in voided urine samples would be of value for the detection of bladder cancer. The method is based on the Methylation-Specific PCR technology (MSP). This approach has the theoretical advantage of being non invasive, reproducible and based on DNA, whose stability, in urine, is higher than that of proteins. The results of a large prospective study, recently publised in European Urology, have shown that the identification by MSP of 2 methylated genes, TWIST1 and NID2, in voided urine samples, is a sensitive (+/- 90%) and specific (+/- 93%) test for the detection of bladder cancer. The test is largely more sensitive than cytology while both techniques have similar specificity. Based on these promising results, we are currently evaluating this novel, non invasive MSP approach for the follow-up of patients with non-muscle invasive bladder cancer. [less ▲]

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See detailThe inside-out transobturator sling for the surgical treatment of post-radical prostatectomy urinary incontinence: Short term results of a prospective study
Waltregny, David ULg; Leruth, Julie ULg; de Leval, Jean ULg

in European Urology Supplements (2009), 4(8), 336

Introduction and Objective: To prospectively evaluate the short-term safety and efficacy of a new transobturator sling procedure for treating post-radical prostatectomy (RP) stress urinary incontinence ... [more ▼]

Introduction and Objective: To prospectively evaluate the short-term safety and efficacy of a new transobturator sling procedure for treating post-radical prostatectomy (RP) stress urinary incontinence (SUI). Methods: The sling technique uses specific instruments and a polypropylene mesh with 2 arms that are passed inside to outside through the obturator foramens, pulled for compressing the bulbar urethra upward, and tied to each other across the midline. Inclusion criteria were clinically and urodynamically demonstrated SUI, positive bulbar compression test, and signed informed consent. Patients with detrusor overactivity were excluded. Baseline and followup evaluations included uroflowmetry, and continence and quality of life (QoL) questionnaires. Cure was defined by no pad use and improvement by a number of pads/d ≤ 2 and reduced by at least 50%. Complications were recorded. Results: From 04/2006 through 10/2008, 70 consecutive patients who fulfilled inclusion and exclusion criteria underwent the sling procedure using the same operative protocol. As of October 2008, 55 and 35 patients who consecutively underwent the sling procedure were expected to have a minimum followup of 6 months and 1 year, respectively. Preoperatively, 13 (24%), 25 (45%), and 17 (31%) patients were using 2, 3 to 5, and >5 pads/d, respectively. Nine and 6 patients had undergone prior surgery for SUI and/or previous pelvic irradiation, respectively. The sling procedure was preceded by an endoscopic urethrotomy in 5 (9%) patients. No perioperative complication was noted. Seven (13%) patients required suprapubic catheterization; normal voiding resumed in all 7 patients except 1 who underwent urinary diversion for radiation-induced complete anastomotic stricture. Six-month and 1-year minimum followup was available on 51 (93%) and 33 (94%) patients, respectively (Table 1). Of note, at 6 months, among the 17 patients with preoperative severe incontinence (> 5 pads/day), 9 (53%) patients were cured and 6 others (35%) were improved (1 pad/d). Overall, QoL was significantly enhanced and 85% patients were moderately to completely satisfied with the procedure. Preoperative and postoperative max flow rate and postvoid residual values were not statistically different. No sling infection, urethra erosion, persistent pain or neurological complication was observed. No sling was withdrawn or cut. Conclusions: The inside-out transobturator sling procedure appears to be safe and efficient at short term. [less ▲]

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See detailThe inside-out transobturator sling for the surgical treatment of post-radical prostatectomy urinary incontinence: Interim results of a prospective, observational study after a 1-year minimum follow-up
Waltregny, David ULg; Leruth, Julie ULg; de Leval, Jean ULg

in Neurourology and Urodynamics (2009), 28(7), 687-688

Hypothesis / aims of study The aim of this study was to prospectively evaluate the short-term safety and efficacy of the inside-out transobturator sling procedure for treating post-radical prostatectomy ... [more ▼]

