Pierre Bonnet

Inside out transobturator vaginal tape for the treatment of female stress urinary incontinence: Interim results of a prospective study after a 1-year minimum followup

PURPOSEnWe analyzed the results of a prospective, observational trial designed to assess the safety and efficacy of the TVT-O procedure for female SUI.nnnMATERIALS AND METHODSnPreoperative and postoperative evaluations included physical examination, and urinary symptom and quality of life scale questionnaires.nnnRESULTSnBetween March 2003 and December 2004, 253 patients with clinical and urodynamic diagnoses of SUI who fulfilled inclusion and exclusion criteria were enrolled in the trial and underwent the TVT-O procedure. No significant intraoperative complications were observed. One-year minimum followup was available on 99 of the initial 102 patients, of whom 16 had undergone concomitant pelvic organ prolapse surgical treatment. The SUI complete cure rate was 91%. No patient had vaginal or urethral erosion. Four patients required tape release or section. Frequency and urge symptoms improved after the operation (p <0.001). The severity of obstructive symptoms slightly increased postoperatively in the group of patients who did not undergo associated pelvic organ prolapse treatment (p <0.05), while maximum flow rates somewhat decreased (p <0.001) and post-void residual urine volumes somewhat increased (p <0.005). Most patients reported a significant decrease in incontinence severity and improvement in quality of life (p <0.0001).nnnCONCLUSIONSnThe results of this study, which suggest that the TVT-O procedure is a safe and efficient surgical treatment for female SUI, warrant further comparative evaluation of this procedure with retropubic and outside in transobturator approaches in appropriately designed, prospective, randomized trials.

An anatomic comparison of the original versus a modified inside-out transobturator procedure

Introduction and hypothesisThe objective of this study was to evaluate the modification of a shortened tape and reduced dissection of the inside-out transobturator procedure on the tape’s relationship to the relevant anatomical structures.MethodsIn ten fresh frozen cadavers, relevant distances between the two different tapes and anatomical structures were recorded.ResultsThe shorter tape traversed less muscular structures, but consistently traversed the obturator membrane. The median distance from the tape to the obturator canal measured 2.0 versus 1.9xa0cm, to the anterior obturator nerve 3.0 versus 2.7xa0cm, and to the posterior obturator nerve 2.2 versus 2.0xa0cm [modified versus original procedure, respectively (pu2009>u20090.05)]. Significantly, less mesh was inserted in the modified procedure on each side of the body (6.1 versus 9.9xa0cm, pu2009<u20090.05).ConclusionsThe shorter, inside-out transobturator tape traverses less muscular structures than its original counterpart, while still consistently anchoring in the obturator membrane at a similarly safe distance from the obturator canal.

A study of the anatomy and injection techniques of the ovine stifle by positive contrast arthrography, computed tomography arthrography and gross anatomical dissection

Although ovine stifle models are commonly used to study osteoarthritis, meniscal pathology and cruciate ligament injuries and repair, there is little information about the anatomy of the joint or techniques for synovial injections. The objectives of this study were to improve anatomical knowledge of the synovial cavities of the ovine knee and to compare intra-articular injection techniques. Synovial cavities of 24 cadaver hind limbs from 12 adult sheep were investigated by intra-articular resin, positive-contrast arthrography, computed tomography (CT) arthrography and gross anatomical dissection. Communication between femoro-patellar, medial femoro-tibial and lateral femoro-tibial compartments occurred in all cases. The knee joint should be considered as one synovial structure with three communicating compartments. Several unreported features were observed, including a communication between the medial femoro-tibial and lateral femoro-tibial compartments and a latero-caudal recess of the lateral femoro-tibial compartment. No intermeniscal ligament was identified. CT was able to define many anatomical features of the stifle, including the anatomy of the tendinous synovial recess on the lateral aspect of the proximal tibia under the combined tendon of the peroneus tertius, extensor longus digitorum and extensor digiti III proprius. An approach for intra-articular injection into this recess (the subtendinous technique) was assessed and compared with the retropatellar and paraligamentous techniques. All three injection procedures were equally successful, but the subtendinous technique appeared to be most appropriate for synoviocentesis and for injections in therapeutic research protocols with less risk of damaging the articular cartilage.

L’anatomie pelvi-périnéale de l’homme

Le complexe sphincterien uretral s’etend du pelvis au perinee, la partie externe, striee, forme une gouttiere disposee verticalement, epaisse et quasi annulaire dans sa portion mediane. La notion de diaphragme urogenital est revolue. n n nLa partie interne du sphincter uretral, lisse, comprend en sus-montanal les extensions caudales du trigone en arriere et des faisceaux du detrusor (longitudinaux et cervicaux) en avant. En sous-montanal, le sphincter lisse constitue un cylindre lisse sous-muqueux. n n nLa structure sphincterienne est logee entre les faisceaux les plus mediaux du releveur de l’anus, les muscles pubo-perinei et puboanali. Elle est reliee en avant au pubis par les ligaments pubo-uretraux et en arriere au rectum et au centre tendineux du pelvis par le muscle recto-uretralis. n n nLe complexe sphincterien recoit une innervation double : autonome par voie pelvienne et volontaire par une voie mixte : perineale et pelvienne. Lors d’une approche pelvienne de l’apex prostatique et de l’uretre, cette innervation se localise a 5 et 7 heures par rapport a l’uretre tandis que les nerfs caverneux longent l’uretre a 3 et 9 heures.

The ENTRAMI technique: Endoscopic transgluteal minimal invasive technique for implantation of a pudendal electrode under full visual control: A cadaver study

The aim of this article is to describe a minimal invasive trans gluteal endoscopic approach to implant a pudendal electrode for neuromodulation under full visual control.

Surgical treatment of cardiovascular complications in patients with Marfan syndrome: a report of two cases and literature review.

Abstract Cardiovascular disease is the main cause of morbidity and mortality in patients with Marfan syndrome. The most life threatening complication is aortic root aneurysms leading to aortic dissection or rupture. It can be prevented by regular aortic follow-up and prophylactic aortic surgery. Modern aortic surgery has led to a substantial increase in the life expectancy of these patients. We report two cases of Marfan syndrome with cardiovascular complications. Their management is discussed according to the most recent literature.