Validation linguistique en français des versions courtes des questionnaires de symptômes (PFDI-20) et de qualité de vie (PFIQ-7) chez les patientes présentant un trouble de la statique pelvienne

INTRODUCTION

The aim of this work was to develop a linguistically validated French version of two short-form questionnaires on symptoms and quality of life in female patients with pelvic floor disorders (PFDI-20, PFIQ-7), originally developed and psychometrically validated in English.

MATERIAL AND METHODS

French versions of the short form Pelvic Floor Disorder Inventory (PFDI-20) and Pelvic Floor Impact Questionnaire (PFIQ-7) were developed after two independent forward translations (English-French), one back translation (French-English), a review by French clinicians and patient testing on a sample of patients with pelvic floor disorders. This linguistic validation process was led in collaboration with Mapi Research Institute and the author of the original English version, Dr Matthew Barber, and sponsored by Coloplast.

RESULTS

These two self-administered questionnaires are completed by patients without a medical presence. They cover urinary, colo-recto-anal and pelvic/vaginal symptoms related to pelvic floor disorders. Psychometric evaluation of the original US English questionnaires found a good correlation between answers provided and clinical symptoms leading the patient to seek medical attention. Their main advantage is their ease of interpretation through the use of a numeric score. Linguistic validation does not consist in translating original questionnaires literally, but rather in developing conceptually equivalent and culturally appropriate versions adapted to the target country. These questionnaires are invaluable instruments to evaluate functional aspects of various forms of pelvic organ prolapse.

CONCLUSION

The French versions of the PFDI-20 and PFIQ-7 are the first linguistically validated instruments available in French to evaluate symptoms and quality of life in patients with pelvic floor disorders.

[Amniocentesis practice assessment of the south-west Francilian network during 2003]

OBJECTIVES

To assess amniocentesis practice of a network during one year.

MATERIALS AND METHODS

In a retrospective multicenter study of the south-west Francilian network, we have enrolled 2400 patients who underwent amniocentesis, from 1 January 2003 to 31 December 2003.

RESULTS

The rate of amniocentesis was 9.5%. The most frequent indication was a positive maternal serum screening test result (44%). The rate of global fetal losses (spontaneous miscarriage and intrauterine death) was 1.4%. Once the fetuses with aneuploidy and lethal pathology excluded, the rate of global fetal losses potentially related to amniocentesis was 1.21%. The rate of premature rupture of the membranes was 1.12% and prematurity affected 6.5% of the living births.

CONCLUSION

Our study has highlighted several practices of amniocentesis within the network. Overall, amniocentesis potentially induces 1.12% of fetal losses. Screening tests are currently used sequentially, which leads to an increase number of amniocentesis and to an increase number of losses of "a priori" healthy fetus. Only the use of a combined screening could lower the frequency of amniocentesis without decreasing the detection rate of chromosome abnormalities.

Les hémorragies utérines fonctionnelles

Dysfunctionnal uterine bleeding (DUB) is a significant health problem in premenopausal women. First line therapy is traditionally medical therapy but often ineffective. Hysterectomy is obviously effective in stopping bleeding but is associated with morbidity and is most costly. Endometrial ablation technique is becoming the first conservative line in the management of DUB. In 2007, the Cochrane Data Base, and the NICE published the new guidelines for DUB treatment. Pharmaceutical treatments should be considered in the following order: levonorgestrel-releasing intra uterine system and if hormonal treatment is not acceptable, tranexamic acid can be used. This is the exclusive line of treatment for women who desire to be pregnant, and the first step for the others one. The rapid development of second generation technique of endometrial destruction suggests that these techniques are becoming "the gold standart" for the patients without desire of future pregnancy. These techniques are easier that endometrial resection/ablation by hysteroscopy without major complications. In France, the National Health Insurance must find a codification CCAM for giving an exact price to the procedure. This new tarification could include the device cost and could avoid either inefficient procedure like datation and curetage or morbide procedure like hysterectomy.

Infracoccygeal sacropexy or sacrospinous suspension for uterine or vaginal vault prolapse

OBJECTIVE

To compare infracoccygeal sacropexy (IS) and sacrospinous suspension (SS) for the treatment of uterine or vault prolapse.

METHODS

A randomized trial of 49 women assigned to either the IS group using IVS tape (n=24) or SS group (n=25). Concomitant hysterectomy and repairs were performed as appropriate. Evaluations included prolapse staging using the POP-Q system and validated questionnaires for symptoms (PFDI), quality of life (PFIQ), and sexuality (PISQ-12). The primary outcome measure was postoperative pain.

RESULTS

Patients' characteristics were similar in both groups. IS was quicker, easier, and less painful than SS (P<0.01). Hemorrhage or hematoma rates were similar. Neither rectal injury nor vaginal erosion occurred. Mean follow-up was 16.8 months. Prolapse cure rates, symptom scores, and quality of life were similar. Postoperative cystocele occurred in 4.8% of women after IS and 25% after SS (P>0.05).