Hypothesis / aims of study The aim of this study was to prospectively evaluate the short-term safety and efficacy of the inside-out transobturator sling procedure for treating post-radical prostatectomy (RP) stress urinary incontinence (SUI). Study design, materials and methods The sling technique uses specific instruments and a polypropylene mesh with 2 arms that are passed inside to outside through the obturator foramens, pulled for compressing the bulbar urethra upward, and tied to each other across the midline. Intra-operative urodynamic evaluation is performed to record the urethral pressure profile (UPP) and to measure the abdominal leak point pressure (ALPP) and maximal urethral pressure (MUP) before and after sling tensioning. Urodynamic measurements are repeated until tension on both arms of the mesh increases ALPP to approximately 100 cm H2O. In case of associated urethral stenosis, classic endoscopic urethrotomy is performed first. Inclusion criteria were clinically and urodynamically demonstrated SUI, positive bulbar compression test, and signed informed consent. Patients with detrusor overactivity or active urinary infection were excluded. Baseline evaluation included detailed history, physical examination with a bulbar urethra compression test, urine analysis, multichannel urodynamics, administration of self-questionnaires assessing urinary continence (questions 1 through 3 of the urinary section of the UCLA-PCI-SF questionnaire (1)) and quality of life (QoL) (Ditrovie questionnaire (2)), flexible urethrocystoscopy, and urethrocystography. The degree of incontinence was arbitrarily categorized as mild (1–2 pads/day), moderate (3–5 pads/day) or severe (>5 pads/day), as previously described (3). Follow-up evaluation at 1, 6, 12 months, and yearly thereafter included physical examination, uroflowmetry with PVR measurement, and administration of the self-questionnaires assessing urinary continence and QoL. All patients were also asked to self-evaluate their satisfaction with the treatment. Cure was defined by no pad use and improvement by a number of pads/day ≤ 2 and reduced by at least 50%. Peri- and post-operative complications were recorded. Results From April 2006 through March 2009, 95 consecutive patients who fulfilled inclusion and exclusion criteria underwent the sling procedure using the same operative protocol. As of March 2009, 58 patients who consecutively underwent the sling procedure were expected to have a minimum follow-up of 1 year. Mean age of the patients was 67.6 ± 6.5 years (range 52-79). Mean body mass index was 27.0 ± 3.6 (range 21.3 – 39.0). Of the 58 patients, 9 (16%) patients had undergone prior surgery for SUI: bulking agent injection in 5 patients, prior sling implantation in 1 patient and artificial urinary sphincter (AUS) implantation in 4 patients. A previous urethrotomy or urethral dilatation for urethral stenosis had been performed in 8 (14%) patients and 8 (14%) patients had had pelvic irradiation. Preoperatively, 14 (24%), 26 (45%), and 18 (31%) patients were using 2 (mild SUI), 3 to 5 (moderate SUI), and >5 pads/day (severe SUI), respectively. The sling procedure was performed under general and spinal anesthesia in 22 (38%) and 36 (62%) patients, respectively, and was preceded by an endoscopic urethrotomy in 5 (9%) patients. Penile prostheses were implanted concomitantly to the sling in 2 patients. Before sling tensioning, mean MUP and ALPP were 40 ± 21 cm H2O (range 5-101) and 45 ± 22 cm H2O (range 10-100). After sling tensioning, mean MUP and ALPP were 89 ± 24 cm H2O (range 44-141) and 109 ± 26 cm H2O (range 60-165). Mean increase in MUP and ALPP between post- and pre-tensioning of the sling was 49 ± 29 cm H2O (range 1-125) and 64 ± 32 cm H2O (range 20-135), respectively. Mean