References of "de Leval, Jean"
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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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See detailActualités therapeutiques en urologie. Le TVT-O, nouvelle technique mini-invasive pour le traitement de l'incontinence urinaire d'effort féminine, développements et expérience clinique
de Leval, Jean ULg; Bonnet, Pierre ULg; Waltregny, David ULg

in Revue Médicale de Liège (2007), 62 Spec No

Tension-free sub-urethral tapes have revolutionized the surgical treatment of female stress urinary incontinence for the past decade. The inside-out transobturator approach, developed in our Institution 5 ... [more ▼]

Tension-free sub-urethral tapes have revolutionized the surgical treatment of female stress urinary incontinence for the past decade. The inside-out transobturator approach, developed in our Institution 5 years ago, is currently being utilized worldwide. The technique is simple and reproducible and the incidence of complications is minimized. Stress urinary incontinence cure rates of almost 90% are achieved after a 3-year minimum follow up. These good results have been confirmed in the international literature. [less ▲]

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See detailDevelopment of urine-based DNA methylation assay for prostate cancer screening
Vener, T. I.; Derecho, C.; Varde, S. et al

Poster (2007)

Introduction: The best outcome for patients with prostate cancer (PCa) is seen for those treated at an early stage of the disease. A digital rectal examination (DRE) and the measurement of serum prostate ... [more ▼]

Introduction: The best outcome for patients with prostate cancer (PCa) is seen for those treated at an early stage of the disease. A digital rectal examination (DRE) and the measurement of serum prostate specific antigen (PSA) levels are the current standards for PCa early detection. However, serum PSA testing lacks both sensitivity and specificity, and core biopsies frequently fail to identify small foci of PCa. The availability of non-invasive diagnostic molecular tests that could allow for a more precise identification of malignant prostate cells in asymptomatic men would be of great clinical value to improve PCa diagnosis. Study design: 114 men scheduled to undergo a prostate biopsy were enrolled in the study. The biopsies were triggered either by an abnormally high PSA value or by suspicious findings on DRE. Patients with other known or suspected urinary malignancy were excluded from the study. Morning, post-prostate massage and post-biopsy urine samples were collected from all individuals. The main goals of this study were a) to determine if prostate massage can improve the prostate DNA quantity compared to urine collected in the morning or after biopsy, and b) to evaluate the methylation status of a gene panel in urine samples from subjects with cancer found in prostate biopsy tissue cores versus subjects without cancer. Methods: Gene promoter methylation is associated with prostate cancer and has been successfully used for the molecular detection of neoplasia in urine. We have developed real-time methylation specific PCR assays to define the methylation status of several genes. Results: Median age of the patients was 65 years (range 48-85). PCa was found in 51% of the patients. Histological diagnosis of the biopsies was compared to methylation results in urine from 102 samples (89% success rate due low DNA yields for 12 samples). The comparison between different urine sampling techniques showed that prostate massage is needed. The best results were obtained in post massage urine samples with a combination of GSTP1, p14, p16, RARβ2 and RASSF1A resulting in a sensitivity of 74% and a specificity of 75%. Future: A multiplex assay using the Cepheid SmartCycler™ II platform is under development. Further studies are in progress to validate the assay across multiple centers. [less ▲]

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See detail192ir Low Dose Rate Brachytherapy for Boosting Locally Advanced Prostate Cancers after External Beam Radiotherapy: A Phase Ii Trial
Nickers, Philippe ULg; Coppens, Luc ULg; De Leval, Jean ULg et al

in Radiotherapy & Oncology (2006), 79(3), 329-34

BACKGROUND AND PURPOSE: To evaluate on 201 locally advanced prostatic cancers prospectively treated in a phase II trial, the efficacy of a combination of external beam radiotherapy (39.6 Gy) and (192)Ir ... [more ▼]

BACKGROUND AND PURPOSE: To evaluate on 201 locally advanced prostatic cancers prospectively treated in a phase II trial, the efficacy of a combination of external beam radiotherapy (39.6 Gy) and (192)Ir low dose rate brachytherapy (Bt) (40-45 Gy). PATIENTS AND METHODS: Sixty-four patients were included in the intermediate prognosis group with only one of the following adverse factors (PSA > 10 ng/ml, Gleason score > or = 7 or clinical stage > or =T2b) and 137 in the unfavourable group when at least two of these factors were present. RESULTS: The actuarial 4 years biochemical no evidence of disease is 82.8% for the entire population. It is, respectively, 97 and 76% in the intermediate and unfavourable prognosis groups (P < 0.0001). Grade > or =3 late urinary complications occurred in 13 patients (6.5%). Eight patients (4%) presented late grade 2 rectal complications but no grades 3-5 was observed. CONCLUSIONS: Even if an alpha/beta of 1.5-3 Gy theoretically favours the use of a high dose rate mode of irradiation, the early results presented here are as good as those reported for similar groups of patients with high dose rate treatments. Late toxicity is identical but our urinary toxicity is within the less favourable and rectal toxicity within the most favourable results. We can postulate that while inducing very high hyperdosage regions (V150) mainly focused on the peripheral zone, most of the Bt techniques consist of a more ablative treatment. Many of the radiobiological studies on Bt did not in fact take into account the heterogeneity of irradiation inside the CTV. This study highlights the need to explore pulsed dose rate therapies, permanent implant and new available radioisotopes such as (169)Ytterbium that will offer the safety of low and lower dose rates. The actual late toxicity of the different Bt techniques is not yet inexistent indeed. [less ▲]

