{"id":822,"date":"2024-09-24T15:26:50","date_gmt":"2024-09-24T13:26:50","guid":{"rendered":"https:\/\/menoscope.fr\/?p=822"},"modified":"2024-09-24T15:26:51","modified_gmt":"2024-09-24T13:26:51","slug":"fuites-urinaires-chirurgie","status":"publish","type":"post","link":"https:\/\/menoscope.fr\/index.php\/2024\/09\/24\/fuites-urinaires-chirurgie\/","title":{"rendered":"Fuites urinaires : quand la r\u00e9\u00e9ducation ne suffit pas"},"content":{"rendered":"\n<p>Sacr\u00e9es fuites urinaires&nbsp;! \u00c0 mesure qu\u2019on avance dans la p\u00e9rim\u00e9nopause, elles peuvent survenir lors d\u2019un \u00e9ternuement, lorsqu\u2019on tousse, qu\u2019on \u00e9clate de rire ou pendant une s\u00e9ance de sport. Elles sont embarrassantes, on a tendance \u00e0 ne pas en parler.<\/p>\n\n\n\n<p>Et l\u2019on se retrouve \u00e0 pr\u00eater une oreille plus attentive aux publicit\u00e9s pour les protections sp\u00e9ciales. Quand une marque de serviettes ou de tampons que l\u2019on conna\u00eet bien, \u00e0 qui l\u2019on fait confiance depuis des ann\u00e9es, se met \u00e0 nous parler de protections tout aussi efficaces pour ces moments g\u00eanants (ne pas mettre un nom, surtout), on \u00e9coute.<\/p>\n\n\n\n<p>Ce qui est probl\u00e9matique, c\u2019est qu\u2019alors on ne remet pas en question l\u2019hypoth\u00e8se de d\u00e9part&nbsp;: <em>il est normal d\u2019avoir des fuites urinaires \u00e0 partir d\u2019un certain \u00e2ge<\/em>.<\/p>\n\n\n\n<p>Alors qu\u2019au contraire, ce n\u2019est pas normal, ni acceptable et il y a beaucoup de choses \u00e0 faire pour \u00e9viter et r\u00e9soudre les probl\u00e8mes d\u2019incontinence, avant d\u2019en arriver \u00e0 \u00ab&nbsp;juste&nbsp;\u00bb prot\u00e9ger ses v\u00eatements.<\/p>\n\n\n\n<p>Il y a l\u2019entretien sportif du p\u00e9rin\u00e9e (regardez <a href=\"https:\/\/menoscope.fr\/index.php\/2024\/03\/17\/renforcement-perinee\/\">les exercices en vid\u00e9o<\/a> propos\u00e9s par une kin\u00e9sith\u00e9rapeute).<\/p>\n\n\n\n<p>Il y a la r\u00e9\u00e9ducation p\u00e9rin\u00e9ale (\u00e9coutez <a href=\"https:\/\/menoscope.fr\/index.php\/2024\/09\/19\/secrets-reeducation-perineale\/\">notre podcast<\/a> avec une sage-femme).<\/p>\n\n\n\n<p>Et si ces diff\u00e9rentes actions ne suffisent pas, il existe un certain nombre d\u2019options chirurgicales.<\/p>\n\n\n\n<p>Nous pr\u00e9sentons un aper\u00e7u de quelques techniques chirurgicales disponibles, avec leurs indications et contre-indications, leurs avantages et leurs inconv\u00e9nients.<\/p>\n\n\n\n<h3 class=\"wp-block-heading has-central-palette-1-color has-text-color has-link-color wp-elements-41f2d991f898d7e31deb87033f229f3d\">La bandelette sous-ur\u00e9trale<\/h3>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-full is-resized\"><img fetchpriority=\"high\" decoding=\"async\" width=\"922\" height=\"344\" src=\"https:\/\/menoscope.fr\/wp-content\/uploads\/2024\/09\/bandelette-sous-uretrale.png\" alt=\"\" class=\"wp-image-850\" style=\"width:630px\" srcset=\"https:\/\/menoscope.fr\/wp-content\/uploads\/2024\/09\/bandelette-sous-uretrale.png 922w, https:\/\/menoscope.fr\/wp-content\/uploads\/2024\/09\/bandelette-sous-uretrale-300x112.png 300w, https:\/\/menoscope.fr\/wp-content\/uploads\/2024\/09\/bandelette-sous-uretrale-768x287.png 768w\" sizes=\"(max-width: 922px) 100vw, 922px\" \/><\/figure>\n<\/div>\n\n\n<p>Il s\u2019agit d\u2019un ruban de treillis en polypropyl\u00e8ne qui sert \u00e0 relever et soutenir l\u2019ur\u00e8tre, prenant le relais des tissus affaiblis pour \u00e9viter les fuites lors d\u2019efforts.<\/p>\n\n\n\n<p>Ces bandelettes sont destin\u00e9es \u00e0 r\u00e9soudre l\u2019incontinence urinaire d\u2019effort lorsque les traitements dits \u00ab&nbsp;conservateurs&nbsp;\u00bb (c\u2019est-\u00e0-dire la r\u00e9\u00e9ducation, les exercices physiques cibl\u00e9s, la nutrition, etc.) ont \u00e9chou\u00e9 ou n\u2019ont pas suffi.