operative time was 65 ± 18 minutes. No intra-operative complication was noted. Seven (12%) patients required suprapubic catheterization; normal voiding resumed in all 7 patients except 1 who underwent urinary diversion for complete radiation-induced anastomotic stenosis. Mild perineal hematoma not requiring therapy was observed in 6 patients. Six-month and 1-year minimum follow-up was available on 54 (93%) and 56 (96%) of the 58 patients, respectively (Table 1). Two patients were completely lost to follow-up after the 1-month visit. At this 1-month visit, one patient was cured while the other was improved. Table 1. Postoperative pad usage Follow-up 6-month visit 1-year visit Preoperative SUI severity / Outcome Mild to moderate SUI (≤5 pads/d) Severe SUI (> 5 pads/d) Entire cohort (≥ 2 pads/d) Mild to moderate SUI (≤ 5 pads/d) Severe SUI (> 5 pads/d) Entire cohort (≥ 2 pads/d) Cure 22 (55.0%) 9 (50.0%) 31 (53.5%) 23 (57.5%) 8 (44.5%) 31 (53.5%) Improvement 13 (32.5%) 5 (27.8%) 18 (31.0%) 14 (35.0%) 6 (33.3%) 20 (34.4%) Failure 1 (2.5%) 4 (22.2%) 5 (8.6%) 1 (2.5%) 4 (22.2%) 5 (8.6%) Data not available 4 (10.0%) 0 (0.0%) 4 (6.9%) 2 (5.0%) 0 (0.0%) 2 (3.5%) Of note, at 12 months, among the 18 patients with preoperative severe incontinence, 8 (44.5%) were cured and 6 (35%) others were improved. In addition, SUI cure/improvement rates appeared to be similar at the 6 and 12 months time points. The 3 failures included one patient who had undergone post-RP radiation therapy. This man later developed a complete urethral anastomotic closure and underwent cystectomy with transileal ureterostomy 9 months after the sling procedure. The two other failed patients had a vesico-urethral anastomotic stricture before sling implantation. Both patients were implanted with an AUS after the sling procedure. After cutting the mesh arms laterally to the bulb, the AUS cuff was placed without difficulty around the bulbar urethra. The 4th failed patient had undergone previous radiation therapy and had a bulbar urethral stenosis. He is now wearing penile collectors. The 5th patient had a vesico-urethral stenosis that underwent urethrotomy just before the sling implantation. The patient has been offered the placement of an artificial urinary sphincter. Preoperative and postoperative max flow rate and postvoid residual values were not different (Table 2). Overall, QoL was substantially enhanced and 85% patients were satisfied with the procedure. Table 2. Postoperative evolution of QoL scores and voiding parameters QoL and voiding parameters Baseline (mean ± SD [range]) 6-month visit (mean ± SD [range]) 1-year visit (mean ± SD [range]) Ditrovie QoL scores (scale from 10 [best] to 50 [worst]) 32 ± 7 (17-50) 16 ± 8 (10-40) 17 ± 8 (10-42) Max flow rate (mL/sec) 20 ± 9 (6-46) 18 ± 9 (6-44) 17 ± 10 (4-51) Post void residual (mL) 17 ± 32 (0-160) 21 ± 51 (0-243) 6 ± 21 (0-87) No sling infection, urethra erosion, persistent pain or neurological complication was observed. No sling was withdrawn or cut. Interpretation of results The inside-out transobturator sling was associated with a minimal risk of intra- and post-operative complications. Postoperative SUI cure/improvement rates were found to remain stable over a 1-year period. The sling procedure appeared to be efficient at short term even in the group of patients with severe SUI before surgery. The sling procedure does not compromise concomitant penile prostheses or subsequent AUS implantation. Longer follow-up times are required to determine the long-term efficacy of this sling procedure. Concluding message The one-year results of this prospective study suggest that the inside-out transobturator sling is a safe and efficient surgical procedure at short term for the treatment of post-RP SUI. [less ▲]

