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Abstract
Diagnostic adenomyosis is done by pathologist (grade A). Adenomyosis is usually asymptomatic (grade C). Symptomatic adenomyosis gives pains and/or bleedings (grade C). Hysterosalpingography is not included in diagnostic strategy (grade B). Sonography has a good sensitivity and can be exclusively used for therapeutic strategy (grade B). MRI is pertinent but only useful in case of associated lesions (grade B). Hysterectomy is the gold standard for symptomatic patients without desire of pregnancy (grade B). Medical treatments are: IUD with levonorgestrel, Gn-RH analog, antigonadotrope progestin (grade C). Uterine artery embolisation is not recommended (professional agreement). Endometrial resection/destruction are indicated in case of menorraghia (grade C).
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Seror V, Gelfucci F, Gerbaud L, Pouly JL, Fernandez H, Job-Spira N, Bouyer J, Coste J. Care pathways for ectopic pregnancy: a population-based cost-effectiveness analysis. Fertil Steril 2007; 87:737-48. [PMID: 17222832 DOI: 10.1016/j.fertnstert.2006.11.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2006] [Revised: 10/31/2006] [Accepted: 11/02/2006] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To define care pathways in terms of frequency, costs, and outcomes and to assess their cost-effectiveness. DESIGN Population-based cost-effectiveness study. SETTING Auvergne EP registry (France). PATIENT(S) Women (n = 1,664) registered between 1994 and 2003. INTERVENTION(S) Standard diagnosis and treatment of EP. MAIN OUTCOME MEASURE(S) Costs before, during, and after hospitalization were assessed from data concerning medical costs of examinations and treatments. One-year fertility was used for effectiveness assessment. We assessed cost-effectiveness for the healthcare system. RESULT(S) Diagnostic ultrasound (47% of scans were nondiagnostic) was essential for the use of methotrexate as a first-line treatment for subacute EP. Hospital and ambulatory care costs were similar for all surgical-care pathways (diagnostic or nondiagnostic ultrasound scan followed by conservative or radical laparoscopy). Hospital and ambulatory-care costs associated with methotrexate treatment were less than half those for surgical-care pathways. In subacute cases, conservative treatments, and methotrexate in particular, were associated with better fertility at similar or lower cost to salpingectomy for EP for reproductive failure. CONCLUSION(S) Conservative treatments are cost-effective with respect to salpingectomy, when subsequent fertility is at stake. Efforts should be made to increase the frequency of diagnostic ultrasound scans, making it possible to increase methotrexate use and cost-effectiveness.
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Donnadieu AC, Deffieux X, Gervaise A, Faivre E, Frydman R, Fernandez H. Essure®sterilization associated with endometrial ablation. Int J Gynaecol Obstet 2007; 97:139-42. [PMID: 17379221 DOI: 10.1016/j.ijgo.2007.02.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2006] [Revised: 02/02/2007] [Accepted: 02/08/2007] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the feasibility and the outcome of Essure sterilization associated with different techniques of endometrial ablation. METHOD Retrospective study conducted among 23 women with confirmed menometrorrhagia and with the desire for or the medical need for permanent tubal sterilization. Patients underwent combined hysteroscopic placement of Essure and hysteroscopic endometrial resection procedures: ThermaChoice (n=14), NovaSure (n=4), Hydrothermablator (n=2) and endometrial resection using monopolar energy (n=1), or bipolar energy (n=2). RESULTS Fallopian tubes were successfully cannulated bilaterally in 87% of the cases (20/23). No adverse event was reported. Adequate bilateral occlusion was confirmed for all patients (20/20) by 3D ultrasound and pelvic X-ray at a 3-month follow-up. Furthermore, 85% of these patients were satisfied with the results of the procedure, all experiencing a significant reduction in menstrual blood loss (Higham blood loss score). CONCLUSION Combining EA and hysteroscopic sterilization seems to be feasible and efficient in patients with menometrorrhagia.