<\/p>\n\n\n\n<p>Elles ne peuvent pas \u00eatre utilis\u00e9es lorsqu\u2019il y a une infection urinaire active, chez les femmes qui ont des probl\u00e8mes de cicatrisation, ni en cas d\u2019allergie au mat\u00e9riau synth\u00e9tique. Lorsque les troubles urinaires ont une cause neurologique, la bandelette n\u2019est pas une bonne solution non plus.<\/p>\n\n\n\n<p>Cette m\u00e9thode peu invasive (insertion par voie vaginale) est souvent r\u00e9alis\u00e9e en ambulatoire et son taux de succ\u00e8s est tr\u00e8s \u00e9lev\u00e9 (70 \u00e0 90&nbsp;%).<\/p>\n\n\n\n<p>Ses inconv\u00e9nients comprennent un risque d\u2019usure qui peut n\u00e9cessiter une nouvelle intervention, des douleurs persistantes chez certaines personnes et une possibilit\u00e9 de r\u00e9tention urinaire apr\u00e8s l\u2019intervention.<\/p>\n\n\n\n<p>La cha\u00eene YouTube Urologie fonctionnelle \u2013 Anatomie publie <a href=\"https:\/\/youtu.be\/lk-edcVQh3Y?si=YsmwhDEKq6YIlcWV\">une vid\u00e9o tr\u00e8s claire<\/a> sur les diff\u00e9rents types de bandelettes sous-ur\u00e9trales.<\/p>\n\n\n\n<h3 class=\"wp-block-heading has-central-palette-1-color has-text-color has-link-color wp-elements-0da89d7b0f533e666f909c9e8e90a753\">La colposuspension<\/h3>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"alignleft size-full is-resized\"><img decoding=\"async\" width=\"686\" height=\"634\" src=\"https:\/\/menoscope.fr\/wp-content\/uploads\/2024\/09\/colposuspension.png\" alt=\"\" class=\"wp-image-851\" style=\"width:350px\" srcset=\"https:\/\/menoscope.fr\/wp-content\/uploads\/2024\/09\/colposuspension.png 686w, https:\/\/menoscope.fr\/wp-content\/uploads\/2024\/09\/colposuspension-300x277.png 300w\" sizes=\"(max-width: 686px) 100vw, 686px\" \/><\/figure>\n<\/div>\n\n\n<p>La colposuspension consiste \u00e0 fixer le col de la vessie aux ligaments pubiens par des fils de suture, l\u00e0 encore pour renforcer le soutien de l\u2019ur\u00e8tre.<\/p>\n\n\n\n<p>Elle donne de bons r\u00e9sultats dans l\u2019incontinence urinaire d\u2019effort et peut \u00eatre utilis\u00e9e en cas de contre-indication \u00e0 la bandelette sous-ur\u00e9trale.<\/p>\n\n\n\n<p>Ses inconv\u00e9nients sont que l\u2019intervention est plus invasive, n\u00e9cessitant une anesth\u00e9sie g\u00e9n\u00e9rale, avec une r\u00e9cup\u00e9ration plus longue. Elle pr\u00e9sente aussi un risque de prolapsus (descente d\u2019organes) sur le long terme.<\/p>\n\n\n\n<h3 class=\"wp-block-heading has-central-palette-1-color has-text-color has-link-color wp-elements-091460b6fb6273e944b308c1e51c6f38\">Injection d\u2019agents de comblement<\/h3>\n\n\n\n<p>L\u2019injection p\u00e9ri-ur\u00e9trale d\u2019agents de comblement sert \u00e0 augmenter le volume de tissu entourant l\u2019ur\u00e8tre, am\u00e9liorant sa fermeture pendant les efforts.<\/p>\n\n\n\n<p>Ce traitement tr\u00e8s peu invasif peut \u00eatre r\u00e9alis\u00e9 sous anesth\u00e9sie locale et le r\u00e9tablissement est court. Il est cependant moins efficace que d\u2019autres techniques chirurgicales et ses r\u00e9sultats sont temporaires, c\u2019est-\u00e0-dire qu\u2019il peut \u00eatre n\u00e9cessaire de r\u00e9p\u00e9ter les injections.