B. Fatton

An International Urogynecological Association (IUGA) / International Continence Society (ICS) joint terminology and classification of the complications related directly to the insertion of prostheses (meshes, implants, tapes) & grafts in female pelvic floor surgery

Introduction and hypothesisA terminology and standardized classification has yet to be developed for those complications arising directly from the insertion of synthetic (prostheses) and biological (grafts) materials in female pelvic floor surgery.MethodsThis report on the above terminology and classification combines the input of members of the Standardization and Terminology Committees of two International Organizations, the International Urogynecological Association (IUGA) and the International Continence Society (ICS) and a Joint IUGA/ICS Working Group on Complications Terminology, assisted at intervals by many expert external referees. An extensive process of 11 rounds of internal and external review took place with exhaustive examination of each aspect of the terminology and classification. Decision-making was by collective opinion (consensus).ResultsA terminology and classification of complications related directly to the insertion of prostheses and grafts in female pelvic floor surgery has been developed, with the classification based on category (C), time (T) and site (S) classes and divisions, that should encompass all conceivable scenarios for describing insertion complications and healing abnormalities. The CTS code for each complication, involving three (or four) letters and three numerals, is likely to be very suitable for any surgical audit or registry, particularly one that is procedure-specific. Users of the classification have been assisted by case examples, colour charts and online aids (www.icsoffice.org/complication).ConclusionsA consensus-based terminology and classification report for prosthess and grafts complications in female pelvic floor surgery has been produced, aimed at being a significant aid to clinical practice and research.

An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint terminology and classification of the complications related directly to the insertion of prostheses (meshes, implants, tapes) and grafts in female pelvic floor surgery.

A terminology and standardized classification has yet to be developed for those complications arising directly from the insertion of synthetic (prostheses) and biological (grafts) materials in female pelvic floor surgery.

Diagnosis and management of adult female stress urinary incontinence: guidelines for clinical practice from the French College of Gynaecologists and Obstetricians

Urinary incontinence is a frequent affliction in women and may be disabling and costly {LE1}. When consulting for urinary incontinence, it is recommended that circumstances, frequency and severity of leaks be specified {Grade B}. The cough test is recommended prior to surgery {Grade C}. Urodynamic investigations are not needed before lower urinary tract rehabilitation {Grade B}. A complete urodynamic investigation is recommended prior to surgery for urinary incontinence {Grade C}. In cases of pure stress urinary incontinence, urodynamic investigations are not essential prior to surgery provided the clinical assessment is fully comprehensive (standardised questionnaire, cough test, bladder diary, post-void residual volume) with concordant results {PC}. It is recommended to start treatment for stress incontinence with pelvic floor muscle training {Grade C}. Bladder training is recommended at first intention in cases with overactive bladder syndrome {Grade C}. For overweight patients, loss of weight improves stress incontinence {LE1}. For surgery, sub-urethral tape (retropubic or transobturator route) is the first-line recommended technique {Grade B}. Sub-urethral tape surgery involves intraoperative risks, postoperative risks and a risk of failure which must be the subject of prior information {Grade A}. Elective caesarean section and systematic episiotomy are not recommended methods of prevention for urinary incontinence {Grade B}. Pelvic floor muscle training is the treatment of first intention for pre- and postnatal urinary incontinence {Grade A}. Prior to any treatment for an elderly woman, it is recommended to screen for urinary infection using a test strip, ask for a bladder diary and measure post-void residual volume {Grade C}. It is recommended to carry out a cough test and look for occult incontinence prior to surgery for pelvic organ prolapse {Grade C}. It is recommended to carry out urodynamic investigations prior to pelvic organ prolapse surgery when there are urinary symptoms or occult urinary incontinence {Grade C}.

International Urogynecological Association (IUGA)/International Continence Society (ICS) joint terminology and classification of the complications related to native tissue female pelvic floor surgery

A terminology and standardized classification has yet to be developed for those complications related to native tissue female pelvic floor surgery.

