Purpose: Post-prostatectomy incontinence remains a problem, even in minor or moderate degrees. In order to minimize surgical morbidity and costs, sling procedures have been proposed. The authors have developed a new transobturator male sling procedure and report their results after one-year experience. Materials and Methods: A prospective multicenter study was conducted in 50 patients with minor or moderate post-prostatectomy incontinence. Evaluation of TOMS TM two arms bulbar sling was based on clinical form assessment, The International Consultation on Incontinence Questionnaire (ICIQ) and short-form (SF) 36 questionnaire pre and postoperatively and at 3, 6, 9 and 12 months. Results: The surgical procedure was considered easy to perform and no post-surgery complication was reported except for one retention. The median number of pads per day decreased significantly from 2 pads before surgery (95% CI: 2 -3) to 1 during the follow-up period (95% CI: 0 -2 at 360 days), and at 3 months patients using none or one pad per day were 30% and 32% respectively. The SF 36 continence and quality of life score improved from a median of 100 (95% CI: 83 -133) to 300 (95% CI: 167 -375), and the median ICIQ incontinence and quality of life score decreased from 15 (95% CI: 14 -16) to 8 (95% CI: 5 -12) one year after surgery. Conclusion: The transobturator perineal male sling TOMS TM is an attractive simple sling technique for moderate or minor post-prostatectomy stress incontinence and offers an improvement in the quality of life.
La psychiatrie allemande est un des lieux où s'élabore une psychiatrie non conventionnelle, caractérisée par son recours à des courants philosophiques éloignés des sciences de la nature et par son accentuation de la globalité de l'homme malade mental. Cette orientation s'est préparée à la période de la psychiatrie compréhensive promue par Karl Jaspers et Kurt Schneider entre autres, qui a abouti à fixer des limites déterminées à la schizophrénie et à la mélancolie. Elle se penchait sur le vécu intérieur du patient et tentait de le comprendre, notamment par l'empathie. Elle a rapidement été renforcée par une méthodologie philosophique, la phénoménologie de Husserl puis de Heidegger, dans l'étude des phénomènes aussi bien que dans l'utilisation des anthropologies. Les applications à la psychiatrie sont nombreuses. Nous aborderons la psychiatrie compré-hensive, la phénoménologie, nous présenterons Alfred Kraus, puis nous traiterons des bases philosophiques de ses travaux et de sa notion de l'identité. La partie clinique abordera la structure identitaire des dépressifs, la crise identitaire de la psychose, la notion de comportement hypernomique (élaboration du typus melancholicus), et le concept d'intolérance à l'ambiguïté.Mots clés Phénoménologie · Alfred Kraus · Mélancolie · Typus melancholicus · Hypernomie · Intolérance à l'ambiguïté · Dépression · Troubles bipolaires Abstract German psychiatry is one of the areas where we see the development of an unconventional psychiatry, characterized by its reference to philosophical traditions that are remote from the natural sciences, and by its emphasis on the overall nature of the mentally ill person. This approach first emerged during the period of comprehensive psychiatry promoted by Karl Jaspers and KurtSchneider. This particular form of psychopathology focuses its attention on the inner experience of the ill person and attempts to understand it, in particular through empathy. This approach was soon reinforced by a philosophical method founded by Husserl and further developed by Heidegger: phenomenology. Firstly, this consists of a way of approaching and examining the discrete elements of consciousness, leading to the notion of intentionality (Brentano, Husserl). The central place of consciousness in this approach leads to the questioning of existence and of the person supporting this consciousness: this philosophy thus leads to existentialism (Jaspers, Sartre) and Heidegger's concept of Dasein (the existential analytic, Dasein's ontology). Phenomenological psychiatry is thus a clinical science characterized by its approach and its reference to what might overall be described as comprehensive anthropology. There are numerous authors who affiliate themselves with this phenomenological psychology. Our article is devoted to Alfred Kraus's approach. We will first of all address the notions of comprehensive psychiatry and phenomenology. After introducing Alfred Kraus and the specific philosophical and clinical foundations of his work, we will examine the Krausian theory of ...
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