References of "LERUTH, Julie"
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See detailIncidence and risk factors of postoperative stress urinary incontinence following laparoscopic sacrocolpopexy in patients with negative preoperative prolapse reduction stress testing
LERUTH, Julie ULg; FILLET, Marc ULg; Waltregny, David ULg

in International Urogynecology Journal & Pelvic Floor Dysfunction (2013), 24(3), 485-491

Introduction and hypothesis: The objectives of this study were to evaluate the incidence of postoperative stress uri- nary incontinence (SUI) after laparoscopic sacrocolpopexy (LSCP) in women with ... [more ▼]

Introduction and hypothesis: The objectives of this study were to evaluate the incidence of postoperative stress uri- nary incontinence (SUI) after laparoscopic sacrocolpopexy (LSCP) in women with negative preoperative prolapse re- duction stress testing (PPRST) and to identify associated risk factors. Methods: This was a retrospective cohort study comprising women who consecutively underwent double-mesh LSCP without concomitant SUI surgery after a negative PPRST at a tertiary referral center. Negative PPRST was defined by the absence of SUI during cough testing and urodynamic studies with prolapse reduction. Results: Fifty-five patients were assessed in the final analy- sis. No significant complication was encountered during and after LSCP. Mean follow-up was 25±11 (range 12–48) months. No patient developed recurrent pelvic organ pro- lapse (POP) or mesh erosion at last follow-up. Thirty (54.5 %) patients reported the symptom of SUI (subjective SUI) postoperatively, 13 (23.6 %) had a positive cough test (objective SUI) at last visit, and nine (16.4 %) underwent a sling procedure. In univariate analyses, advanced cystocele (stage 3–4) and a history of patient-reported SUI before surgery were associated with a higher risk of postoperative subjective and objective SUI after LSCP. Multivariate anal- yses identified preoperative SUI as the sole independent predictor of subjective SUI [risk ratio (RR04.03; 95% con- fidence interval (CI)01.16–14.09), objective SUI, (RR0 4.67; 95% CI01.14–19.23), and subsequent anti-SUI sur- gery after LSCP (RR06.17; 95% CI01.30–29.41). Conclusions: SUI is far from uncommon in women after LSCP despite negative PPRST, especially in those with advanced cystocele and a history of SUI preoperatively; after at least 1 year of follow-up, approximately one in six women eventually underwent a sling surgery. These data are useful for counseling patients. [less ▲]

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See detailThe Inside-Out Transobturator Male Sling for the Surgical Treatment of Stress Urinary Incontinence After Radical Prostatectomy: Midterm Results of a Single-Center Prospective Study.
LERUTH, Julie ULg; Waltregny, David ULg; de Leval, Jean ULg

in European Urology (2012), 61(3), 608-615

BACKGROUND: Transobturator slings are currently promoted for the treatment of stress urinary incontinence (SUI) after radical prostatectomy (RP), but data on outcome remain limited. OBJECTIVE: To assess ... [more ▼]

BACKGROUND: Transobturator slings are currently promoted for the treatment of stress urinary incontinence (SUI) after radical prostatectomy (RP), but data on outcome remain limited. OBJECTIVE: To assess, at midterm, the efficacy and safety of the inside-out transobturator male sling for treating post-RP SUI and to determine factors associated with failure. DESIGN, SETTING, AND PARTICIPANTS: Prospective one-center trial involving 173 consecutive patients without detrusor overactivity, treated between 2006 and 2011 for SUI following RP. INTERVENTION: Placement of an inside-out transobturator sling. MEASUREMENTS: Baseline and follow-up evaluations included uroflowmetry and continence and quality-of-life (QoL) questionnaires. Cure was defined as no pad use and improvement as a number of pads per day reduced by >/=50% and two or fewer pads. Complications were recorded, and factors associated with treatment failure were evaluated. RESULTS AND LIMITATIONS: Preoperatively, 21%, 35%, and 44% of the patients were using two, three to five, and more than five pads per day, respectively. After a median follow-up of 24 mo (range: 12-60 mo), 49% were cured, 35% improved, and 16% not improved. QoL was enhanced (p<0.001), and 72% of patients were moderately to completely satisfied with the procedure. Maximum flow rates were slightly reduced (p=0.004); postvoid residual volumes were similar (p=0.097). Complications were urinary retention after catheter removal (15%), perineal/scrotal hematoma (9%), pain lasting >6 mo (3%), and sling infection (2%); all were managed conservatively. Severe SUI before sling surgery was not associated with a worse outcome, whereas obesity and a history of pelvic irradiation or bladder neck stenosis were independent risk factors of failure, with risk ratios of 7.9 (95% confidence interval [CI], 3.3-18.9), 3.3 (95% CI, 1.4-7.8), and 2.6 (95% CI, 1.1-6.5), respectively. CONCLUSIONS: The inside-out transobturator male sling is an efficient and safe treatment for post-RP SUI at midterm. Patients with prior pelvic irradiation may not be suitable candidates. [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 detailComparison of inflammatory responses after off-pump and on-pump coronary surgery using surface modifying additives circuit
Quaniers, Janine ULg; Leruth, Julie ULg; Albert, Adelin ULg et al

in Annals of Thoracic Surgery (2006), 81(5), 1683-1690

Background. Cardiac surgery is followed by various degrees of inflammation, which have harmful consequences. Because of the central role of extracorporeal circulation ( EC), off- pump coronary bypass ... [more ▼]

Background. Cardiac surgery is followed by various degrees of inflammation, which have harmful consequences. Because of the central role of extracorporeal circulation ( EC), off- pump coronary bypass surgery is deemed preferable. Do different modalities of EC challenge this view? Methods. Four groups of similar patients underwent coronary surgery: ( group 1) on- pump, EC with closed surface modifying additives ( SMA) circuit and no pump suckers ( n = 20); ( group 2) on- pump, EC with open SMA circuit and pump suckers ( n = 20); ( group 3) off- pump ( beating heart) and heparin 3 mg/ kg ( n = 20); ( group 4) off- pump ( beating heart) and heparin 1 mg/ kg ( n = 20). Interleukins ( IL)- 6, IL- 8, IL- 10, myeloperoxidase, elastase, and terminal complex of the complement ( TCC) were analyzed at various times: at induction ( time I); after heparin ( time II); after complete revascularization ( time III); after protamine ( time IV); and 24 hours later ( time V). Results. The TCC was significantly higher in groups 1 and 2 at time III. The pattern of IL- 6 was the same for the four groups. No significant difference in myeloperoxydase content was noted; however, elastase was significantly higher in the two EC ( on- pump) groups. Conclusions. Except for the complement system and elastase, on- pump surgery with SMA- coated circuits did not elicit any greater inflammatory response than off-pump surgery. [less ▲]

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