Performance de l'IRM après traitement par radio-chimiothérapie des cancers du col avancés (comparaison radio-histologique après chirurgie radicale de clôture)

LYON1-BU Santé (693882101) / SudocSudocFranceF

Why and how to proceed to an ultrasound-guided transvaginal drainage of tubo-ovarian abscesses (with demonstrative video)?

The treatment of the acute phase of complicated tubo-ovarian abscesses relies on antibiotics associated with surgical management in case of visible abscess, poor clinical tolerance and resistance to medical treatment. Transvaginal, ultrasound-guided, puncture drainage can be considered as an alternative to initial laparoscopy and has multiple advantages over the latter: same success rate, less invasive nature, simple and fast to perform, easy to access, better tolerated by the patient, decreased hospitalization time and less cost. This video article describes and standardizes the essential steps to perform a transvaginal adnexal abscess drainage with a step-by-step explanation of the technique in logical sequences, making the procedure ergonomic and easy to learn. Thus, as part of minimally invasive approach, this technique is henceforth suggested as an effective alternative and signifies a first-line procedure that can promote a therapeutic de-escalation strategy.

Identification of risk factors for postpartum urinary retention following vaginal deliveries: A retrospective case-control study

International audienceObjective: Postpartum urinary retention (PUR) is an uncommon complication of vaginal delivery, defined as a failure to void spontaneously in the six hours following vaginal birth. The objective of this study was to identify risk factors for PUR in order to provide prompt management.Study design: A retrospective, comparative, case-control study, including two groups of 96 patients who delivered vaginally, was conducted at the Women and Children's University Hospital in Lyon, France. Patients were selected based on data extraction from the medical records of the obstetrics and gynecology department. The first group included patients with postpartum urinary retention and the second group, without PUR, was selected randomly, respecting 1:1 matching criteria, paired according to the year of delivery and patient's age at delivery.Results: Logistic regression analysis found that instrumental delivery (OR 13.42, 95%CI [3.34;53.86], p = 0.0002), absence of spontaneous voiding before leaving the delivery room (OR 6.14, 95%CI [2.56;14.73], p < 0.0001), no intact perineum (OR 3.29, 95%CI [1.10;9.90], p = 0.03) and vulvar edema or perineal hematoma (OR 8.05, 95%CI [1.59;40.67], p = 0.01) were independent risk factors associated with PUR.Conclusion: The present study identified risk factors for PUR that should be taken into consideration as soon as delivery is over in order to implement appropriate management. Future studies are needed to assess the contribution of early systematic bladder scanning in patients with risk factors for early diagnosis of PUR

Outpatient vaginal surgery for pelvic organ prolapse: a prospective feasibility study

In the light of recent progress in pelvic organ prolapse surgery, the modalities of hospital admission need reconsidering. This work aims to assess success rate of outpatient (ambulatory) vaginal mesh surgery for genital prolapse

Serious Complications and Recurrence following Sacrospinous Ligament Fixation for the Correction of Apical Prolapse

Objective: To evaluate the rates of serious complications and reoperation for recurrence following sacrospinous ligament fixation (SSLF) for apical pelvic organ prolapse. Methods: This was a national registry ancillary cohort comparative study. The VIGI-MESH registry includes data from 24 French health centers prospectively collected between May 2017 and September 2021. Time to occurrence of a serious complication or reoperation for genital prolapse recurrence was explored using the Kaplan–Meier curve and Log-rank test. The inverse probability of treatment weighting, based on propensity scores, was used to adjust for between-group differences. Results: A total of 1359 women were included and four surgical groups were analyzed: Anterior SSLF with mesh (n = 566), Anterior SSLF with native tissue (n = 331), Posterior SSLF with mesh (n = 57), and Posterior SSLF with native tissue (n = 405). Clavien–Dindo Grade III complications or higher were reported in 34 (2.5%) cases, with no statistically significant differences between the groups. Pelvic organ prolapse recurrence requiring re-operation was reported in 44 (3.2%) women, this was higher following posterior compared with anterior SSLF (p = 0.0034). Conclusions: According to this large database ancillary study, sacrospinous ligament fixation is an effective and safe surgical treatment for apical prolapse. The different surgical approaches (anterior/posterior and with/without mesh) have comparable safety profiles. However, the anterior approach and the use of mesh were associated with a lower risk of reoperation for recurrence compared with the posterior approach and the use of native tissue, respectively