Validation linguistique en français de la version courte du questionnaire sur la sexualité (PISQ-12) chez les patientes présentant un prolapsus génital et/ou une incontinence urinaire

INTRODUCTION The aim of this paper was to report a linguistically validated French version of the PISQ-12. PATIENTS AND METHODS French validated version of the PISQ-12 was developed after two independent translations (English-French), one back-translation (French-English), a review by two French clinicians skilled in urogynecology and a testing on a sample of patients with pelvic floor disorders. This linguistic validation process was conducted by Mapi Research Institute in collaboration with the author of the original version, R. Rogers, and sponsored by Coloplast. RESULTS PISQ-12 is the short form of a reliable specific condition, originally developed and psychometrically validated in English, and a self-administrated instrument to evaluate sexual function in women with pelvic organ prolapse and/or urinary incontinence. The questionnaire contains 12 items divided into three domains, labelled behavioral/emotive, physical and partner-related. French linguistic validation does not consist in literally translating the original questionnaire but rather in developing conceptually equivalent and an easily understood version by French women. CONCLUSION This tool is essential to assess the sexual impact of pelvic floor disorders and to better understand the consequences of their treatments on sexuality.

Urethral erosion after suburethral synthetic slings: risk factors, diagnosis, and functional outcome after surgical management.

Urethral erosion (UE) is an uncommon but potentially severe complication after suburethral synthetic slings. We aimed to identify the risk factors and diagnostic modalities of UE and also functional outcome after UE surgical management. We retrospectively analyzed eight cases of UE managed in our department between 1997 and 2007. The main presumptive risk factors of UE were excessive sling tensioning (six of eight) and postoperative urethral dilation (four of eight). The most frequent symptoms included voiding difficulties (five of eight), storage symptoms (three of eight), pain (three of eight), and recurrent stress incontinence (three of eight). UE diagnosis was accessible to introital ultrasound (five of five) and confirmed by urethroscopy (eight of eight). Surgical management was performed in seven cases and included transvaginal sling removal with urethral repair (two of seven), endoscopic transurethral sling resection (four of seven), and combined approach (one of seven). All the approaches provided good functional outcomes. Transurethral endoscopy is a mini-invasive treatment of UE and should be tried first in selected cases.

An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint terminology and classification of the complications related to native tissue female pelvic floor surgery

Introduction and hypothesisA terminology and standardized classification has yet to be developed for those complications related to native tissue female pelvic floor surgery.MethodsThis report on the terminology and classification combines the input of members of the Standardization and Terminology Committees of two International Organizations, the International Urogynecological Association (IUGA) and the International Continence Society (ICS) and a Joint IUGA/ICS Working Group on Complications Terminology, assisted at intervals by many external referees. A process of rounds of internal and external review took place with decision making by collective opinion (consensus).ResultsA terminology and classification of complications related to native tissue female pelvic floor surgery has been developed, with the classification based on category (C), time (T), and site (S) classes and divisions that should encompass all conceivable scenarios for describing operative complications and healing abnormalities. The CTS code for each complication, involving three (or four) letters and three numerals, is likely to be very suitable for any surgical audit or registry, particularly one that is procedure-specific. Users of the classification have been assisted by case examples, colour charts and online aids (www.icsoffice.org/ntcomplication).ConclusionsA consensus-based terminology and classification report for complications in native tissue female pelvic floor surgery has been produced. It is aimed at being a significant aid to clinical practice and particularly to research.

Stress urinary incontinence and LUTS in women[mdash]effects on sexual function

The sexual impact of urinary incontinence in women depends on a host of parameters, including physical, psychological, social and cultural dimensions. Evaluation of the effects of stress urinary incontinence (SUI) and lower urinary tract symptoms on sexual function is often biased by their common association with other pelvic floor disorders, such as pelvic organ prolapse, which also affect sexual satisfaction. Indeed, these complexities are reflected in the literature, which shows considerable disparity in sexual functional characteristics in women with incontinence both before and after treatment. This discordance is further emphasized by heterogeneity in study design, quality and analysis. Here, we describe the nature of sexual dysfunction in women with incontinence, including coital incontinence. The various treatments for SUI, which include transvaginal tape surgeries, can also affect sexual function, positively or negatively. Coital incontinence seems to be a good predictor of an improvement in postoperative sexual parameters: its cure, achieved by >90% of women, to a large extent explains the sexual benefits reported in several studies. By contrast, deterioration in sexual function is sometimes reported after surgery, with de novo or worsened dyspareunia being the most common cause. The literature does not contain any convincing arguments for one treatment or another on the basis of sexual functional outcome.