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Fernandez H. Fertilité tubaire et chirurgie : le point de vue du gynécologue. IMAGERIE DE LA FEMME 2007. [DOI: 10.1016/s1776-9817(07)88605-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Fernandez H. [Fertiloscopy: Clermont-Ferrand's experiment]. GYNECOLOGIE, OBSTETRIQUE & FERTILITE 2007; 35:280-1. [PMID: 17321187 DOI: 10.1016/j.gyobfe.2006.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Kharfan-Dabaja M, Kumar A, Behera M, Field T, Ayala E, Perez L, Fernandez H, Anasetti C, Djulbegovic B. 95: Autologous hematopoietic cell transplantation (auto-HCT) in chronic lymphocytic leukemia (CLL). Biol Blood Marrow Transplant 2007. [DOI: 10.1016/j.bbmt.2006.12.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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de Tayrac R, Chevalier N, Chauveaud-Lambling A, Gervaise A, Fernandez H. Is vaginal hysterectomy a risk factor for urinary incontinence at long-term follow-up? Eur J Obstet Gynecol Reprod Biol 2007; 130:258-61. [PMID: 16876308 DOI: 10.1016/j.ejogrb.2006.01.032] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2005] [Revised: 11/22/2005] [Accepted: 01/30/2006] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the prevalence of urinary symptoms at long-term follow-up after vaginal hysterectomy. STUDY DESIGN One hundred and seventeen patients, who had a vaginal hysterectomy for menorrhagia, from January 1991 to December 2001, answered to a self-report questionnaire about de novo urinary symptoms. The control group was a population of 116 patients who had a conservative treatment for dysfunctional uterine bleeding by endometrial thermocoagulation from January 1994 to December 2001. RESULTS Patient characteristics (mean age, mean parity, menopausal status, smoking status, drink habits) were similar in the two groups. Mean follow-up was 4.6+/-2.2 years (range 1.5-11) after vaginal hysterectomy and 4+/-1.8 years (range 1.5-7) after conservative treatment. The prevalence of urinary symptoms, included urge and stress incontinence, were statistically similar in the two groups. CONCLUSION This study reveals no risk of urge or stress urinary incontinence at long-term follow-up after vaginal hysterectomy, compared with conservative treatment.
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Fernandez H. [New features for your journal in 2007]. JOURNAL DE GYNECOLOGIE, OBSTETRIQUE ET BIOLOGIE DE LA REPRODUCTION 2007; 36:1. [PMID: 17293246 DOI: 10.1016/j.jgyn.2007.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
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Le Ray C, Donnadieu AC, Gervaise A, Frydman R, Fernandez H. Prise en charge chirurgicale des patientes présentant un utérus cloisonné total. ACTA ACUST UNITED AC 2006; 35:797-803. [PMID: 17151536 DOI: 10.1016/s0368-2315(06)76482-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Septate uterus is the principal müllerian anomaly, but complete septate uterus is uncommon and often associated with frequent obstetrical complications. Surgical section of the septum is however possible. MATERIAL AND METHOD We report patients with a complete septum uterus operated in our department between 2002 and 2006. We performed a hysteroscopic section of the cervical, uterine and vaginal septum at discovery of the anomaly. The accuracy of imaging exams, frequency of associated malformations, past obstetrical events and reproductive outcome post surgery were analyzed. RESULTS The surgical technique was based on section of the cervical part with scissors and hysteroscopic section of the uterine septum; no perforation was noted. Four patients required a second procedure to achieve complete uterine section. Five patients became pregnant after surgery, 8 pregnancies are reported: 2 term delivery, 1 preterm delivery, 4 miscarriages and 1 ectopic pregnancy. CONCLUSION Complete surgical section of the cervical and uterine septum in case of complete septum uterus is safe. However, we cannot conclude about the obstetrical benefit of this surgical technique. A longer follow-up is needed.