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See detailInside out transobturator vaginal tape for the treatment of female stress urinary incontinence: Interim results of a prospective study after a 1-year minimum followup
Waltregny, David ULg; Reul, Olivier ULg; Mathantu, Balombi et al

in Journal of Urology (The) (2006), 175(6), 2191-2195

Purpose: We analyzed the results of a prospective, observational trial designed to assess the safety and efficacy of the TVT-O procedure for female SUI. Materials and Methods: Preoperative and ... [more ▼]

Purpose: We analyzed the results of a prospective, observational trial designed to assess the safety and efficacy of the TVT-O procedure for female SUI. Materials and Methods: Preoperative and postoperative evaluations included physical examination, and urinary symptom and quality of life scale questionnaires. Results: Between March 2003 and December 2004, 253 patients with clinical and urodynamic diagnoses of SUI who fulfilled inclusion and exclusion criteria were enrolled in the trial and underwent the TVT-O procedure. No significant intraoperative complications were observed. One-year minimum followup was available on 99 of the initial 102 patients, of whom 16 had undergone concomitant pelvic organ prolapse surgical treatment. The SUI complete cure rate was 91%. No patient had vaginal or urethral erosion. Four patients required tape release or section. Frequency and urge symptoms improved after the operation (p < 0.001). The severity of obstructive symptoms slightly increased postoperatively in the group of patients who did not undergo associated pelvic organ prolapse treatment (p < 0.05), while maximum flow rates somewhat decreased (p < 0.001) and post-void residual urine volumes somewhat increased (p < 0.005). Most patients reported a significant decrease in incontinence severity and improvement in quality of life (p < 0.0001). Conclusions: The results of this study, which suggest that the TVT-O procedure is a safe and efficient surgical treatment for female SUI, warrant further comparative evaluation of this procedure with retropubic and outside in transobturator approaches in appropriately designed, prospective, randomized trials. [less ▲]

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See detailLipomatose pelvienne associee a une cystite glandulaire: rapport de deux cas
Leruth, Elisabeth; Coppens, Luc ULg; Andrianne, Robert ULg et al

in Progrès en Urologie (2005), 15(1), 81-4

The authors report two cases of pelvic lipomatosis associated with glandular cystitis. This is a rare disease with variable and nonspecific clinical features. Complementary investigations useful for the ... [more ▼]

The authors report two cases of pelvic lipomatosis associated with glandular cystitis. This is a rare disease with variable and nonspecific clinical features. Complementary investigations useful for the diagnosis of pelvic lipomatosis are CT and especially MRI, intravenous urography and biopsies. The clinical features, radiological findings and therapeutic approach are discussed in the light of a review of the literature. [less ▲]

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See detailInside-out Transobturator Vaginal Tape (TVT-O): one-year results of a prospective study
Waltregny, David ULg; Reul, Olivier ULg; Keppenne, Véronique ULg et al

in European Urology Supplements (2005), 4(3), 1653

Title Inside-out transobturator vaginal tape (TVT-O): One-year results of a prospective study Introduction and Objectives The aim of this study was to prospectively assess the efficacy of a new surgical ... [more ▼]

Title Inside-out transobturator vaginal tape (TVT-O): One-year results of a prospective study Introduction and Objectives The aim of this study was to prospectively assess the efficacy of a new surgical technique, the inside-out transobturator vaginal tape (TVT-O), for the treatment of female stress urinary incontinence (SUI). Study design, materials and methods From 03/2003 through 10/2003, a TVT-O tape was inserted in 83 consecutive patients with clinical evidence of SUI. Preoperative evaluation included complete history, physical examination, urodynamics, urine analysis, and cystoscopy. None of the patients presented the following exclusion criteria: post-void residual (PVR) >100 cc, detrusor overactivity or acontractility, pregnancy, neurological pathology, active urinary or vaginal infection, age >85 years, negative stress test, and maximum cystometric capacity <300 mL. Post-operative evaluation was carried out using symptom scoring and quality of life (QoL) questionnaires, visual analog scales, physical examination, uroflowmetry, and PVR measurement. Cure was defined as no leakage based on both symptom scale scoring and physical examination. Improvement was defined as ≥50% decrease in symptoms based on the questionnaire’s results. Results Mean age of the patients was 61 years. The TVT-O procedure was associated with pelvic organ prolapse cure in 15 patients (18%). Follow-up time was ≥12 months in all women (mean = 13.6); 3 patients were lost to follow-up. No significant blood loss (≥100 cc), vaginal wall, urethral, or bladder perforation was encountered. No hematoma, vaginal or urethral erosion, or neurological complication was observed. No patient complained of persistent pain. At the latest follow-up visit, max flow rate was ≥10 mL/sec and PVR was <100 cc in 90% and 94% patients, respectively. Two patients underwent an immediate tape release procedure while the tape was sectioned in 2 other patients for retention and/or urgency associated with obstruction. Sixty eight patients (85%) were cured of their SUI while 9 patients (11%) were improved. Urgency questionnaire’s results showed that 5 (5/46) patients developed de novo urgency. Twenty and 14 out of the 34 patients with preoperative urge symptoms reported either disappearance or no change of urgency, respectively. Obstruction symptoms appeared or worsened in 3 patients and were unchanged or decreased in all other patients. Analysis of the incontinence visual analog and QoL scale scores showed that the majority of patients reported disappearance of incontinence together with significant improvement of their QoL. Conclusions The one-year results of this study suggest that TVT-O is associated with a low incidence of peri- and post-operative complications and high objective and subjective SUI cure rates. [less ▲]

