Do Surgeons Anticipate Women’s Hopes and Fears Associated with Prolapse Repair? A Qualitative Analysis in the PROSPERE Trial

Women’s preoperative perceptions of pelvic-floor disorders may differ from those of their physicians. Our objective was to specify women’s hopes and fears before cystocele repair, and to compare them to those that surgeons anticipate. We performed a secondary qualitative analysis of data from the PROSPERE trial. Among the 265 women included, 98% reported at least one hope and 86% one fear before surgery. Sixteen surgeons also completed the free expectations-questionnaire as a typical patient would. Women’s hopes covered seven themes, and women’s fears eleven. Women’s hopes were concerning prolapse repair (60%), improvement of urinary function (39%), capacity for physical activities (28%), sexual function (27%), well-being (25%), and end of pain or heaviness (19%). Women’s fears were concerning prolapse relapse (38%), perioperative concerns (28%), urinary disorders (26%), pain (19%), sexual problems (10%), and physical impairment (6%). Surgeons anticipated typical hopes and fears which were very similar to those the majority of women reported. However, only 60% of the women reported prolapse repair as an expectation. Women’s expectations appear reasonable and consistent with the scientific literature on the improvement and the risk of relapse or complication related to cystocele repair. Our analysis encourages surgeons to consider individual woman’s expectations before pelvic-floor repair

LES NOUVELLES BANDELETTES SOUS-URETRALES PERMETTENT-ELLES DE DIMINUER LA PREVALENCE DES COMPLICATIONS ? (EXEMPLES DU TVT EXACT ET DU TVT ABBREVO )

Introduction. La mise en place d une bandelette sous-urétrale (BSU) est le traitement de référence de l incontinence urinaire à l effort. Les BSU disponibles sont nombreuses mais les plus récentes sont mal évaluées. Nous avons étudié la prévalence des complications pour deux dispositifs nouveaux : le TVT Exact (voie rétropubienne) et le TVT Abbrevo (voie transobturatrice) par rapport à deux dispositifs de référence : le TVT et le TVT-O . Matériel et Méthodes. Etude comparative rétrospective sur 2 centres avec suivi sur 12 mois, comparant 49 TVT Exact vs 49 TVT et 50 TVT Abbrevo vs 50 TVT-O . Les critères de jugement étaient la prévalence des plaies vésicales pour le TVT Exact et l intensité des douleurs post-opératoires pour le TVT Abbrevo , ainsi que l efficacité des deux BSU. Résultats. Pour le TVT Exact la prévalence des plaies vésicales était inchangée par rapport au TVT (8 vs 6% ; p=1). L intensité des douleurs post-opératoires (ENS/100) était moindre pour le TVT Exact (8,0 vs 15,9, p=0.01) mais le premier résidu post-mictionnel (RPM) était augmenté (153,9 vs 78,9 ; p=0.045). L efficacité à 12 mois des deux BSU était comparable (80 vs 82% ; p=1). Pour le TVT Abbrevo l intensité des douleurs post-opératoires était moindre par rapport au TVT-O (12,2 vs 24,4 ; p<0.01). La prévalence des complications était comparable pour les deux BSU ainsi que l efficacité à 12 mois (88 vs 78% ; p=0.29). Conclusion. Pour le TVT Exact la prévalence des plaies vésicales était inchangée. Les douleurs étaient diminuées mais le premier RPM était augmenté. Pour le TVT Abbrevo l efficacité était comparable au TVT-O avec des douleurs post-opératoires moindres.Introduction. The placement of a mid-urethral sling (MUS) is the standard treatment for urinary stress incontinence. Most recent MUS are poorly evaluated. We assessed the prvalence of complications associated with two "new" devices : TVT Exact (retropubic) and TVT Abbrevo (transobturator) compared with two "reference" slings : TVT and TVT-O . Material and Method. The current study is a retrospective comparative study concerning two centers with 12 moonth follow-up comparing 49 TVT Exact vs 49 TVT and 50 TVT-O . Main outcomes were the prevalence of bladder injury for TVT Exact and the amount of postoperative pain associated with TVT Abbrevo , such as the efficacy of both MUS. Results. Prevalence of bladder injury was unchanged with TVT Exact comared to TVT (8 vs 6%, p=1). The amount of postoperative pain (VAS/100) was lower with TVT Exact (8.0 vs 15.9, p=0.01) but the first post-void residual volume (PVR) was increased (153.9 vs 78.9, p=0.045). Efficacity of both MUS at 12 months was comparable (80 vs 82%, p=1). the amount of postoperative pain was lower with TVT Abbrevo compared to TVT-O (12.2 vs 24.4, p<0.01). the prevalence of complications was similar for both MUS as well the efficacy at 12 months (88 vs 78%, p=0.29). Conclusion. Prevalence of bladder injury was unchanged with TVT Exact . The amount of postoperative pain was decreased but first PVR was increased. The efficacy of TVT Abbrevo was equal compared to TVT-O with less postoperative pain.ST QUENTIN EN YVELINES-BU (782972101) / SudocSudocFranceF