<\/p>\n\n\n\n<h3 class=\"wp-block-heading has-central-palette-1-color has-text-color has-link-color wp-elements-2198ee079a4911be2508f2514a070925\">Ballonnets p\u00e9ri-ur\u00e9traux<\/h3>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"alignleft size-full is-resized\"><img decoding=\"async\" width=\"574\" height=\"390\" src=\"https:\/\/menoscope.fr\/wp-content\/uploads\/2024\/09\/ballonnets-peri-uretaux.png\" alt=\"\" class=\"wp-image-852\" style=\"width:350px\" srcset=\"https:\/\/menoscope.fr\/wp-content\/uploads\/2024\/09\/ballonnets-peri-uretaux.png 574w, https:\/\/menoscope.fr\/wp-content\/uploads\/2024\/09\/ballonnets-peri-uretaux-300x204.png 300w\" sizes=\"(max-width: 574px) 100vw, 574px\" \/><\/figure>\n<\/div>\n\n\n<p>De petits ballons sont mis en place de part et d\u2019autre de l\u2019ur\u00e8tre, au niveau du col de la vessie. Gonfl\u00e9s par un m\u00e9lange de liquide \u00e0 base d\u2019eau, ils peuvent \u00eatre plus ou moins remplis pour moduler la compression de l\u2019ur\u00e8tre.<\/p>\n\n\n\n<p>L\u2019intervention est peu invasive, les ballonnets sont ins\u00e9r\u00e9s par de petites incisions sur les grandes l\u00e8vres.<\/p>\n\n\n\n<h3 class=\"wp-block-heading has-central-palette-1-color has-text-color has-link-color wp-elements-b1c0aa454b147f53af48167b1acf0337\">Sphincter urinaire artificiel<\/h3>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"alignright size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" width=\"528\" height=\"397\" src=\"https:\/\/menoscope.fr\/wp-content\/uploads\/2024\/09\/sphincter-artificiel.png\" alt=\"\" class=\"wp-image-853\" style=\"width:350px\" srcset=\"https:\/\/menoscope.fr\/wp-content\/uploads\/2024\/09\/sphincter-artificiel.png 528w, https:\/\/menoscope.fr\/wp-content\/uploads\/2024\/09\/sphincter-artificiel-300x226.png 300w\" sizes=\"(max-width: 528px) 100vw, 528px\" \/><\/figure>\n<\/div>\n\n\n<p>Le sphincter artificiel est une proth\u00e8se implant\u00e9e \u00e0 l\u2019int\u00e9rieur du corps. Elle se compose d\u2019une manchette plac\u00e9e autour de l\u2019ur\u00e8tre et du col de la vessie, qui se gonfle et se d\u00e9gonfle pour fermer la vessie ou laisser l\u2019urine s\u2019\u00e9couler.<\/p>\n\n\n\n<p>Un ballon r\u00e9gulateur de pression plac\u00e9 \u00e0 c\u00f4t\u00e9 de la vessie sert de r\u00e9servoir pour le gonflage.<\/p>\n\n\n\n<p>Pour uriner, vous appuyez sur la pompe implant\u00e9e sous la peau des grandes l\u00e8vres. La manchette se d\u00e9gonfle, le sphincter s\u2019ouvre, l\u2019urine s\u2019\u00e9coule. Le dispositif reste ouvert quelques minutes avant de se refermer automatiquement.<\/p>\n\n\n\n<p>L\u2019intervention chirurgicale est plus lourde et la mise en \u0153uvre plus longue&nbsp;: le dispositif n\u2019est mis en marche qu\u2019un mois environ apr\u00e8s l\u2019op\u00e9ration d\u2019implantation, pour laisser cicatriser les structures anatomiques.<\/p>\n\n\n\n<div class=\"wp-block-group has-central-palette-4-background-color has-background\"><div class=\"wp-block-group__inner-container is-layout-constrained wp-block-group-is-layout-constrained\">\n<div class=\"wp-block-group\"><div class=\"wp-block-group__inner-container is-layout-constrained wp-block-group-is-layout-constrained\">\n<div class=\"wp-block-group is-vertical is-layout-flex wp-container-core-group-is-layout-8cf370e7 wp-block-group-is-layout-flex\">\n<p class=\"has-central-palette-4-background-color has-background\">Pour conclure, nous insistons sur le fait que m\u00eame si les fuites urinaires sont fr\u00e9quentes \u00e0 la m\u00e9nopause, elles ne sont ni une fatalit\u00e9 ni un aspect in\u00e9vitable du vieillissement. En plus des traitements conservateurs comme la r\u00e9\u00e9ducation p\u00e9rin\u00e9ale, plusieurs options chirurgicales permettent d\u2019am\u00e9liorer significativement la qualit\u00e9 de vie des femmes confront\u00e9es \u00e0 l\u2019incontinence urinaire.<br><br>Le choix de la m\u00e9thode chirurgicale d\u00e9pend de la cause de l\u2019incontinence, de l\u2019\u00e9tat de sant\u00e9 de la patiente et de ses pr\u00e9f\u00e9rences personnelles. Il est \u00e9galement important que chaque femme discute de mani\u00e8re approfondie avec son gyn\u00e9cologue ou son urologue des b\u00e9n\u00e9fices et des risques associ\u00e9s \u00e0 chaque technique, afin de choisir la solution la plus adapt\u00e9e \u00e0 ses besoins.