Xavier Fritel

Stress urinary incontinence 4 years after the first delivery: a retrospective cohort survey

Background.u2002 Our aim was to estimate the prevalence of stress urinary incontinence 4u2003years after the first delivery and analyze its risk factors.

Abdominal sacrohysteropexy in young women with uterovaginal prolapse: Long-term follow-up

OBJECTIVEnThe purpose of this study was to evaluate the long-term efficiency after abdominal sacrohysteropexy in women with uterovaginal prolapse.nnnSTUDY DESIGNnWe conducted a retrospective chart review at our tertiary referral urogynecology unit. Thirty women of childbearing age with uterovaginal prolapse who wanted uterine preservation underwent abdominal sacrohysteropexy between 1987 and 1999.nnnRESULTSnThe mean age of the women was 35.7 years (range, 29-43 years). All women were parous. Thirteen women had grade 2 uterovaginal prolapse, and 17 women had grade 3 prolapse. In all women, the Burch procedure and posterior colporrhaphy were performed at the same time. Intraoperative and postoperative complications occurred in 2 patients (6.6%) and 4 patients (13.3%), respectively. The mean objective and subjective follow-up periods were 44.5 months (range, 2-156 months) and 94.6 months (range, 8-160 months), respectively. At the time of the last physical examination, there were two cases of recurrent uterovaginal prolapse (6.6%), which was symptomatic in 1 patient and required repeat surgical treatment. At the time of the last questionnaire, apart from the patient who underwent repeat surgery, no patients had any uterovaginal prolapse symptoms. Three women had pregnancies that were conceived spontaneously, which led to three early legal abortions.nnnCONCLUSIONnThe abdominal sacrohysteropexy is effective and safe in the treatment of uterovaginal prolapse in women of childbearing age. This procedure has a high success rate in correcting prolapse without a time-dependent decrease in efficiency.

Predictive value of urethral mobility before suburethral tape procedure for urinary stress incontinence in women.

PURPOSEnWe determined whether preoperative urethral mobility predicts the outcome of the suburethral tape procedure outcome in women with urinary stress incontinence.nnnMATERIALS AND METHODSnThis retrospective study included 78 women who underwent preoperative cystourethrography while standing. Proximal urethral support was assessed by lateral cystourethrograms at rest and during straining. The 2 images were anatomically superimposed and the angle formed by the 2 proximal urethra axes determined urethral mobility. Surgical outcome was assessed by stress and pad tests.nnnRESULTSnMedian followup was 9 months (range 1 to 37) and the objective success rate was 85% (66 of 78 cases). Median rotation of the proximal urethra was 67 degrees in cases without previous surgery for incontinence, 33 degrees in those with 1 and 28 degrees in those with 2 or more procedures (p <0.0001). The success rate was 97% (29 of 30 cases) when urethral mobility exceeded 60 degrees versus 86% (18 of 21) for mobility between 30 and 60 degrees, and 70% (19 of 27) when it was less than 30 degrees (p = 0.023). The success rate was 96% (26 of 27 cases) without previous surgery for incontinence versus 84% (31 of 37) when 1 unsuccessful procedure had been performed and 64% (9 of 14) with 2 or more surgical failures (p = 0.026). Patient age at surgery, menopausal status, mixed incontinence, body mass index, parity, overactive bladder and low maximal urethral closure pressure had no significant prognostic value.nnnCONCLUSIONSnThe suburethral sling procedure takes advantage of urethral mobility to avoid leakage. The more the proximal part of the urethra moves while under stress, the better the continence achieved. Risk factors for failure are poor proximal urethral mobility and previous surgery for incontinence.

Pelvic floor disorders 4 years after first delivery: a comparative study of restrictive versus systematic episiotomy

Objectiveu2002 To compare two policies for episiotomy: restrictive and systematic.

RESULTS OF TRANSURETHRAL INJECTION OF SILICONE MICRO-IMPLANTS FOR FEMALES WITH INTRINSIC SPHINCTER DEFICIENCY

PURPOSEnWe evaluated the medium term efficiency of silicone micro-implants injected in women with intrinsic sphincter deficiency.nnnMATERIALS AND METHODSnA total of 21 women with intrinsic sphincter deficiency underwent transurethral injection of silicone micro-implants between August 1996 and February 1997. Each patient was assessed preoperatively by questionnaire, physical examination and urodynamic study. The results were evaluated by questionnaire at 1 month, and 1 and 2 years after silicone injection. The outcome was classified as dry in all circumstances, improved or failure.nnnRESULTSnAll patients (median age 68 years, range 46 to 83) had undergone previous anti-incontinence or prolapse surgeries. At 1 month 2 patients (10%) were dry and 9 (42%) were improved, and treatment failed in 10 (48%). At 1 year (median 16 months, range 14 to 22) 2 cases (10%) were classified as dry, 8 (38%) improved and 11 (52%) failures. At last followup (median 31 months, range 24 to 34) 4 cases (19%) were classified as dry, 6 (29%) improved and 11 (52%) failures. None of the 6 patients with bladder neck hypermobility was dry.nnnCONCLUSIONSnOur results of silicone transurethral injection are disappointing but comparable to other bulking agents without a time dependent decrease in efficiency. The use of silicone micro-implants is an alternative for the treatment of intrinsic sphincter deficiency in patients without bladder neck hypermobility and in whom the sling procedure has failed.