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Donnadieu AC, Deffieux X, Le Ray C, Mordefroid M, Frydman R, Fernandez H. Unusual fast-growing ovarian cystic teratoma during pregnancy presenting with intracystic fat "floating balls" appearance. Fertil Steril 2006; 86:1758-9. [PMID: 17067585 DOI: 10.1016/j.fertnstert.2006.06.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2006] [Revised: 06/20/2006] [Accepted: 06/20/2006] [Indexed: 11/28/2022]
Abstract
A large ovarian cyst was diagnosed at 22 weeks' of gestation in a 32-year-old woman. The ultrasonographic appearance of the ovarian cyst was unusual with multiple mobile, spherical echogenic structures floating in the cystic mass, called intracystic "fat balls." Right adnexectomy was performed by laparotomy at 28 weeks' of gestation, because of rapid growth and overall size exceeding 20 cm. Pathological examination confirmed ovarian cystic teratoma. Usually, dermoid cysts are slow-growing, even in premenopausal women. The exact mechanism related to the fast growth during pregnancy is unknown. It could be related to an unusual pattern of estrogen (E)/P receptors expression in the cystic teratoma. This case shows that a fast-growing, mature ovarian cystic teratoma may occur during pregnancy.
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Deffieux X, De Tayrac R, Louafi N, Gervaise A, Bonnet K, Frydman R, Fernandez H. Novel application of polypropylene sling: transvaginal cervicoisthmic cerclage in women with high risk of preterm delivery. J Minim Invasive Gynecol 2006; 13:216-21. [PMID: 16698528 DOI: 10.1016/j.jmig.2006.01.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2005] [Revised: 01/11/2006] [Accepted: 01/15/2006] [Indexed: 11/27/2022]
Abstract
STUDY OBJECTIVE To describe a novel technique of transvaginal cervicoisthmic cerclage with a polypropylene sling in prevention of preterm labor in pregnant women at high risk. DESIGN Retrospective study (Canadian Task Force classification: III). SETTING University hospital (department of obstetrics and gynecology). PATIENTS Twenty-one women showing symptoms of high risk of preterm delivery: histories of pregnancy losses in the second trimester and prior failure of MacDonald's cerclage or absent portio vaginalis of the cervix. The median age of the patients was 32.8 years (range 22-39 years). INTERVENTIONS Cerclage was performed between 12 and 16 weeks' gestation. A polypropylene tape was placed at the cervicoisthmic junction by vaginal route. Caesarean delivery was systematically performed in all patients because the cerclage was considered to be definitive. MEASUREMENTS AND MAIN RESULTS No intraoperative complications occurred. The mean operating time was 36 +/- 6 minutes (range 30-45 minutes). The mean length of stay was 1.4 +/- 0.5 days. Mean gestational age and birth weight at delivery were respectively 37.1 +/- 1.8 weeks (CI 95%: 36.4-37.9) and 2850 +/- 745 g (CI 95%: 2531-3168). The preterm birth rate was 19% (4/21). One neonatal death occurred after amniotic fluid infection at 34 weeks. Birth at less than 32 weeks occurred in one patient (4%). CONCLUSION Transvaginal cervicoisthmic cerclage with polypropylene sling may be considered as an effective and minimally invasive alternative to the transabdominal cervicoisthmic cerclage in women presenting with high risk of preterm delivery.