CONCLUSION

Infracoccygeal sacropexy is equivalent to sacrospinous suspension, with a decreased rate of postoperative pain and cystocele recurrence.

Le syndrome des ovaires polykystiques (SOPK)

Polycystic ovaries syndrome (PCOS) is one of the most common female hormonal disorders. Its multiple components--reproductive, metabolic, neoplasic and cardiovascular--have a major impact on the public health. Androgen excess and resistance to insulin, probably from genetic origin, are responsible for most of the clinical symptomatology. Resistance to insulin seems to be accompanied by a greater risk of glucose intolerance, type 2 diabetes, lipidic anomalies and can involve the development of cardiovascular diseases. In addition, sleep apnea syndrome is more progressively described in PCOS. Infertility, menses disorders and hirsutism often push these patients to consult their physician. A better understanding of the physiopathological mechanisms led to the emergence of new therapeutic options increasing the sensitivity to insulin. Besides the pregnancy wishes, cares aim to attenuate the marks of the hyper-androgenism (hormonal treatment and cosmetic) and to correct cardiovascular, respiratory and gynaecological risk factors. In case of infertility by anovulation, cares must be performed by trained experts to minimize the risk of ovarian hyper-stimulation syndrome and multiple pregnancies. A gradation from loose weight to clomiphene citrate ovulation induction, ovarian drilling, low dose gonadotropin, in vitro fertilisation, or in vitro maturation of oocytes should bring back good reproduction potential.

[Chemoprevention and prophylactic surgery in ovarian carcinoma]

INTRODUCTION

Ovarian cancer is the leading cause of death from gynaecological malignancy, especially because of late diagnosis. The objective of the study was to provide the clinician with current concepts regarding prevention of ovarian cancer.

MATERIAL AND METHODS

A computerized search of articles published was performed using the Medline database We performed a review of the literature (PubMed, Embase) using the following search terms (MeSH and non-MeSH): prevention, chemoprevention, chemoprevention, ovarian cancer, ovarian, ovary, carcinoma, tumor, tumour.

RESULTS

Oral contraceptive and acetaminophen use may provide substantial protection against ovarian cancer, whereas aspirin, carotenoids and non-steroidal anti-inflammatory agents do not decrease the risk. However, to date, there is no recommendation concerning low risk population. At the opposite, young women (<35-40 years old) presenting with BRCA1 or 2 mutation or Lynch syndrome may be counseled for chemoprevention using oral contraceptive. For high risk women over 35-40 years old, prophylactic bilateral salpingo-oophorectomy should be performed. Indeed, it has been showed that prophylactic surgery significantly decrease mortality rates in high risk women.

CONCLUSION

Large randomized studies are required to assess the efficacy of ovarian cancer chemoprevention in low risk women. High-risk women over 35-40 years old should be counseled for prophylactic salpingo-oophorectomy or for chemoprevention using oral contraceptive.

[Vaginal mesh extrusion after transvaginal repair of cystocele using a prosthetic mesh: Treatment and functional outcomes]

OBJECTIVE

To describe management of vaginal mesh erosion following transvaginal repair of acystocele by placement of a polypropylene mesh.

MATERIALS AND METHOD

Retrospective analysis of 34 consecutive cases of vaginal mesh erosion following transvaginal repair of cystocele using synthetic mesh (Gynemesh or Gynemesh-Soft). We have analyzed the results of both medical and surgical management of this complication. Furthermore, we also assessed sexual and urinary morbidity in women with mesh erosion (n = 34) and in women who had undergone the same procedure but without mesh erosion (n = 111).

RESULTS

Among the 34 patients with vaginal mesh erosion, 23 (68%) have undergone local therapy using Colposeptine (Chlorquinaldol + Promestriène). In 12 (52%) cases no modification of the surface of the erosion was observed. In 6 (26%) cases, a decrease of the surface of the mesh erosion was observed. In 5 (22%) cases the mesh erosion had completely disappeared, with a follow-up of 2 to 9 months. Nineteen symptomatic patients (19/32, 59%) required partial (n = 18) or complete (n = 1) excision of the mesh, associated with vaginal mucosal closure, under general anaesthesia. Duration of operation ranged from 15 to 40 minutes for partial excision of the mesh. This procedure was successful in 14 cases (77%). Four women required repeated resection of the mesh because of recurrence. The incidence of de novo dyspareunia was 12% in patients with vaginal mesh erosion, and 11% in patients without mesh erosion (p = 0.81). The incidence of urge urinary symptoms and voiding dysfunction symptoms was respectively 8% versus 9% (p = 0.95), and 8% versus 10% (p = 0.81) in the 2 groups.

CONCLUSION

Management of vaginal mesh erosion is simple and is associated with a low rate of morbidity. However, patients should be informed that vaginal erosion of the mesh can occur.