Aurélia Chauveaud-Lambling

Combined genital prolapse repair reinforced with a polypropylene mesh and tension‐free vaginal tape in women with genital prolapse and stress urinary incontinence: a retrospective case–control study with short‐term follow‐up

Background.  To evaluate the tension‐free vaginal tape (TVT) in both stress urinary incontinence (SUI) and occult SUI as an associated procedure at the time of tension‐free polypropylene mesh repair for the treatment of genitourinary prolapse.

Long-term anatomical and functional assessment of trans-vaginal cystocele repair using a tension-free polypropylene mesh.

We report a case series of 63 women with cystocele who underwent the same trans-vaginal procedure between October 1999 and October 2002. The polypropylene mesh (GyneMesh, Gynecare, Ethicon, France) was placed from the retropubic space to the inferior part of the bladder in a tension-free fashion. Patients were followed up for 24 to 60 months, with a mean follow-up of 37 months. Fifty-five patients returned for follow-up (87.3%). At follow-up, 49 women were anatomically cured (89.1%), five women had stage 2 anterior vaginal wall prolapse (9.1%), and one had a recurrent stage 3 (1.8%). Functional results and sexual function were also investigated. Fifty-three women had significant improvement in their quality of life (96.4%). There were a total of three cases of local pain around a mesh shrinkage (5.5%) and five vaginal erosions of the mesh (9.1%). Four out of 24 patients had dyspareunia (16.7%). In conclusion, the vaginal repair of anterior vaginal wall prolapse reinforced with a polypropylene mesh was efficient at 2 to 5 years follow-up. However, the first generation of polypropylene mesh we used was responsible for high rates of local complications and dyspareunia. Therefore, the polypropylene mesh has to be improved (lower weight) and the technique has to be documented by a randomized controlled trial before we could recommend its use in clinical practice.

Hysteroscopic Management of Residual Trophoblastic Tissue and Reproductive Outcome: A Pilot Study

We report on the feasibility, efficiency, and reproductive outcomes of hysteroscopic resection of late residual trophoblastic tissue in 50 patients in an observational study over 6 years. Complete evacuation of the uterus was achieved in all patients by hysteroscopy. The median operative time was 21 (15-30) min. Only one surgical complication was registered: a uterine perforation in a patient with previous metroplasty. Hysteroscopic resection of persistent trophoblastic tissue seems to be a safe and efficient procedure that could be proposed as an alternative to conventional non-selective blind curettage. We would also recommend systematic second-look hysteroscopy to asess the exact prevalence of post-procedure intrauterine adhesions.

Traitement du prolapsus génital avec mise en place d’une prothèse de polypropylène par voie vaginale: Résultats anatomiques et fonctionnels chez des femmes de moins de 50 ans

