Une première en France : une nouvelle technique de reconstruction de l’appareil urinaire féminin
Infections urinaires à répétition, diminution du jet ou encore vidange vésicale incomplète figurent parmi les symptômes de la sténose de l’urètre, ce conduit partant de la vessie pour évacuer les urines. Pathologie bénigne mais rare chez la femme, elle se caractérise par le rétrécissement du calibre de l’urètre. Mal connues, ses causes sont présumées être essentiellement iatrogènes, c’est-à-dire survenant dans les suites d’un sondage urinaire, d’une dilatation urétrale ou d’une intervention chirurgicale sur l’urètre. Dans certains cas, elles pourraient être dues à des traumatismes du périnée, des infections urogénitales ou des accouchements traumatiques.
Jusqu’à ce jour cette pathologie n’était pas traitée en France, la seule option thérapeutique proposée étant la dilatation urétrale qui pourrait, en réalité, être l’une des principales causes de sténose en aggravant la fibrose péri-urétrale.
Une technique chirurgicale inédite mise au point aux USA
A l’occasion d’un séjour d’un an à la New York University (New York, USA), le Dr Benoit Peyronnet, urologue au CHU de Rennes, a découvert une nouvelle technique chirurgicale de traitement de la sténose urétrale chez la femme, mise au point par l’équipe d’urologie américaine.
Cette technique consiste à reconstruire un urètre de calibre normal en greffant un morceau de tissu prélevé à l’intérieur de la bouche de la patiente (muqueuse buccale). Parfois utilisée chez l’homme elle n’avait, à ce jour, jamais été réalisée en France chez la femme et n’est pratiquée que dans quelques centres dans le monde, essentiellement aux USA et en Angleterre.
Bien que restreintes à quelques études comprenant un nombre limité de patientes, les données disponibles après un an de recul suggèrent des résultats très prometteurs, puisque 100% des patientes intégrées de la série de la New York University reconnaissent une amélioration de leurs symptômes urinaires.
Grace à la collaboration intense entre les services d’urologie du CHU de Rennes et de la New York University établie à l’issue de ce séjour achevé en novembre 2018, cette technique a été importée dans le service d’urologie rennais. Les deux premières patientes ont été opérées au CHU de Rennes ce vendredi 13 septembre 2019 par le Dr Benoit Peyronnet et l’équipe d’urologie fonctionnelle (Dr Juliette Hascoet, Dr Andrea Manunta, Dr Quentin Alimi, Dr Lucas Freton) en présence du Dr Benjamin Brucker, chef de la division d’urologie fonctionnelle et reconstructrice de la New York University, venu spécialement pour l’occasion.
L'équipe d'ORL du CHU de Rennes du Pr Franck Jegoux, a également été impliquée dans ces interventions puisque les chirurgiens ORL ont prélevé le tissu de muqueuse buccale utilisé pour la reconstruction urétrale.
Les deux patientes souffrant depuis de nombreuses années de symptomes urinaires - et dont l’une est porteuse d’une sonde de drainage des urines depuis près de deux ans - devraient ainsi pouvoir retrouver une vie « normale » avec seulement une à deux journées d’hospitalisation.
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30/04/2021 20:21
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03/05/2021 23:08
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07/05/2021 01:52
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07/05/2021 07:09
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