<br><br>Enfin, ces solutions chirurgicales devraient \u00eatre per\u00e7ues comme des outils pour reprendre le contr\u00f4le d\u2019une fonction corporelle essentielle et retrouver une meilleure qualit\u00e9 de vie.<\/p>\n\n\n\n<p class=\"has-central-palette-4-background-color has-background\"><\/p>\n<\/div>\n<\/div><\/div>\n<\/div><\/div>\n\n\n\n<p class=\"has-small-font-size\"><br>Sources\u00a0:<\/p>\n\n\n\n<div class=\"wp-block-group has-small-font-size\"><div class=\"wp-block-group__inner-container is-layout-constrained wp-block-group-is-layout-constrained\">\n<ol class=\"wp-block-list\">\n<li><a href=\"https:\/\/ansm.sante.fr\/dossiers-thematiques\/surveillance-des-bandelettes-sous-uretrales-et-implants-de-renfort-pelvien\/les-indications-medicales-des-bandelettes-et-implants-de-renfort\">Dossier th\u00e9matique de l\u2019ANSM sur les bandelettes sous-ur\u00e9trales et les implants de renfort pelvien<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/youtu.be\/lk-edcVQh3Y?si=YsmwhDEKq6YIlcWV\">Vid\u00e9o de la cha\u00eene YouTube Urologie fonctionnelle<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.canal-u.tv\/chaines\/canal-u-medecine\/film\/technique-de-colposuspension-cervico-urethrale-par-voie-vaginale-avec\">Vid\u00e9o chirurgicale&nbsp;: Technique de colposuspension cervico-ur\u00e9trale par voie vaginale avec ancrage viss\u00e9 pubien des fils de colposuspension<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.revmed.ch\/view\/407766\/3583906\/RMS_673_2186.pdf\">Revue m\u00e9dicale suisse&nbsp;: Actualit\u00e9 du traitement chirurgical de l\u2019incontinence urinaire d\u2019effort chez la femme<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.urofrance.org\/fileadmin\/documents\/data\/FI\/2012\/sphincter-artificiel-femme\/sphincter-artificiel-femme.pdf\">Association fran\u00e7aise d\u2019urologie&nbsp;: Cure d\u2019incontinence urinaire de la femme par implantation d\u2019un sphincter urinaire artificiel<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.sphere-sante.com\/incontinence-information\/sphincter-urinaire-artificiel.html\">Le sphincter urinaire artificiel dans le traitement de l\u2019incontinence urinaire<\/a><\/li>\n<\/ol>\n<\/div><\/div>\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>D\u00e9couvrez les solutions chirurgicales pour traiter les fuites urinaires li\u00e9es \u00e0 la m\u00e9nopause. Une approche compl\u00e8te des diff\u00e9rentes techniques avec leurs indications, b\u00e9n\u00e9fices et risques, afin d\u2019aider les femmes \u00e0 choisir le traitement adapt\u00e9 \u00e0 leur situation.<\/p>\n","protected":false},"author":1,"featured_media":856,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[6,7],"tags":[46,43],"class_list":["post-822","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-articles","category-informations","tag-chirurgie","tag-perinee"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.5 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Fuites urinaires : quand la r\u00e9\u00e9ducation ne suffit pas - M\u00e9noscope<\/title>\n<meta name=\"description\" content=\"Une approche compl\u00e8te des solutions chirurgicales pour traiter les fuites urinaires li\u00e9es \u00e0 la m\u00e9nopause, afin d\u2019aider les femmes \u00e0 choisir le traitement adapt\u00e9 \u00e0 leur situation.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/menoscope.fr\/index.php\/2024\/09\/24\/fuites-urinaires-chirurgie\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Fuites urinaires : quand la r\u00e9\u00e9ducation ne suffit pas - 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