OBJECTIVES We evaluated the results of surgical insertion of a polypropylene mesh via the vaginal route in young women presenting genital prolapse. MATERIAL AND METHODS Retrospective study concerning 20 women under age 50 who underwent between July 2000 and December 2003 surgical insertion of an anterior (n=14), posterior (n=3) or double (anterior and posterior) (n=3) polypropylene mesh via the vaginal route. A minimum follow-up of 6 months was required for inclusion in the study. Anatomical results were assessed using the Pelvic Organ Prolapse Quantification (POP-Q) according to ICS (International Continence Society) recommendations. To document the functional results, the patients answered 3 validated self-assessment questionnaires related to pelvic symptoms, sexual behaviors and quality of life. RESULTS Mean follow-up was 21 months (6 to 52 months). A vaginal erosion of the mesh occurred in 2 women (10%). Cystocele recurred in one woman among the 17 patients who had an anterior polypropylene mesh (Gynemesh, Gynecare, Ethicon). Seventeen women were sexually active before the surgical procedure and 19 post-operatively. Among these women, 5 (26%) reported alteration of sexual activity after surgery (with dyspareunia in 4 cases (21%)), and 14 women (74%) reported no changes or improvement in sexual activity. CONCLUSION Surgical management of genital prolapse using a polypropylene mesh inserted via the vaginal route has proven its anatomical efficacy in young women. The potential adverse consequences on sexual life would require clinical research concerning the surgical approach (abdominal or vaginal route) and synthetic materials used in prolapse surgery for young women.Resume Objectifs Evaluer chez les femmes jeunes, les resultats a moyen terme des cures de prolapsus par voie vaginale avec mise en place de protheses de polypropylene. Materiels et methodes Etude retrospective portant sur 20 patientes âgees de moins de 50 ans et operees entre juillet 2000 et decembre 2003 d’une cure de prolapsus genital avec mise en place d’une prothese de polypropylene anterieure (n = 14), posterieure (n = 3), ou double (anterieure et posterieure) (n = 3). Les patientes devaient avoir un suivi minimum de 6 mois pour etre eligible dans l’etude. L’evaluation des resultats anatomiques a ete realisee avec la classification POP-Q (Pelvic Organ Prolapse — Quantification) recommandee par l’I.C.S. (International Continence Society). L’evaluation fonctionnelle a ete realisee grâce a des questionnaires de symptomes, de qualite de vie et de sexualite. Resultats Le suivi moyen a ete de 21 mois (de 6 a 52 mois). Le taux d’erosion vaginale avec exposition de prothese a ete de 10 % (2/10). Une seule recidive de cystocele a ete observee parmi les 17 femmes ayant eu la mise en place d’une prothese anterieure de Gynemesh tm (Gynecare

Technique de cerclage cervico-isthmique par voie vaginale avec bandelette de polypropylène: technique de Fernandez: Description et résultats

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 35 - N° 5 - p. 465-471OBJECTIVE To assess the efficacy of performing transvaginal cervico-isthmic cerclage using synthetic tape in prevention of preterm labor in high-risk women. PATIENTS AND METHODS A retrospective analysis of 24 transvaginal cerclages using polypropylene tape performed in women presenting with high risk of preterm delivery: prior histories of pregnancy losses in the second trimester, prior failure of Mac Donalds cerclage and/or absent portio vaginalis of the cervix. Cerclage was performed between 12 and 16 weeks of gestation. A polypropylene tape was placed at the cervicoisthmic junction by vaginal route. RESULTS The median age of the patients in this series was 32.1 years (range 22-39 years). No intra-operative complication occurred. The median operating time was 34.9 minutes (+/-5.1) (range 30-45 min). Cesarean delivery was systematically performed in all patients since the cerclage was considered to be definitive. Mean gestational age and birth weight at delivery were respectively 37.1 weeks (+/-1.8) and 2850 g (+/-745). Preterm birth rate was 19% (4/21). Birth at less than 32 weeks occurred in only one patient (4%). In one case, the tape has been removed later because symptomatic vaginal erosion was noted. One neonatal death occurred following amniotic fluid infection at 34 weeks. At the present time, 3 women are at 22, 26 and 26 weeks of gestation with no preterm labor. CONCLUSION Transvaginal cerclage using polypropylene tape may be considered as an effective and minimally invasive alternative to transabdominal cervico-isthmic cerclage in women presenting with high risk of preterm delivery.

Therapy Insight: fertility in women after cancer treatment

Cancer is the second-commonest cause of death in women under 40 years of age in Western Europe and the US. The survival of cancer patients has, nevertheless, improved during the past two decades. During this period, and especially during the last decade, there have been ground-breaking advances in the optimization of the quality of life of patients treated for cancer, in particular by the development of fertility-enhancing and fertility-preserving procedures in young patients treated for cancer. Surgery, chemotherapy and radiation therapy affect the fertility potential of women in different ways. Surgery to remove the uterus and ovaries has a direct impact on fertility. Radiation therapy (external or brachytherapy) can affect ovarian and also uterine function. Different drugs used in chemotherapy can directly influence ovarian function. Some markers have now been evaluated that are predictive of the potential toxic injury to the gonads and uterus. Various procedures have been proposed to preserve the fertility potential in women before anticancer treatment begins or after the tumor is treated; however, such optimization of management should only be undertaken if it does not have a deleterious effect on the survival of the patient.