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See detailThe TVT-obturator surgical procedure for the treatment of female stress urinary incontinence: a clinical update.
Waltregny, David ULg; De Leval, Jean ULg

in International Urogynecology Journal & Pelvic Floor Dysfunction (2009), 20(3), 337-48

Six years ago, the inside-out transobturator tape TVT-O procedure was developed for the surgical treatment of female stress urinary incontinence (SUI) with the aim of minimizing the risk of urethra and ... [more ▼]

Six years ago, the inside-out transobturator tape TVT-O procedure was developed for the surgical treatment of female stress urinary incontinence (SUI) with the aim of minimizing the risk of urethra and bladder injuries and ensuring minimal tissue dissection. Initial feasibility and efficacy studies suggested that the TVT-O procedure is associated with high SUI cure rates and low morbidity at short term. A recent analysis of medium-term results indicated that the TVT-O procedure is efficient, with maintenance, after a 3-year minimum follow-up, of cure rates comparing favorably with those reported for TVT. No late complications were observed. As of July 2008, more than 35 clinical papers, including ten randomized trials and two national registries, have been published on the outcome of the TVT-O surgery. Results from these studies have confirmed that the TVT-O procedure is safe and as efficient as the TVT procedure, at least in the short/medium term. [less ▲]

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See detailTVT-O for the Treatment of Female Stress Urinary Incontinence: Results of a Prospective Study after a 3-Year Minimum Follow-Up
Waltregny, David ULg; Gaspar, Yves; Hamida, Wissem et al

in European Urology (2008), 53(2), 401-8

OBJECTIVES: Medium-term results of transobturator tapes for the treatment of female stress urinary incontinence (SUI) are largely unknown. We analyzed the 3-yr results of a prospective, observational ... [more ▼]

OBJECTIVES: Medium-term results of transobturator tapes for the treatment of female stress urinary incontinence (SUI) are largely unknown. We analyzed the 3-yr results of a prospective, observational study designed to evaluate the safety and efficacy of the TVT-O procedure. METHODS: Preoperative and postoperative evaluations included physical examination, uroflowmetry and postvoid residual (PVR) measurement, and urinary symptoms and quality of life (QoL) questionnaires. Data were compared by means of the Wilcoxon matched pairs test. RESULTS: Between March 2003 and December 2003, 102 consecutive patients with clinical and urodynamic diagnoses of SUI who fulfilled inclusion and exclusion criteria underwent the TVT-O procedure; the latter was associated with pelvic organ prolapse treatment in 16 patients (15.7%). Three-year minimum follow-up (median, 40 mo) was available for 91 patients (89.2%). No erosion or persistent pain was noted. Four patients required tape release or section. Disappearance and improvement of SUI were observed in 88.4% and 9.3% of the patients, respectively. These cure rates were similar to those obtained 1 yr after the operation (p=0.55). Frequency and urge symptoms were improved at 3 yr (p<0.005). Whereas maximum flow rates were somewhat decreased (p=0.01), the severity of obstructive symptoms and PVR volumes were not statistically different (p=0.11 and p=0.32, respectively). Incontinence severity and QoL scale scores were largely better than preoperative ones (p<0.001) and did not differ from those reported at 1 yr (p=0.15 and p=0.08, respectively). CONCLUSIONS: The TVT-O procedure is a safe and efficient treatment of female SUI, with maintenance of high cure rates after a 3-yr minimum follow-up. [less ▲]

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See detailThe inside-out trans-obturator sling: a novel surgical technique for the treatment of male urinary incontinence
de Leval, Jean ULg; Waltregny, David ULg

in European Urology (2008), 54(5), 1051-65

OBJECTIVES: To describe a new sling procedure for treating stress urinary incontinence (SUI) after radical prostatectomy (RP) and prospectively evaluate its short-term safety and efficacy. METHODS: The ... [more ▼]

