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

Sacrospinous ligament fixation: medium and long-term anatomical results, functional and quality of life results

International audienceBackground To evaluate the medium and long-term anatomical results of sacrospinous ligament fixation (SLF) and its impact on quality of life (QoL).Methods We conducted a retrospective and observational single centre study. Fifty-nine patients were interviewed using the Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire and underwent physical examination using POP-Q several years after SLF. Primary outcome was the comparison of anatomic results of SLF at medium-term (group 1: 1-5 years after surgery) and long-term (group 2: more than 5 years after surgery). The secondary outcome was QoL evaluation.ResultsThe overall recurrence and complication rates were respectively 22% and 10%, with no significant differences between groups 1 and 2. The recurrence rate was similar in both groups [twelve (35%) in group 1 and nine (20%) in group 2, p=0.09]. Two patients (12%) in the recurrence and none in the no recurrence group had clinical symptoms (p=0.08). Two patients (12%) in the recurrence and one patient (2%) in the no-recurrence group had a significant impact on their quality of life (p=0.12).ConclusionThis study showed sustainable anatomic and functional results of SLF in medium and long-term analysis with overall low morbidity

Courbe d'apprentissage de la transplantation utérine chez la brebis

communication libre en Gynécologie Thème: Procréation Médicalement Assistée- CNGOFNational audienc

Critical steps for initiating an animal uterine transplantation model in sheep: experience from a case serie.

International audienceRecent reports have demonstrated uterus transplantation as a relevant solution to treat absolute uterine infertility. Training on animal models is a prerequisite to set up a uterine transplantation program in humans. Sheep have been used as an optimal model for training and research as they display similar vessels size to human. While the ovine model might seem easy there are many difficulties in performing this complex surgery. In this study we describe through our experience the critical initial steps toward building a learning curve toward an optimal ovine uterine transplantation model. We performed nine orthotopic uterine autotransplantations using end-to-side anastomoses to the external iliac vessels in sheep. We recorded the duration of all surgical steps and pointed out specific difficulties and solution found. We were able to perform optimal uterine dissection after the first 5 cases and optimal bilateral arterial and venous anastomoses, after 7 and 9 cases respectively. The main factors associated to success rate were optimal exposure, appropriate equipment, careful vessel preparation and modification of the anastomosis technique. As uterine transplantation research programs are expanding, setting up an ovine model to train and perform research is critical. Such model is complex and requires optimized multidisciplinary approach to build an efficient learning curve

Involving Animal Models in Uterine Transplantation

International audienceAbsolute uterine factor infertility affects 0. 2% women of childbearing age around the world. Uterine transplantation (UTx) is a promising solution for many of them since the first birth from UTx was described by the Swedish team in 2014. The success of Utx in humans has become possible after a systematic and meticulous approach involving years of research on animal models. To date, more than 80 UTx procedures have been performed worldwide and 30 children were born. This review summarizes the research preparation conducted in animals before beginning UTx in humans. It focuses on the advantages and limits of each animal model, their place in surgical training, and current contribution in research to improve UTx successes in humans. The different steps in the process of UTx have been analyzed, such as imaging, surgery, ischemia-reperfusion effects, rejection markers, immunosuppressive treatment, and pregnancy. Animal models have played an essential role in the implementation of UTx, which is a highly complex procedure. While respecting the 3R requirements (replacement, refinement, and reduction), the surgical training using large animal models, such as notably ewes remain irreplaceable for teams wishing to initiate a UTx program. Furthermore, animal models are still mandatory in current research to improve the success rates of UTx in humans as well as to reduce the morbidity associated with this experimental infertility treatment