Female urinary incontinence and artificial urinary sphincter: study of efficacy and risk factors for failure and complications

Background

The artificial urinary sphincter (AUS) has become a commonly used therapy for severe urinary incontinence (UI) due to intrinsic sphincter deficiency (ISD).

Objective

To evaluate retrospectively the efficacy and risk factors for failure and complications of AUS implantation in women with nonneurologic UI.

Design, setting, and participants

From May 1987 to December 2009, 215 women with ISD were treated by AUS implantation, with a mean age of 62.8 yr and a mean follow-up of 6 yr (standard deviation: 5.6 yr). Previous surgical procedures to treat incontinence had been performed in 88.8% of the patients. Urodynamic assessment was required. Patients using only 0 or 1 pad at the end of follow-up were considered continent. The patient's level of satisfaction was evaluated by a global analogue scale and clinical interview.

Intervention

All women had AUS implantation.

Measurements

Patients were evaluated for continence rate, risk factors for failures, and complications.

Results and limitations

At the end of follow-up, 158 patients (73.5%) were continent, and 170 (79%) were satisfied. The redo rate was 15.3% after a mean interval of 8.47 yr for the first redo procedure. Fifteen explantations (7%) were performed. The only risk factor for intraoperative complications (10.7%) was smoking (p < 0.004). Six patients (2.8%) were lost to follow-up. AUS failed to treat incontinence in 51 patients (23.7%) due to defective manipulation in 27.4% of the cases. On multivariate analysis, risk factors for failure were age >70 yr (odds ratio [OR]: 2.46), a history of the Burch procedure (OR: 2.28), or pelvic radiotherapy (OR: 4.37) (p < 0.05).

Conclusions

The place for this safe and long-lasting effective technique in the treatment of UI due to recurrent sphincter deficiency is confirmed. Screening for these risk factors should allow better patient selection.     

Alliesthesia to food cues: heterogeneity across stimuli and sensory modalities

Negative alliesthesia to olfactory and visual stimuli was assessed in 29 normal-weight women who, on alternate days, were either fasting or in a postprandial state after an ad libitum lunch. The participants were alternatively exposed to food and non-food pictures and odorants, and then rated for their hedonic appreciation (liking) and their desire to ingest (wanting) the evoked foods. While negative alliesthesia was observed only for food stimuli, it did not equally affect all food categories in either sensory modality. The stimuli representing foods eaten in typical local main dishes or having high energy density (e.g., pizza, bacon, beef, cheese) evoked clear negative alliesthesia, whereas this was not the case for those less consumed within a customary meal or associated with desserts (i.e., fruits). Furthermore, the visual food stimuli triggered a more negative shift in liking than did the food odours. Finally, the shift in wanting between pre- and post-meal state was more important than the shift in liking. These results suggest that alliesthesia may be influenced by both metabolic and non-metabolic factors.     

Characterization of a new rat model of head and neck squamous cell carcinoma

AIM: To develop and characterize by imaging and pathological examination a new immunocompetent rat model of head and neck squamous cell carcinoma (HNSCC). STUDY DESIGN: Prospective animal research. MATERIALS AND METHODS: Frozen specimens of HNSCC induced chemically by 4-nitroquinoline 1 oxide (4-NQO) in Sprague Dawley rats were used for the first graft. Serial allografts were then performed with fresh specimens of tumor in twenty-five Sprague Dawley rats. A specimen of tumor (100 mm3) was picked up by head and neck dissection during an autopsy. The graft was performed in a subcutaneous manner, in the ventral part of the neck, using an incision of 4 mm, through the masseter muscle. Tumors were clinically measured once a week and volumes were calculated. 2-[18F]Fluoro-2-deoxy-D-glucose positron emission tomography coupled with computed tomography (FDG-PET/CT) was performed on days 14 and 30 after the graft. Rats were euthanized and pathological features were assessed using hematoxylin-eosin (HE) staining and immunohistochemistry markers to characterize the tumor. RESULTS: An 80% take rate was achieved using fresh tumor specimens. Tumors grew rapidly; the mean tumoral volume was 1.013 cm3 on day 14 and 7.994 cm3 on day 30. FDG-PET/CT imaging targeted regions of metabolically active tumor. It showed a uniform uptake of 18F-FDG on day 14 and a large area of central necrosis on day 30. Pathological examinations showed a typical squamous cell carcinoma, with similar immunohistochemical analyses to the human squamous cell carcinoma. CONCLUSION: We propose a new allograft HNSCC rat model which is easily reproducible and rapidly obtained in comparison to that induced chemically with 4-NQO. This model was developed in immunocompetent rats, with similar conditions to human carcinogenesis and could be used for testing new therapeutics.