Incontinence : stress urinary incontinence treatment—surgery first?

A randomized trial involving 460 women with stress urinary incontinence compared physiotherapy with midurethral-sling surgery. We question whether the results, showing higher rates of improvement and cure for surgery than for physiotherapy, should change best practice and clinical practice guideline recommendations

Chikungunya Fever During Pregnancy and in Children: An Overview on Clinical and Research Perspectives

Chikungunya fever (CF) is an arboviral disease in worldwide expansion due to the plasticity of its pathogen and vector. Chikungunya virus (CHIKV), a positive-sense, single-stranded RNA alphavirus, is transmitted by Aedes (Stegomyia) aegypti and Aedes albopictus mosquitoes, two hegemonic anthropophilic day-biting mosquitoes capable of colonizing very different environments. This expert review discusses the molecular epidemiology, pathophysiology, clinical features, diagnosis, management, and prevention of CF during pregnancy, infancy, and childhood. Specifically, it will focus not only on the issue and challenges of perinatal mother-to-child transmission of CHIKV, its pathogenesis, and effects on neurodevelopment, but also on CHIKV-associated central nervous system disease in children, two previously ill-characterized features of the infection

Continence Across Continents To Upend Stigma and Dependency (CACTUS-D): study protocol for a cluster randomized controlled trial

Background: Urinary incontinence occurs in 40 % of women aged 65 years and over; however, only 15 % seek care and many delay healthcare seeking for years. Incontinence is associated with depression, social isolation, reduced quality of life, falls and other comorbidities. It is accompanied by an enormous cost to the individual and society. Despite the substantial implications of urinary incontinence on social, psychological and physical well-being of older women, the impact of continence promotion on urinary symptom improvement and subsequent effects on falls, quality of life, stigma, social participation and the cost of care remains unknown. Methods: This study is a mixed methods multi-national open-label 2-arm parallel cluster randomized controlled trial aiming to recruit 1000 community-dwelling incontinent women aged 65 years and older across Quebec, Western Canada, France and United Kingdom. Participants will be recruited through community organizations. Data will be collected at 6 time points: baseline and 1 week, 3 months, 6 months, 9 months and 12 months after baseline. One of the primary objectives is to evaluate whether the continence promotion intervention improves incontinence symptoms (measured with the Patient Global Impression of Improvement questionnaire, PGI-I) at 12 months post intervention compared to the control group. Other co-primary outcomes include changes in incontinence-related stigma, fall reduction, and incremental cost-effectiveness ratio and quality-adjusted life years. Data analysis will account for correlation of outcomes (clustering) within community organizations. A qualitative sub-study will explore stigma reduction. Discussion: Community-based continence promotion programs may be a cost-effective strategy to reduce urinary incontinence, stigma and falls among older women with untreated incontinence, and simultaneously improve quality of life and healthy active life expectancy.European Research Area on Ageing2 (ERA-AGE2) progra

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

Chikungunya Virus Infection during Pregnancy, Réunion, France, 2006

Except for prenatal hospital admissions for those infected, this virus had no effect on outcomes

Impact des Pratiques Obstétricales sur l'Incontinence Urinaire de la Femme de l'Accouchement à la Ménopause.