Long-term survival with consolidation intraperitoneal chemotherapy for patients with advanced ovarian cancer with pathological complete remission.

OBJECTIVESnThe goal of this study was to evaluate the long-term outcome after consolidation intraperitoneal (IP) chemotherapy in patients with a negative second-look laparotomy (SLL) following first-line intravenous chemotherapy for advanced ovarian cancer.nnnMETHODSnThis study included patients with FIGO stage III-IV ovarian cancer who entered into four prospective trials (1984-1995) including intravenous chemotherapy based on cisplatin (six cycles) and anthracycline, early debulking surgery after three cycles of chemotherapy in the case of initial residual disease >2 cm, SLL, and IP consolidation chemotherapy. Among 218 patients, 68 with biopsy-negative SLL received every 4 weeks three consolidation cycles of IP chemotherapy (mitoxantrone, cisplatin, etoposide) via a totally implantable port. Long-term outcome of these patients is reported.nnnRESULTSnMean age was 56 years (33-72 years). Overall, 51% of the patients had at least a grade 3 or 4 toxic effect. Main toxic effects were leukopenia, abdominal pain related to the catheter, and nausea and vomiting. Only 13 patients (19%) did not receive the full three cycles. The median progression-free survival (PFS) for the whole population is 34 months, 34% of the patients being estimated to be free of disease at 5 years. The median overall survival is 73 months, and the 5-year survival is 58%.nnnCONCLUSIONSnIn this selected population treated with IP consolidation chemotherapy, prolonged survival was observed. However, the occurrence of late relapses in this most favorable patient category underlines the need to improve the consolidation therapy options in ovarian cancer.

Pour ou contre la rééducation périnéale du post-partum ?

La prévention de l’incontinence urinaire féminine est une priorité de santé publique inscrite dans la loi française [1]. Le lien entre grossesse et incontinence urinaire d’effort féminine est clairement établi tant sur le court terme que sur le moyen ou long terme [2–4]. Mais les différentes méthodes de prévention proposées, que ce soit la césarienne, l’épisiotomie ou la rééducation périnéale, sont sujettes à controverse [3–6]. Même si les techniques de rééducation périnéale du postpartum ont montré une efficacité pour traiter ou diminuer la gêne liée à l’incontinence urinaire ou fécale, les essais comparatifs existants sont peu nombreux, de qualité variable et hétérogènes quant aux critères d’inclusion et au type d’intervention rééducative choisie qui est souvent éloignée de la pratique française (Tableau 1) [7–13]. Le travail de Meyer et al. (Lausanne) est intéressant, car proche de notre pratique [11]. Les femmes étaient incluses et évaluées avant l’accouchement, puis à deux mois du postpartum. Pour le groupe rééducation, elle débutait deux mois après l’accouchement et comportait deux séances par semaines pendant six semaines avec, à chaque fois, 20 minutes de biofeedback et 15 minutes d’électrostimulation. Au moment de l’évaluation, dix mois après l’accouchement, la prévalence de l’incontinence urinaire d’effort était inchangée dans le groupe témoin (16 % à deux mois versus 14 % à dix mois du post-partum) tandis qu’elle était diminuée dans le groupe rééducation (31 versus 12 %). Cependant, ce travail

Long-term functional stability of sacrospinous ligament-fixation repair of pelvic organ prolapse

The objective of this study was to evaluate the variation over 5 years of functional discomfort associated with pelvic organ prolapse (POP) repaired by sacrospinous ligament fixation (SLF). A total of 178 women who had undergone SLF from 1992 to 2001. In 2002 and 2008, patients were sent a questionnaire including the pelvic floor distress inventory (PFDI-20); 79 responded and comparison of those data served to evaluate subjective signs at 5 years. This population was divided into two groups: ≤60 and >60 years old, and their 2002–2008 differences were compared. The outcomes were satisfaction, functional results and sexuality. Mean follow-up was 115 (72–173) months. Our results showed the long-term stability of SLF functional outcomes for women >60 years. However, for those ≤60 years, functional outcomes and satisfaction had declined at 5 years.

Fistule urogénitale obstétricale: a propos de deux observations en France [Obstetric vesicovaginal fistula: reporting two cases in France].

Obstetric vesicovaginal fistula is nowadays rare in developed countries. We are reporting two cases of patients with obstetric vesicovaginal fistula that occurred after operative vaginal deliveries performed in a French hospital. Early postpartum symptoms were vaginal urine leakage and infectious syndrome. The fistula has been cured by vaginal surgery one case and combined (laparotomy and vagina surgery) in the other case. Patients were totally healed a few months following the surgery.

Fistule urogénitale obstétricale : à propos de deux observations en France

Obstetric vesicovaginal fistula is nowadays rare in developed countries. We are reporting two cases of patients with obstetric vesicovaginal fistula that occurred after operative vaginal deliveries performed in a French hospital. Early postpartum symptoms were vaginal urine leakage and infectious syndrome. The fistula has been cured by vaginal surgery one case and combined (laparotomy and vagina surgery) in the other case. Patients were totally healed a few months following the surgery.