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Daraï E, Frobert JL, Grisard-Anaf M, Lienhart J, Fernandez H, Dubernard G, David-Montefiore E. Functional results after the suburethral sling procedure for urinary stress incontinence: a prospective randomized multicentre study comparing the retropubic and transobturator routes. Eur Urol 2006; 51:795-801; discussion 801-2. [PMID: 17010507 DOI: 10.1016/j.eururo.2006.08.046] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2006] [Accepted: 08/25/2006] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To compare short-term functional outcomes, urodynamic parameters, and quality of life of transobturator and retropubic routes in the cure of urinary stress incontinence. POPULATION AND METHODS This prospective, multicentre study involved 88 women undergoing suburethral sling procedure for stress urinary incontinence (SUI). The retropubic route (RPR) and the transobturator route (TOR) were used in 42 and 46 women, respectively. No difference in epidemiologic and preoperative urinary functional status (SUI stage, and pollakiuria, nocturia, and urgency rates) was found between the groups. Functional results and quality of life were evaluated before surgery and at 1, 3, 6, and 12 mo postoperatively. Urodynamic examinations were performed before and 3 mo after surgery. RESULTS The mean follow-up was 10 mo. No difference in the rate of de novo urge incontinence and immediate and late voiding dysfunction was noted between the groups. No difference in the cure rate was observed between the groups (89.3% in the RPR group and 88.6% in the TOR group). RPR was associated with a significant decrease in maximum urinary flow and an increase in residual urine volume. Quality of life was significantly improved after surgery without difference between the groups. CONCLUSIONS Retropubic and transobturator routes for treatment of female SUI have similar high cure rates and quality of life improvement. Because of advantages in the rate of complications and postoperative pain previously demonstrated on the same population, the transobturator route appears to be the best option for the treatment of urinary incontinence.
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Fernandez H, Al-Najjar F, Chauveaud-Lambling A, Frydman R, Gervaise A. Fertility after treatment of Asherman’s syndrome stage 3 and 4. J Minim Invasive Gynecol 2006; 13:398-402. [PMID: 16962521 DOI: 10.1016/j.jmig.2006.04.013] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2005] [Revised: 04/12/2006] [Accepted: 04/24/2006] [Indexed: 11/29/2022]
Abstract
STUDY OBJECTIVE To evaluate the efficacy of hysteroscopic adhesiolysis and subsequent fertility in patients with adhesions stage 3 and 4. DESIGN A retrospective cohort study (Canadian Task Force classification II-2). SETTING A tertiary referral center for hysteroscopic surgery. PATIENTS Seventy-one patients with intrauterine permanent adhesions. INTERVENTIONS Hysteroscopic surgery with monopolar energy (n=31) or bipolar energy (n=40). Uterine cavity with at least one free ostial area was restored after one (n=31), two (n=20), three (n=15), or four or more (n=5) surgical procedures RESULTS Sixty-four patients were followed. Evaluation of the uterine cavity after surgery has been performed by hysteroscopy for all the patients. All patients had resumption of menses, except for two patients with a history of uterine artery embolization. Pregnancy index rate after the procedure was 28 (43.8%) of 64, and the live birth rate was 21 (32.8%) of 64. In patients 35 years of age or younger, 20 of 30 (66.6%) conceived compared with 8 of 34 (23.5%) in patients older than 35 years (p=.01). Three patients had either hysterectomy (n=2) or hypogastric arteries ligation for placenta accreta with uneventful postoperative course. CONCLUSIONS Hysteroscopic adhesiolysis can be performed for severe adhesions stage 3 and 4 with safety and efficacy. Age is the main predictive factors of success: the pregnancies were at risk of abnormal placentation.
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Chevalier N, Doumerc S, Bourcigaux N, Mendez Lozano D, Frydman R, Fernandez H. P-863. Fertil Steril 2006. [DOI: 10.1016/j.fertnstert.2006.07.1253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Deffieux X, de Tayrac R, Louafi N, Gervaise A, Sénat MV, Chauveaud-Lambling A, Picone O, Faivre E, Bonnet K, Frydman R, Fernandez H. Technique de cerclage cervico-isthmique par voie vaginale avec bandelette de polypropylène: technique de Fernandez. ACTA ACUST UNITED AC 2006; 35:465-71. [PMID: 16940914 DOI: 10.1016/s0368-2315(06)76418-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE 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 Donald's 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.
