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Les manœuvres de soutènement sont-elles prédictives du résultat de la chirurgie de l’incontinence urinaire ?

Do support manoeuvres predict the results of surgery for urinary incontinence?

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Pelvi-périnéologie

Résumé

Parmi les éléments pronostiques du succès de la mise en place d’une bandelette sous-urétrale, le défaut de soutien de l’urètre, évalué par exemple par les manoeuvres de soutènement, est peu cité. Pourtant, sur le plan physiopathologique, la différenciation de l’incontinence urinaire d’effort (IUE) par défaut de soutien de l’urètre, de l’IUE par insuffisance sphinctérienne paraît essentielle pour optimiser la prise en charge. De récentes publications amènent à penser que le paramètre fonction sphinctérienne évalué urodynamiquement ne peut être considéré isolément et que d’autres facteurs, lorsque la fonction sphinctérienne est défaillante, sont susceptibles d’intervenir. C’est probablement le cas du défaut de soutien de l’urètre. Il reste cependant à standardiser les manoeuvres de soutènement urétral et à réaliser des études spécifiques pour le démontrer.

Abstract

Failure of urethral support, which can be assessed using support manoeuvres, is rarely quoted as a prognostic factor for the success of sub-urethral taping. Yet, the pathophysiological distinction between urinary stress incontinence (SUI) due to defective urethral support and that due to sphincter deficiency is essential for optimal management. Recent publications suggest that urodynamically assessed sphincter function should not be considered in isolation. Other factors may well be playing a part when sphincter function is poor. Of these, defective urethral support is the likeliest. It is, however, important to standardise urethral support manoeuvres and carry out specific studies to validate this.

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  1. Service d’urologie, CHU Bichat, 46, rue Henri-Huchard, F-75018, Paris, France

    J. -F. Hermieu

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  1. J. -F. Hermieu
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Correspondence to J. -F. Hermieu.

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Public/Intérêt: Chercheurs/Élevé. Cliniciens/Majeur. Enseignants/Majeur. Étudiants/Majeur. Autres professions de santé/Élevé. Cadres santé publique/Faible.

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Hermieu, J.F. Les manœuvres de soutènement sont-elles prédictives du résultat de la chirurgie de l’incontinence urinaire ?. Pelv Perineol 6, 118–122 (2011). https://doi.org/10.1007/s11608-011-0369-7

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  • DOI: https://doi.org/10.1007/s11608-011-0369-7

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