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See detailTransobturator tape for sling procedures
Waltregny, David ULg; Reul, Olivier ULg; Bonnet, Pierre ULg et al

in AUANews (2005), 10

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See detailNew surgical technique for treatment of stress urinary incontinence TVT-Obturator: New developments and results
de Leval, Jean ULg; Waltregny, David ULg

in Surgical Technology International (2005), 14

A new surgical technique, the inside-out transobturator tension-free urethral suspension (TVT-Obturator), has been developed for treatment of women suffering from stress urinary incontinence (SUI). This ... [more ▼]

A new surgical technique, the inside-out transobturator tension-free urethral suspension (TVT-Obturator), has been developed for treatment of women suffering from stress urinary incontinence (SUI). This simple procedure uses specifically designed surgical instruments to allow the accurate passage of a synthetic tape from underneath the urethra, through the obturator foramens, toward the thigh folds, with the tape being positioned without tension under the junction between mid and distal urethra. Cadaver dissection studies have demonstrated that the anatomical trajectory of the tape in tissues is strictly perineal and consistently coursed away from neighboring neurovascular structures, including the obturator, femoral, and saphenous nerves and vessels, as well as the pudendal nerve. Consequently, as opposed to retropubic sling systems, no perioperative cystoscopy is required because the TVT-O tape does not enter the pelvic region at any time during the procedure. These anatomical data, which suggest the TVT-O technique is safe, have been corroborated by initial clinical experience. Our feasibility and ongoing efficacy studies have shown that TVT-O is associated with a low incidence of perioperative and postoperative complications. In our current series of more than 500 consecutive patients treated with TVT-O, no injury to the bladder or urethra was encountered and no perineal or obturator hematoma, heavy bleeding, or neurological complication was observed. Medium-term results have suggested that TVT-O is as efficient as retropubic tension-free slings for treatment of female SUI, with +/-90% complete cure rates after one-year follow up. [less ▲]

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See detailTransobturator vaginal tape inside out for the surgical treatment of female stress urinary incontinence: anatomical considerations.
Bonnet, Pierre ULg; Waltregny, David ULg; Reul, Olivier ULg et al

in Journal of Urology (The) (2005), 173(4), 1223-8

PURPOSE: We have recently described a novel surgical technique for female stress urinary incontinence, that is the transobturator vaginal tape inside out, which uses specific instruments for the passage ... [more ▼]

PURPOSE: We have recently described a novel surgical technique for female stress urinary incontinence, that is the transobturator vaginal tape inside out, which uses specific instruments for the passage of a synthetic tape from beneath the urethra toward the thigh folds. Herein we report the results of cadaver dissection performed to determine the anatomical trajectory of the tape and its relationships with neighboring neurovascular structures and organs. MATERIALS AND METHODS: Insertion of the transobturator vaginal tape inside out tape was performed by different surgeons in 12 freshly frozen female cadavers according to the standard procedure. The thigh, obturator, perineal and pelvic regions were dissected and tape trajectory was recorded. An additional cadaver was dissected without prior tape placement. RESULTS: The tape was inserted according to a certain consistent path, that is penetration from the suburethral space into a strictly perineal region limited medial and cranial by the levator ani muscle, caudal by the perineal membrane and lateral by the obturator internus muscle. This region corresponded to the most anterior recess of the ischiorectal fossa. The tape then perforated the obturator membrane and muscles, and exited through the skin after traversing adductor muscles and subcutaneous tissue. The tape was coursed away from 1) the dorsal nerve to the clitoris located more superficially below the perineal membrane, 2) the obturator nerve and vessels, and 3) the saphenous and femoral vessels. CONCLUSIONS: These findings strongly suggest that our transobturator technique is highly accurate, reproducible and safe, and it does not require perioperative cystoscopy. [less ▲]

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See detailRéponse à : Chirurgie de l'incontinence urinaire a l'effort feminine par voie transobturatrice: dehors dedans ou dedans dehors? etude anatomique comparative.
de Leval, Jean ULg; Bonnet, Pierre ULg; Waltregny, David ULg et al

in Progrès en Urologie : Journal de l'Association Française d'Urologie et de la Société Française d'Urologie (2005), 15(6), 1161-2

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