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Deffieux X, Donnadieu AC, Mordefroid M, Levante S, Frydman R, Fernandez H. Prepubic and thigh abscess after successive placement of two suburethral slings. Int Urogynecol J 2006; 18:571-4. [PMID: 16832590 DOI: 10.1007/s00192-006-0154-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2006] [Accepted: 05/14/2006] [Indexed: 10/24/2022]
Abstract
We present a case of prepubic and thigh abscess after the placement of two types of suburethral slings in a 65-year-old woman suffering from stress urinary incontinence (SUI). The first surgical procedure (prepubic tension-free vaginal tape) was unsuccessful. Thus, 2 months later, we placed an ObTape sling by transobturator approach. This second procedure was successful. Seven months later, the patient presented with vaginal erosion of the sling with no inflammatory signs. The suburethral portion of the sling was immediately removed and the vagina was sutured. Nine months later, a prepubic abscess occurred and required removal of the prepubic sling, drain placement, and antibiotic therapy. Unfortunately, 9 months later, a thigh abscess occurred. Magnetic resonance imaging (MRI) allowed precise diagnosis and anatomic localization of the thigh abscess. Surgery consisted of opening and draining the abscess and removing the transobturator sling. At 6 months follow-up, no persistent inflammatory sign was observed on MRI, and SUI did not recur.
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Benhaim Y, de Tayrac R, Deffieux X, Gervaise A, Chauveaud-Lambling A, Frydman R, Fernandez H. Traitement du prolapsus génital avec mise en place d’une prothèse de polypropylène par voie vaginale. ACTA ACUST UNITED AC 2006; 35:219-26. [PMID: 16645554 DOI: 10.1016/s0368-2315(06)78305-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
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.
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de Tayrac R, Cortesse A, Fernandez H, Fritel X. [Transurethral injections under local anaesthesia for ambulatory treatment of stress urinary incontinence in women: indications, feasibility and results]. ACTA ACUST UNITED AC 2006; 34:702-10. [PMID: 16270009 DOI: 10.1016/s0368-2315(05)82904-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate feasibility and results of ambulatory transurethral injections of Macroplastique using the system MIS under local anaesthesia, for treatment of female stress urinary incontinence. MATERIAL AND METHODS We have performed a prospective multicentre study which has enrolled 20 patients between January 2003 and May 2004. Mean age was 72.8 ans (range 40 to 91). Preoperative inclusion criterias were positive stress test, 24 hours PAD test more than 10 g and post-void residual less than 100 ml. Urethral hypermobility was present in 8 patients (42.1%), and 3 patients was diagnosed as intrinsic sphincter deficiency (16.7%) on urodynamics examination. Pre and post-operative evaluation of urinary symptoms and quality of life were performed with the MHU score (Mesure du Handicap Urinaire), the Ditrovie score and the Contilife scale. The Macroplastique implant (Uroplasty) contains silicone and a bioabsorbable gel. Injections were perfomed under the mid-urethral mucosa (2.5 ml at 6 hours and 1.25 ml at 2 and 10 hours) using the system MIS (Uroplasty). No cystoscopy was required and the mean operative time was 15 minutes. RESULTS The procedure was feasible under pure local anaesthesia in all cases. No intra-operative complications occurred. Postoperative complications had included 2/19 local pain (10.5%), 3/19 minimal urethrorrhagia (15.8%) and 6/19 urinary retentions (31.6%), which were treated by heterologous intermittent catheterization during 3 to 20 days. Eight patients returned home the same day (42.1%). The mean hospital stay was 2.3 days. Mean postoperative follow-up was 8.3 months (range 2.7 to 19.1). No patient required a second injection. Results had shown a 36.9% success rate (7/19), 52.6% improvement (10/19) and 10.5% failure (2/19). At follow-up, stress test was negative in 66.7% of patients (12/18) and PAD test was<10 g in 66.7% (10/15). Modifications on maximal flow rate were non significant after injections. Postoperatively, all urinary symptoms were improved except nocturia and voiding difficulties. Quality of life was improved on all parameters. CONCLUSION The surgical treatment of female stress urinary incontinence by transurethral injections of Macroplastique using the system MIS under local anaesthesia was feasible in all cases with a success or improvement rate of 89.5% at a mean follow-up of 8.3 months. Ambulatory treatment was compromised by the high rate of postoperative urinary retention (31.6%).