Bilateral extraperitoneal uterosacral vaginal vault suspension: a 2-year follow-up longitudinal case series of 123 patients

Introduction and hypothesisThe objective of this study is to assess anatomical and functional results of the extraperitoneal uterosacral ligament suspension (USL) in women with post-hysterectomy vaginal vault prolapse.MethodsOne hundred and twenty-three consecutive women were included. Concurrent procedures were anterior colporraphy with fascial repair (20%) and mesh reinforcement (49%), posterior colporraphy with fascial repair (38%) and mesh reinforcement (56%) and a sling procedure (29%). Women were assessed using Baden and Walker and pelvic organ prolapse quantification classification pre- and post-operatively.ResultsOne hundred and ten patients (89%) were available for follow-up. Mean follow-up was 2 years. Objective success rate regarding the vaginal cuff is 95.4%. Global anatomical success rate was 85.5%. Urinary, coital and bowel symptoms were improved following surgery. Mesh exposure rate was 19.3%, with all cases managed conservatively or with minor interventions.ConclusionBilateral extraperitoneal USL is an effective operation to restore apical support with low morbidity, which avoids potential risks associated with opening the peritoneal cavity.

Bilan avant le traitement chirurgical d’un prolapsus génital : Recommandations pour la pratique clinique

Resume Objectif La question abordee dans ce chapitre de recommandations concerne le bilan clinique et paraclinique a realiser chez les patientes presentant un prolapsus genital et pour qui une prise en charge chirurgicale a ete decidee. Quels sont les examens du bilan clinique a prendre en compte comme facteur de risque d’echec ou de recidive apres chirurgie, pour anticiper et evaluer les difficultes chirurgicales possibles, et pour orienter vers une technique chirurgicale preferentielle ? Materiel et methodes Ce travail s’appuie sur une revue systematique de la litterature (PubMed, Medline, Cochrane Library, Cochrane Database of Systemactic Reviews, EMBASE) concernant les meta-analyses, essais randomises, registres, revues de la litterature, etudes controlees et grandes etudes non controlees publies sur le sujet. Sa realisation a suivi la methodologie de la Haute autorite de sante (HAS) concernant les recommandations pour la pratique clinique, avec un argumentaire scientifique (accompagne du niveau de preuve, NP) et un grade de recommandation (A, B, C et accord professionnel [AP]). Resultats Il convient tout d’abord de decrire le prolapsus, par l’examen clinique, au besoin aide d’un complement d’imagerie si les donnees de l’examen clinique sont insuffisantes, ou en cas de discordance entre les signes fonctionnels et les anomalies cliniques constatees, ou de doute sur une pathologie associee. Il convient de rechercher les facteurs de risque de recidive (prolapsus de haut grade) et de complications postoperatoires (facteurs de risque d’exposition prothetique ou de difficultes d’abord chirurgical, syndrome douloureux pelvien avec hypersensibilisation) afin d’en informer la patiente et de guider le choix therapeutique. Les troubles fonctionnels urinaires associes au prolapsus (incontinence urinaire, hyperactivite vesicale, dysurie, infection urinaire, retentissement sur le haut appareil) seront recherches et evalues par l’interrogatoire et l’examen clinique, ainsi que par une debitmetrie avec mesure du residu postmictionnel, un examen cytobacteriologique des urines (ECBU), et une echographie reno-vesicale. En presence de troubles mictionnels il convient de faire leur evaluation clinique et urodynamique. En l’absence de tout signe urinaire spontane ou masque, il n’y a a ce jour aucun argument pour recommander un bilan urodynamique de maniere systematique. Il convient de rechercher et d’evaluer les symptomes anorectaux associes au prolapsus (syndrome d’intestin irritable, syndrome d’obstruction defecatoire [ODS], incontinence anale). Avant toute chirurgie de prolapsus, il est indispensable de ne pas meconnaitre une pathologie utero-annexielle. Conclusion Avant de proposer une cure chirurgicale d’un prolapsus genital de la femme, il convient de faire un bilan clinique et paraclinique visant a decrire le prolapsus (structures anatomiques impliquees, grade), chercher des facteurs de risque de recidive, de difficultes et de complications postoperatoires, et apprecier le retentissement ou les symptomes associes au prolapsus (urinaires, anorectaux, gynecologiques, douleurs pelvi-perineales) afin d’orienter leur evaluation et leur traitement.