Virginie RINGA, Co-directeur de ThèseThe objective was to specify the effect of preventive obstetrical practices, episiotomy and caesarean, on female urinary incontinence (UI).The first cohort comes from 2 maternity wards promoting opposite policies for episiotomy. A preliminary investigation had determined the number of necessary subjects. Criteria of inclusion were a 1st alive and term childbirth in cephalic presentation and an up to date postal address. Out of 774 women who met these conditions, we received 627 answers (81%). The other sample is from GAZEL cohort made up of employees voluntary for medical research. Out of 3114 women aged 50-62 who received the questionnaire, 2640 returned it (85%). Four years after childbirth, risk factors for stress UI are age, pre-existent UI, pregnancy UI, labour duration and mode of delivery. Comparison between the maternity wards that had a policy of systematic episiotomy and those that had a restrictive policy does not show any result in favour of a systematic use. For women around fifty, risk factors for severe stress UI are parity, obesity, diabetes, previous surgery of UI and a young age at first childbirth. Mode of delivery does not have any effect. The effect of mode of delivery on stress UI attenuates with age and is not measurable any more after 50, which is the average age for stress UI surgery. The risk related to the effect of pregnancy is still identifiable at this age. This attenuation with age of delivery consequences is in favour of a mechanism of deterioration of continence related to pregnancy and whatever the mode of childbirth. Our results suggest that prevention of stress UI by interventions at childbirth, episiotomy or caesarean, is ineffective.L'objectif était de préciser l'effet des pratiques obstétricales préventives, épisiotomie et césarienne, sur l'incontinence urinaire (IU).La première cohorte provient de 2 maternités aux politiques opposées pour l'épisiotomie. Une enquête préliminaire a déterminé le nombre de sujets nécessaire. Les critères d'inclusion sont une 1ère naissance vivante à terme en présentation céphalique et une adresse postale à jour, 774 femmes remplissent ces conditions, nous avons reçu 627 réponses (81%). L'autre population est issue de la cohorte GAZEL constituée de salariées volontaires pour la recherche médicale, 3114 femmes âgées de 50 à 62 ans ont reçu le questionnaire, 2640 ont répondu (85%).Quatre ans après l'accouchement, les facteurs de risque pour l'IU d'effort sont l'âge, l'IU préexistante, l'IU de la grossesse, la durée du travail et le mode d'accouchement. La comparaison entre les 2 politiques d'épisiotomie ne montre pas bénéfice en faveur d'une utilisation systématique.A la cinquantaine, les facteurs de risque pour l'IU d'effort sévère sont la parité, l'obésité, le diabète, la chirurgie de l'IU et un jeune âge au premier. Le mode d'accouchement n'a aucun effet.L'effet du mode d'accouchement sur l'IU à l'effort s'atténue avec l'âge et n'est plus mesurable après 50 ans, qui est l'âge moyen pour la chirurgie de l'IU. Le risque lié à la grossesse est toujours identifiable à cet âge. Cette atténuation avec l'âge des conséquences de l'accouchement est en faveur d'un mécanisme d'altération de la continence indépendant du mode d'accouchement. Nos résultats suggèrent que la prévention de l'IU d'effort par des interventions à l'accouchement, épisiotomie ou césarienne, est inefficace

Pour ou contre la rééducation périneale du post-partum ?

International audienceAucu

Césarienne et troubles génitosexuels du post-partum

National audienceObjet La prévalence et la prévention des troubles génitosexuels consécutifs à l'accouchement sont peu connues. Il serait logique de penser que la césarienne qui évite le traumatisme périnéal s'accompagne de moins de troubles de la fonction sexuelle. Méthode Nous avons réalisé une revue de la littérature sur le sujet. Résultat La prévalence de la dyspareunie en post-partum immédiat est estimée entre 20 et 50 %, la durée moyenne des symptômes est de quatre mois. La déchirure périnéale est un facteur de risque pour la dyspareunie du post-partum immédiat. Les troubles sexuels peuvent persister plus longtemps en cas de déchirure grave. À distance de l'accouchement, il n'existe pas de différence entre les femmes accouchées par césarienne et les femmes accouchées par les voies naturelles pour la prévalence de la dyspareunie dans un essai randomisé, les cohortes de femmes suivies après l'accouchement et les enquêtes transversales. Conclusion La césarienne ne semble pas apporter de protection contre les troubles génitosexuels

Est-il encore justifié et éthique de réaliser un bilan urodynamique avant la chirurgie de l’incontinence d’effort de la femme ?

International audienceDe nombreux chirurgiens ont l’habitude de demander un bilan urodynamique avant de réaliser une chirurgie de l’incontinence urinaire de la femme en particulier en cas d’incontinence mixte. Cet usage est conforme aux recommandations des sociétés savantes françaises (Collège National des Gynécologues et Obstétriciens Français et Association Française d’Urologie) publiées en 2010..