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Deffieux X, Bonnet K, Chevalier N, Gervaise A, Frydman R, Fernandez H. [Urinary complications in sub-urethral sling procedures]. ACTA ACUST UNITED AC 2006; 34:745-56. [PMID: 16319764 DOI: 10.1016/s0368-2315(05)82949-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Urinary complications following sub urethral sling procedures are common, and management of these complications continue to be discussed. METHODS The literature available on Medline/PubMed, relating to urinary complications associated with suburethral sling procedures, was reviewed. RESULTS Bladder perforation, which occurs with an incidence of 5.7% in tension-free vaginal tape procedure, requires repositioning of the sling, but does not cause any increase in postoperative morbidity. The trans-obturator approach appears to decrease this risk. Urethral perforation, which is uncommon (0.4-1%), is a contraindication to maintenance of the sling. Bladder erosion is rare, requiring resection of the mesh with a combined abdominal and cystoscopic approach. Urethral mesh erosion (0.07% to 1.5%) also requires surgical sling removal, but few patients remain continent because this removal requires a large urethrolysis (recurrence rate of incontinence is 66% following removal of the sling). Bladder outlet obstruction occurs frequently after sub-urethral procedures. When complete obstruction is clinically evident 2 days after a sub-urethral sling procedure, immediate reintervention is performed with a rapid return to normal voiding. Recurrence rate of stress incontinence is less than 30% following reintervention.
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Fernandez H. [Strengthening the College's journal in 2006]. JOURNAL DE GYNECOLOGIE, OBSTETRIQUE ET BIOLOGIE DE LA REPRODUCTION 2006; 35:5. [PMID: 16446604 DOI: 10.1016/s0368-2315(06)76364-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
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Veyradier A, Gervaise A, Boyer-Neumann C, Wolf M, Fernandez H. Screening for bleeding disorders in women with menorrhagia using a platelet function analyzer. J Thromb Haemost 2006; 4:483-5. [PMID: 16420588 DOI: 10.1111/j.1538-7836.2006.01748.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Fernandez H. Grossesse isthmique localisée au niveau d'une cicatrice d'hystérotomie traitée par méthotréxate. À propos d'un cas. ACTA ACUST UNITED AC 2006; 34:181. [PMID: 16495114 DOI: 10.1016/j.gyobfe.2006.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Anaissie E, Schuster M, Hurd D, Bensinger W, Mason J, McCarty J, Rifkin R, Maziarz R, Bolwell B, Mehta J, Mangan K, Skikne B, Abboud C, Chao N, Stadtmauer E, Fernandez H, Lazarus H, Westervelt P, Halvorsen Y, Gerwien R, Annino V, Hahne W. A phase II, multicenter, randomized, double-blind, placebo-controlled trial of the safety and efficacy of velafermin (CG53135-05) administered intravenously as a single dose for the prevention of oral mucositis in patients receiving autologous hematopoietic stem cell transplant (AHSCT). Biol Blood Marrow Transplant 2006. [DOI: 10.1016/j.bbmt.2005.11.068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Deffieux X, de Tayrac R, Huel C, Bottero J, Gervaise A, Bonnet K, Frydman R, Fernandez H. Vaginal mesh erosion after transvaginal repair of cystocele using Gynemesh or Gynemesh-Soft in 138 women: a comparative study. Int Urogynecol J 2006; 18:73-9. [PMID: 16391882 DOI: 10.1007/s0192-005-0041-2] [Citation(s) in RCA: 128] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2005] [Accepted: 10/19/2005] [Indexed: 10/25/2022]
Abstract