OBJECTIVES: To describe a new sling procedure for treating stress urinary incontinence (SUI) after radical prostatectomy (RP) and prospectively evaluate its short-term safety and efficacy. METHODS: The sling technique uses specific instruments and a polypropylene mesh with two arms that are passed inside to outside through the obturator foramens, pulled for compressing the bulbar urethra upward, and tied to each other across the midline. Patients with detrusor overactivity were excluded. Baseline and follow-up evaluations included uroflowmetry and continence and quality of life (QoL) questionnaires. Cure was defined by no pad use and improvement by a number of pads/d <or=2 and reduced by at least 50%. Complications were recorded. RESULTS: From April 2006 through February 2007, 20 consecutive patients suffering from post-RP SUI underwent the sling procedure using the same operative protocol. Preoperatively, 3 (15%), 11 (55%), and 6 (25%) patients were using 2, 3-5, and >5pads/d, respectively. The procedure was preceded by an endoscopic urethrotomy in four patients. No perioperative complication was noted; three patients required suprapubic catheterization. At 6 mo, nine (45%) patients were cured and eight others (40%) were improved (1pad/d). QoL was significantly enhanced and 80% of patients were moderately to completely satisfied with the procedure. Preoperative and postoperative maximum flow rate and postvoid residual values were not statistically different. No sling infection, urethra erosion, persistent pain, or neurologic complications were observed. CONCLUSIONS: The inside-out trans-obturator sling procedure appears to be safe and efficient at short term. Further studies are warranted to determine long-term outcome. [less ▲]

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See detailThe inside-out transobturator sling for the treatment of male urinary incontinence
de Leval, Jean ULg; Waltregny, David ULg

in Journal of Urology (The) (2008), 179(4), 123

Introduction and objective: <br />Sling procedures are currently re-emerging as an attractive alternative to the artificial urinary sphincter for the treatment of post-radical prostatectomy (RP) stress ... [more ▼]

Introduction and objective: <br />Sling procedures are currently re-emerging as an attractive alternative to the artificial urinary sphincter for the treatment of post-radical prostatectomy (RP) stress urinary incontinence (SUI), given that they are inexpensive, nonmechanical and allow for physiological voiding without significant obstruction. The aim of this study was to describe a novel transobturator sling procedure for treating post-RP SUI, and to prospectively evaluate its short-term safety and efficacy. <br /> <br />Methods: <br />The inside-out transobturator sling technique used specific instruments and a polypropylene mesh with 2 arms that were passed inside to outside through the obturator foramens, pulled for compressing the bulbar urethra upward, and then tied to each other across the midline. Perioperative dual channel urodynamic studies were repeated until tension on both arms of the mesh increased abdominal leak point pressure to approximately 100 cm H2O. The two mesh arms were then tied to each other for maintaining bulbar urethra compression. Patients with detrusor overactivity were excluded. Baseline and followup evaluations included uroflowmetry, and continence, quality of life (QoL), and satisfaction questionnaires. Cure was defined by no pad use and improvement by a number of pads/day ≤2 and reduced by at least 50%. Complications were recorded. The video also illustrates anatomic and physiopathologic differences between male and pelvis in relation with transobturator tapes. <br /> <br />Results: <br />From April 2006 through February 2007, 20 consecutive patients suffering from post-RP SUI underwent the sling procedure using the same operative protocol. Preoperatively, 3 (15%), 11 (55%), and 6 (25%) patients were using 2, 3 to 5, and more than 5 pads/day, respectively. The procedure was preceded by an endoscopic urethrotomy in 4 patients. No perioperative complication was noted; 3 patients required suprapubic catheterization. At 6 months, 9 (45%) patients were cured and 8 others (40%) were improved (1 pad/day). QoL was significantly enhanced and 80% patients were moderately to completely satisfied with the procedure. Preoperative and postoperative max flow rate and postvoid residual values were not statistically different. No sling infection, urethra erosion, persistent pain or neurological complication was observed. <br /> <br />Conclusions: <br />The inside-out transobturator sling procedure appears to be safe and efficient at short term. Further studies are warranted to determine long term outcome. [less ▲]

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