Mécanismes neuromusculaires impliqués dans l'incontinence urinaire à l'effort de la femme

La toux entraîne une contraction des muscles du plancher pelvien, aboutissant à une augmentation brutale de la pression dans l urètre, empêchant ainsi toute fuite d urine. Nos travaux concernent l adaptation de la réponse musculaire pelvi-périnéale à la toux (modulation de la réponse réflexe périnéale lors d efforts de toux croissants), la cinétique d activation des muscles impliqués dans la toux (intercostaux externes) et de ceux impliqués dans la réponse réflexe pelvi-périnéale lors de la toux, et enfin sur le phénomène de diminution des pressions urétrales apre s des efforts de toux répétés. Les expériences ont été réalisées à la fois chez des volontaires saines, chez des femmes continentes et chez des femmes incontinentes à l effort. Nous retrouvons qu il existe un défaut de pré-contraction des muscles pelvi-périnéaux lors de la toux chez les femmes ayant une incontinence urinaire à l effort.PARIS-BIUSJ-Thèses (751052125) / SudocPARIS-BIUSJ-Physique recherche (751052113) / SudocSudocFranceF

Biopsie testiculaire pour azoospermie non-obstructive (valeur prédictive de l'inhibine B sur la présence de spermatozoïdes)

PARIS5-BU Méd.Cochin (751142101) / SudocPARIS-BIUM (751062103) / SudocCentre Technique Livre Ens. Sup. (774682301) / SudocSudocFranceF

Preoperative predictors and a prediction score for perception of improvement after mesh prolapse surgery

International audienceIntroduction and hypothesis: Pelvic organ prolapse (POP) surgery using a mesh has a complication rate of 26%, and an estimated 10% of those operated on do not consider it brings improvement. The objective of this study was to identify preoperative predictors of improvement after POP repair with mesh to develop a predictive score. Methods: This is a secondary analysis of the randomized multicenter trial PROSPERE, which compared morbidity after prolapse repair with mesh according to the vaginal or laparoscopic approach. Improved women [PGI-I score at 1-year follow-up = 1 (much better) or 2 (better)] were compared with unimproved women. Two hundred fifty-five women were included to derive the prediction score based on multiple logistic regression. An internal validation by bootstrapping estimated the unbiased performance of the model. Results: Criteria independently related to improvement were: (1) cystocele stage > II [OR: 2.93 95% CI (1.22–7.04), p = 0.015]; (2) preoperative expectation related to bulge symptom improvement [OR: 2.57 95% CI (1.07–6.04), p = 0.031] and (3) absence of chronic pelvic pain [OR: 4.55 95% CI (1.77–11.46), p = 0.001]. A score (scored from 0 to 11) was constructed from the aOR of the predictive model: the ROC-AUC of the score was 0.75, and a score ≥ 9 predicted a 97% chance of improvement (95% CI 92–99), with a specificity of 85% (95% CI 68–94). The ROC-AUC corrected for optimism by the bootstrap procedure was 0.70. Conclusions: This score could be used by surgeons in preoperative counseling of women

Correlation between voiding dysfunction symptoms and uroflowmetry in women suffering from stress urinary incontinence

Objectives: To determine whether the completion of a voiding dysfunction (VD) questionnaire could have a good predictive value for uroflowmetry findings, in a population of stress urinary incontinence (SUI) women. Materials and Methods: From a urodynamic database of 415 SUI women, 93 with isolated SUI who underwent urodynamic investigations were eligible for this study. Patients with obvious etiologies of obstruction were excluded. VD symptoms were analyzed using the Bristol Female Lower Urinary Tract Symptoms Questionnaire. Bladder outlet obstruction (BOO) was defined as a maximal flow rate under 15 ml/s for a urine volume > 200 ml, or a post-void residual volume greater than 50 ml, or an abnormal pattern of the flow curve. The sensitivity, specificity, positive and negative predictive value of questioning VD were calculated. Statistical analysis was done using a Wilcoxon test for continuous data and Fisher exact test for categorical data, and multivariate analysis. Results: Reported VD had a poor specificity (41%) and positive predictive value (32%) of BOO on uroflowmetry. No statistical correlation was found between VD symptoms and BOO defined on uroflowmetry (P=0.64) in this specific SUI population showing no obvious etiologies of obstruction. Conclusions: No correlation was found between obstructive symptoms and BOO as defined on uroflowmetry, in a specific population of SUI women. Our results suggest that uroflowmetry may be necessary rather than multichannel urodynamics