The objective of this study was to compare mesh erosion after transvaginal repair of cystocele using Gynemesh or Gynemesh-Soft mesh. We retrospectively analyzed 138 consecutive cases of transvaginal repair of cystocele using synthetic mesh. The study endpoint was the pathological evidence of vaginal erosion. Multiple logistic regression was used to determine independent predictors of vaginal erosion. One hundred and thirty eight women (ages 30-83 years) with cystocele between October 1999 and October 2004, from a French University Hospital, participated in this study. Cystocele repair was performed in all patients according to the technique of tension-free polypropylene mesh. The median follow-up was 32.1 months (range 7.5-59.9) in the Gynemesh group and 7.1 months (range 1-21.9) in the Gynemesh-Soft group. Vaginal erosion was reported in 27 (20%) of the patients. Anatomically, the success rate was 95% (131/138). There was no statistically significant difference between the Gynemesh and the Gynemesh-Soft meshes [the rate of vaginal erosion of the mesh was 16% (15/89) vs 24% (12/49), respectively, p=0.39]. Univariate analysis only identified age class as factor significantly associated with the probability of vaginal erosion. Multivariate analysis revealed that age class is an independent predictive factor of vaginal erosion (age > 70 years, odds ratio (OR) 3.6, 95% confidence interval (CI) 1.3-9.7, p=0.010). Furthermore cystocele stage > 2 (Baden and Walker classification) is a protective factor against vaginal erosion (OR 0.3, 95% CI 0.1-0.8, p=0.016). Thirteen symptomatic patients (13/27, 48%) necessitated a partial excision of the mesh, associated with a vaginal mucosal closure. Two patients (2/27, 7%) underwent a complete excision of the mesh. The incidence of de novo dyspareunia was 9% in patients with vaginal erosion and 11% in patient without mesh erosion (p=0.85). There was no occurrence of bladder or urethral erosion and no vaginal or pelvic infection. Isolated vaginal erosion of the mesh did not prove to be problematic. Gynemesh-Soft mesh does not decrease the incidence of vaginal erosion. Age > 70 years is an independent predictive factor of vaginal erosion. We recommend that mesh placement by vaginal route should be avoided by women with moderate cystocele. Where possible, total hysterectomy and vertical incision should also be avoided. Management of vaginal 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. A multivariate analysis reveals that the incidence of vaginal erosion is not significantly different between Gynemesh and Gynemesh-Soft meshes. Other factors of erosion are analyzed.
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Deffieux X, Huel C, Cosson M, Leveque J, Bonnet K, Fernandez H. Hystérectomie sub-totale : données récentes et implications pratiques. ACTA ACUST UNITED AC 2006; 35:10-5. [PMID: 16446606 DOI: 10.1016/s0368-2315(06)76366-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The advantages and drawbacks of total and sub-total hysterectomy remain a topic of debate. Our study reviews the literature concerning recent comparative and prospective studies regarding the options of total and subtotal hysterectomy. RESULTS Subtotal hysterectomy may be useful in preventing severe complications when total hysterectomy is technically difficult. Furthermore, conservation of the uterine cervix may decrease vaginal erosion in genital prolapse repair when synthetic meshes are used. The type of technique does not appear to determine the persistence or development of problems related to sexual activity (frequency of intercourse, sexual desire, and achievement of orgasm). There are no apparent advantages to subtotal hysterectomy compared with total hysterectomy with respect to bowel or bladder function. Some women (5-20%) who had the subtotal procedure continued to have genital bleeding, although this can be avoided with endocervical electro-coagulation or resection. Cervical stump prolapse is uncommon (1.5-2%), 12 months after subtotal hysterectomy. The risk of carcinoma of the cervical stump is low, and treatment results are similar in both patients with carcinoma of the cervical stump and in patients with carcinoma of the intact uterus. CONCLUSION When subtotal hysterectomy is necessary, it can be performed with a low rate of long term complications. Furthermore, for women undergoing hysterectomy for benign disease, it should be reasonable to discuss advantages and drawbacks of both procedures and offer a choice. Nevertheless, sub-total hysterectomy should be avoided in populations with restricted access to screening programs for cancer of the uterine cervix.
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