Benoit Peyronnet

Objectifs : Décrire les spécificités des troubles vésico-sphinctériens des patients spina bifida, leur impact sur la mortalité et l’intérêt d’outils diagnostiques alternatifs à l’urodynamique pour l’évaluation du régime de pression vésicale dans cette population. Méthodes : une cohorte prospective a été utilisée pour décrire les troubles vésico-sphinctériens des patients spina bifida et une étude épidémiologique nationale sur la base PMSI a été effectuée pour évaluer l’implication des causes urologiques sur la mortalité de cette population. Une étude prospective a été menée pour évaluer le rôle des marqueurs urinaires et de la radiomique dans l’évaluation du régime de pression vésicale chez les patients spina bifida. Résultats: Les troubles vésico-sphinctériens se caractérisent par la forte prévalence de troubles de la compliance et haut régime de pression vésicale. Les pathologies urologiques sont ainsi la première cause de mortalité des patients spina bifida en France. Le TIMP 2 et le MMP-2 urinaire ont associés à l’hypocompliance vésicale et le TIMP 2 urinaire a des performances diagnostiques légèrement supérieure aux paramètres urodynamiques pour l’atteinte du haut appareil urinaire. Le profil des marqueurs urinaires em cas d’hyperactivité détrusorienne diffèrent entre les spina bifida et les autres pathologies neurologiques en particulier pour les marqueurs de remodelage de la matrice extracellulaire tel le TGFβ-1. La radiomique, en particulier l’analyse de texture scanner est associé à certains paramètres urodynamiques et pourrait permettre l’évaluation du régime de pression vésicale chez les patients spina bifida. Conclusion: Les patients spina bifida présentent des troubles vésico-sphinctériens singuliers et sévères dont le remodelage de la matrice extracellulaire semble être un déterminant physiopathologique important. Un évaluation multimodale du régime de pression vésicale incluant les biomarqueurs urinaires et la radiomique pourrait permettre d’optimiser la prise en charge.

Objectives: To compare the outcomes of open versus robotic ureteral reimplantation procedures at a single centre. Material and methods: The charts of all patients with ureteral strictures who underwent open ureteral reimplantation between 2005 and 2024, and those who underwent robotic reimplantation between 2013 and 2024, were retrospectively reviewed, and the outcomes of the two approaches were compared. Results: Eighty patients were included in the final analysis: 45 in the open surgery group and 35 in the robotic group. After a median follow‐up duration of 16,5 months for the open group and 10 months for the robotic group, the stricture recurrence rate was similar in both groups (6,8% vs. 8.6%; p = 0.99). In terms of long‐term complications, there were similar rates of symptomatic reflux (4.4% vs. 5.7%; p = 0.99) and flank pain (8.9% vs. 8.6%; p = 0.99) between both groups. There were more recurrent urinary tract infections in the open group (17.8% vs. 8.6%) and more de novo lower urinary tract symptoms in the robotic group (11.4% vs. 2.2%), but these differences were not statistically significant (p = 0.33 and p = 0.16, respectively). Overall, 30 patients (38%) had at least one long‐term complication (35.6% vs 40%; p = 0.82). The only variable significantly associated with the risk of stricture recurrence was radiotherapy (OR = 11.2; p = 0.01). Conclusion: The robotic approach appears to be non‐inferior to the open approach in terms of stricture recurrence while being associated with a shorter length of hospital stay and lower estimated blood loss. More importantly, the present series raises questions regarding the long‐term consequences of ureteral reimplantation and confirms the higher risk of failure in radiated patients.