Épidémiologie des tumeurs ovariennes présumées bénignes

International audienceOvarian cysts presumed benign can be organic or functional. Their prevalence is estimated between 14 and 18% in postmenopausal women and around 7% in asymptomatic women of childbearing age. Their incidence during pregnancy is between 0.2 and 5% and varies within the term of pregnancy. Ovarian cysts presumed benign have caused nearly 45,000 hospitalizations in France in 2012, bringing the annual risk of hospitalization for a woman residing in France to 1.3‰. Among the risk factors studied in the literature, tamoxifen increases the incidence of ovarian cysts in premenopausal patients and immunosuppressive treatments are associated with a high prevalence of benign ovarian cysts while estrogen contraception reduces the risk of developing functional cysts

Prise en charge d'un antécédent de fausse couche tardive (14 à 22 SA)

International audienceObjective-To provide guidelines concerning management after a late fetal pregnancy loss:etiological assessment, follow-up and therapeutic management for subsequent pregnancy.Methods-French and English publications led to guidelines.Results-In case of a previous late fetal loss, exploration of cavity has to be done (gradeC), except hysterosalpingography, which is not recommended (grade A). If uterine anomaliesare found, it is recommended to correct them (grade C). In case of stillbirth or unknown foetalvitality before expulsion, antiphospholipid syndrome has to be looked for (grade A). In pregnantwomen, measurement of cervical length has to be done between 15 and 24 weeks of gestation(grade B); in case of singleton pregnancy and short cervix (less than 25 mm), a Mc Donaldcerclage has to be done (grade A). A cerclage is also recommended in case of three previousfetal loss (grade B). In case of failure of a previous Mc Donald cerclage, a cervico-isthmiccerclage is recommended (grade C).Conclusion -In case of a previous fetal loss, uterine cavity has to be explored. In subsequentpregnancy, cervical length has to be evaluated between 15 and 24 SA to indicate a cervicalcerclage

Systematic review of guidelines for urinary incontinence in women

International audienceIntroduction and objective: Urinary incontinence in women is the subject of multiple recommendations all over the world. The aim of our study was to compare methodologies and search for inconsistencies in texts and grades in these guidelines. Methods: Seventeen recommendations from different medical societies in English, French and German were included. Their methodologies were analyzed, including writing methods, cyclicity, level of evidence (LE) and grades. The recommendations were synthesized and inconsistencies in texts and grades were studied. The quality of recommendations was evaluated with the Appraisal of Guidelines for Research and Evaluation (AGREE II) scale. Results: Methods, rigour and cyclicity varied depending on societies. LE and grades are broadly consensual for higher LE and grades and less so for lower LE and grades. The Collège National des Gynécologues et Obstétriciens Français, the Deutsche Gesellschaft für Gynäkologie und Geburtshilfe, the European Association of Urology, the International Consultation on Urological Diseases and the National Institute for Health and Care Excellence have an AGREE score ≥ 80 % (third quartile). Grading and textual inconsistencies are explained by the order of studies or the absence of high LE. Conclusion: With the present study we closely explored comparatively the methods and semantics of recommendations for urinary incontinence in women

El Diario de Pontevedra : periódico liberal: Ano XXXIX Número 11375 - 1922 febreiro 13

BACKGROUND:Intra-abdominal packing is a possible option for persistent bleeding following hysterectomy for postpartum hemorrhage. However, to date, only very limited data about maternal outcome after intra-abdominal packing for surgically uncontrolled hemorrhage following hysterectomy are available. The objective of the current study was to estimate maternal outcome after intra-abdominal packing following unsuccessful peripartum hysterectomy for postpartum hemorrhage. METHODS:A questionnaire was mailed to all maternity units performing more than 850 deliveries per year. Inclusion criteria were: all cases of abdominal packing performed following unsuccessful peripartum hysterectomy for postpartum hemorrhage between 2003 and 2013. The primary outcome was success of intra-abdominal packing, defined as the arrest of hemorrhage with no need of additional procedure. RESULTS:The total number of deliveries during the study period that occurred in the 51 participating centers was 1,430,142. The centers reported a total of 718 (1 per 2000 deliveries) peripartum hysterectomies for PPH and 53 abdominal packings performed after unsuccessful peripartum hysterectomy (about 1 per 14 hysterectomies). A median of 5 [IQR 3-7] pads were used for packing. Abdominal packing was removed after a median of 39.5 hours [IQR 24-48]. The success rate of abdominal packing was 62% (33/53). Among the 20 (38%) women in whom bleeding did not stop following the use of abdominal packing, 6 required a second surgical intervention, 6 a pelvic artery embolization and the 8 other women had "only" further intensive resuscitation and pharmacological treatments. Finally, mortality rate was 24% (13/53). CONCLUSION:Our results suggest that abdominal packing, used for duration of 24 to 48 hours, seems to be an option as an ultimate procedure to control persistent life-threatening postpartum hemorrhage following peripartum hysterectomy