Impact de l’hystérectomie sur l’incontinence urinaire : revue de la littérature

International audienceIntroduction: The impact of a hysterectomy on urinary incontinence is a controversial subject in the literature.Objective: To evaluate the prevalence and incidence of urinary incontinence after a hysterectomy as well as associated risk factors such as the type of hysterectomy, the surgical approach, urodynamic criteria and uterine disease.Study design: We conducted a systematic review in Pubmed database with the following keywords and MeSH term: hysterectomy, urinary incontinence.Results: A total of 1340 articles were retrieved, 42 articles were selected for the final text analysis. The results of the different studies were heterogeneous. Hysterectomy seemed to increase the rate of sphincter deficiency (VLPP<60mmH2O for 20% of cases versus 1,7% without hysterectomy, P=0.003). The vaginal route could increase the incidence of UI with OR of 2.3 (95%CI 1.0-5.2). Subtotal hysterectomy appears to increase UI with a 0,74 RR for total hysterectomy (95%CI 0.58-0.94). A radical hysterectomy with nerve conservation would preserve urinary functions, unlike pelvic radiotherapy, which is responsible for irreversible nerve damage by demyelination and bladder fibrosis

Serial hCG and progesterone levels to predict early pregnancy outcomes in pregnancies of uncertain viability: A prospective study

International audienceObjective - To assess the value of serial hCG and progesterone serum level in the diagnosis of early pregnancy viability.Methods - It was a prospective cohort study. Women with a pregnancy of uncertain viability (PUV), defined as the presence of an intra-uterine embryo with a crown-rump length Results - The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of an hCG H48/H0 ratio increase 75% to diagnose a viable pregnancy were 100%, 31%, 45.9% and 100%, respectively. hCG H48/H0 ratio increase 75% was associated with 100% of viable pregnancies in 100% of the cases.Conclusion - Serial hCG levels alone permitted an early viability diagnosis within 48h for 41.1% of patients with PUV instead of 7 to 14days with TVS.<br

Préserver ou non l’utérus en cas de chirurgie du prolapsus : revue de la littérature.

National audienceObjective To evaluate the impact of hysterectomy in case of genital prolapse on the anatomical and functional results, and on per and post operative complications compared with uterine preservation. Material and Methods We conducted a review of the Pubmed, Medline, Embase and Cochrane literature using the following terms and MeSH (Medical Subject Headings of the National Library of Medicine): uterine prolapse; genital prolapse; prolapse surgery; vaginal prolapse surgery; abdominal prolapse surgery; hysterectomy; hysteropexy; sacrocolpopexy; surgical meshes; complications; sexuality; neoplasia; urinary; incontinence; cancer. Results Among the 168 abstracts studied, 63 publications were retained. Whatever performance of hysterectomy or not, anatomical and functional results were similar in abdominal surgery (sacrocolpopexy) (OR = 2.21 [95% CI: 0.33–14.67]) or vaginal surgery (OR = 1.07 [95% CI: 0.38–2.99]). There was no difference in terms of urinary symptoms or sexuality after surgery. Hysterectomy was associated to a higher morbidity (bleeding, prolonged operating time, longer hospital stay), to an increased risk of mesh exposure particularly in case of total hysterectomy (8.6%; 95% CI: 6.3–11). Conclusion In the absence of evidence of superiority in terms of anatomical and functional outcomes, with an increased rate of complications, concomitant hysterectomy with prolapse surgery should probably not be performed routinely.Objectif Évaluer l’impact de la réalisation d’une hystérectomie en cas de cure de prolapsus sur les résultats anatomiques, fonctionnels, les complications per et postopératoires par rapport à la conservation utérine. Matériels et Méthodes Nous avons réalisé une revue de la littérature sur Pubmed, Medline, Embase et Cochrane en utilisant les termes et MeSH (Medical Subject Headings of the National Library of Medicine) suivants : uterine prolapse ; genital prolapse ; prolapse surgery ; vaginal prolapse surgery ; abdominal prolapse surgery ; hysterectomy ; hysteropexy ; sacrocolpopexy ; surgical meshes ; complications ; sexuality ; neoplasia ; urinary ; incontinence ; cancer. Résultats Parmi les 168 résumés étudiés, nous avons retenu 63 articles. Il n’existait pas de différence significative en termes de résultats anatomiques et fonctionnels en cas de promontofixation (OR = 2,21 [IC95 % : 0,33–14,67[) et en cas de chirurgie vaginale sans pose de prothèse (OR = 1,07 [IC95 % : 0,38–2,99]). Il n’y avait pas non plus de différence en termes de symptomatologie urinaire ou de sexualité au décours quel que soit la voie d’abord. L’hystérectomie était associée à une morbidité plus importante (saignements, allongement du temps opératoire, allongement de la durée d’hospitalisation), un risque augmenté d’exposition prothétique en cas d’hystérectomie totale (8,6 % IC95 % : 6,3–11). Conclusion En l’absence de preuve de supériorité en termes de résultats anatomiques et fonctionnels, avec une augmentation du taux de complications, l’hystérectomie concomitante en cas de cure de prolapsus ne doit probablement pas être réalisée de manière systématique

A prospective study of the frequency of severe pain and predictive factors in women undergoing first-trimester surgical abortion under local anaesthesia

International audienceObjective - To determine the frequency of severe pain among women and to identify the associated predictive factors during first-trimester surgical abortion under local anaesthesia (LA).Study design - A prospective cohort study from November 2013 to January 2014 at the Department of Gynecology and Obstetrics, Rennes, France. The study population was composed of one hundred and ninety-four patients who underwent an elective first-trimester surgical abortion under LA. In an anonymized questionnaire, the participants were asked to self-record their perceived pain level 30 min after the completion of the procedure using a 10 cm visual analogue scale (VAS). The main outcome measure was the frequency of severe pain among women, defined as VAS ≥ 7. Secondary outcome measure was the risk factor(s) for severe pain.Results - Severe pain (i.e. VAS ≥ 7) was experienced by 46% (95% CI: 39%-53%) of the population. Multivariate analysis confirmed that >10 weeks of gestation (OR: 2.530 [95% CI: 1.1-5.81], p = .0287) and having 0 or 1 child (OR: 5.206 [95% CI: 1.87-14.49], p = .0016) were significant independent factors of severe pain.Conclusion - Nearly half of the women experienced severe pain. More than 10 weeks of gestation and parity were predictive factors of severe pain. These findings should be useful in counselling women undergoing surgical abortion under LA.<br

Maternal and neonatal outcomes and prognostic factors in acute fatty liver of pregnancy

International audienceObjective To report complications of Acute Fatty Liver of pregnancy (AFLP), a rare liver disease of pregnancy, and identify prognostic factors for mothers and children. Study Design We conducted a retrospective descriptive study over 18 years in three French maternities. Demographic, clinical, biological data, and outcomes of patients and their infants were reviewed. Results 142,450 pregnancies from centers were studied. Eighteen patients with AFLP were identified The prevalence of AFLP was estimated as 1/7,914 pregnancies. Prolonged prothrombin time was identified as a risk factor of maternal complications (OR = 0.86, p = 0.0493). Gestational age at delivery was the only risk factor associated with fetal or neonate complications (OR = 0.37, p = 0.0417). One boy died of previously undiagnosed β-oxidation deficiency at eight months. Conclusion In AFLP, prothrombin time must be carefully monitored to anticipate major maternal complications. Infants born to mothers with ALFP should be screened as early as possible for mitochondrial fatty acid oxidation deficiency. © 2020 Elsevier B.V