Introduction: Overactive bladder (OAB) is a prevalent and potentially debilitating syndrome that significantly impairs quality of life. Mirabegron and vibegron are β ₃ -adrenoceptor (β ₃ AR) agonists that provide a different mechanism of action to antimuscarinic medications. Vibegron has high β ₃ AR selectivity and enhances detrusor relaxation without compromising voiding function. This review summarises the clinical and real-world evidence supporting the efficacy, safety and patient-reported benefits of vibegron in OAB. Methods: A comprehensive search of the PubMed database was conducted in December 2024 using the keyword "vibegron". This search yielded 123 entries, which were subsequently screened by title for relevance to the objectives of this narrative review. All relevant articles identified through this process were included. Results: Pivotal phase III trials have demonstrated significant reductions in urgency, urinary frequency and urgency urinary incontinence with vibegron, with rapid onset of action and a more favourable tolerability profile than antimuscarinics. The benefits of vibegron were consistent across diverse patient populations, including older adults and those with concomitant benign prostatic hyperplasia. Real-world data further suggest that vibegron is associated with improved adherence and persistence compared with other OAB therapies. Additionally, cardiovascular safety studies confirm that vibegron has no clinically significant effects on blood pressure or heart rate. While comparative trials with mirabegron indicate similar efficacy, vibegron’s higher β ₃ AR selectivity and lack of cytochrome P450 interactions offer advantages in specific patient groups. Ongoing research, including real-world phase IV studies, aims to further define the long-term effectiveness and safety of vibegron in clinical practice. Conclusion: Vibegron represents an important advance in the pharmacologic management of OAB, providing a well-tolerated and effective alternative to existing therapies.

Background: The artificial urinary sphincter has been an effective treatment for stress urinary incontinence caused by intrinsic sphincter deficiency in women. However, the use of this device has been limited by the technical difficulties and risks associated with the open implantation procedure. Preliminary studies using robotic techniques have shown promising results, but only one small study has compared robotic to open procedures. This study aims to compare the outcomes of robotic and open artificial urinary sphincter implantation in women with stress urinary incontinence due to intrinsic sphincter deficiency in a large multicenter cohort. Methods: Data were collected retrospectively from female patients who underwent open or robot-assisted artificial urinary sphincter implantation from 2006 to 2020 at 12 urology departments. The primary outcome was the rate of complications within 30 days after surgery, graded using the Clavien-Dindo Classification. Perioperative and functional outcomes were compared between the two groups. Results: A total of 135 patients were included, with 71 in the robotic group and 64 in the open group. The open group had a higher rate of intraoperative complications (27.4% vs. 12.7%; p = 0.03) and postoperative complications (46.8% vs. 15.5%; p < 0.0001). More patients in the robotic group achieved full continence (83.3% vs. 62.3%; p = 0.01). The open group had higher explantation (27.4% vs. 1.4%; p < 0.0001) and revision rates (17.5% vs. 5.6%; p = 0.02). The estimated 1-year explantation-free survival rate was higher in the robotic group. (98.6% vs. 78.3%; p = 0.001). Conclusions: Robot-assisted implantation may reduce perioperative morbidity and improve functional outcomes compared to open implantation in women with stress urinary incontinence.

Background and Objective: The aim of the present report was to provide an overview of the use of the artificial urinary sphincter (AUS) in adult females with stress urinary incontinence (SUI) over the past 50 years. Methods: A literature search was conducted in December 2022 and January 2023 using the MEDLINE and Embase databases, screening for randomized controlled trials (RCTs), prospective and retrospective series and reviews on AUS. Only articles published in English or French were included. The search strategy involved a free text protocol and the narrative review reporting checklist was completed. Key Content and Findings: The AUS is a device used over the past 50 years for SUI caused by intrinsic sphincter deficiency (ISD). It has the theoretical ability to simulate the function of a biological urinary sphincter. Although the role of the AUS for females with ISD remains heterogeneous from one part of the world to the other, the existing literature demonstrates that AUS yields satisfactory functional outcomes in female SUI patients, comparable or better to what has been reported in male AUS series. Hence, the main barrier to its adoption has so far been the technical challenge of its implantation at the bladder neck. Regarding the results of AUS implantation in females, we included in this review 3 reviews, retrospective studies and 1 prospective study. In recent years, robotic techniques of female AUS implantation have spread significantly with promising outcomes including numerous reports suggesting that it may decrease its morbidity. In the near future, the development of electromechanical devices may further expand the role of AUS in the management of female SUI. Conclusions: While the use of AUS in female patients provides excellent functional outcomes, it has been limited to scarce centers. However, due to the rise of minimally invasive approaches, it has started spreading again over the past few years. The future of AUS is likely to be bright, fed by technological advances of the device and robotic surgical system, high level of evidence studies and joint efforts of the urological community to facilitate its diffusion across the world.