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Marcellin L, Goffinet F, Azria E, Thomin A, Garabedian C, Sibiude J, Verspyck E, Koskas M, Santulli P, Rousseau J, Ancel PY, Chapron C. Association Between Endometriosis Phenotype and Preterm Birth in France. JAMA Netw Open 2022; 5:e2147788. [PMID: 35133433 PMCID: PMC8826171 DOI: 10.1001/jamanetworkopen.2021.47788] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
IMPORTANCE Endometriosis is an inflammatory disease with a heterogeneous presentation that affects women of childbearing age. Given the limitations of previous retrospective studies, it is still unclear whether endometriosis has adverse implications for pregnancy outcomes. OBJECTIVE To evaluate the association between the presence of endometriosis and preterm birth and whether the risk varied according to the disease phenotype. DESIGN, SETTING, AND PARTICIPANTS This cohort study with exposed and unexposed groups was conducted in 7 maternity units in France from February 4, 2016, to June 28, 2018. Participants included women with singleton pregnancies who were followed up before 22 weeks' gestation along with their newborns delivered at or after 22 weeks' gestation. The final follow-up occurred in July 2019. Data were analyzed from October 7, 2020, to February 7, 2021. EXPOSURES Women in the endometriosis group had a documented history of endometriosis and were classified according to 3 endometriosis phenotypes: isolated superficial peritoneal endometriosis (SUP), ovarian endometrioma (OMA; potentially associated with SUP), and deep endometriosis (DE; potentially associated with SUP and OMA). Women in the control group did not have a history of clinical symptoms of endometriosis before their current pregnancy. MAIN OUTCOMES AND MEASURES The primary outcome was preterm birth between 22 weeks and 36 weeks 6 days of gestation. Association between endometriosis and the primary outcome was assessed through univariate and multivariate logistic regression analyses and was adjusted for the following risk factors associated with preterm birth: maternal age, body mass index (calculated as weight in kilograms divided by height in meters squared) before pregnancy, country of birth, parity, previous cesarean delivery, history of myomectomy and hysteroscopy, and preterm birth. The same analysis was performed according to the 3 endometriosis phenotypes (SUP, OMA, and DE). RESULTS Of the 1351 study participants (mean [SD] age, 32.9 [5.0] years) who had a singleton delivery after 22 weeks of gestation, 470 were assigned to the endometriosis group (48 had SUP [10.2%], 83 had OMA [17.7%], and 339 had DE [72.1%]) and 881 were assigned to the control group. No difference was observed in the rate of preterm deliveries before 37 weeks 0 days of gestation between the endometriosis and control groups (34 of 470 [7.2%] vs 53 of 881 [6.0%]; P = .38). After adjusting for confounding factors, endometriosis was not associated with preterm birth before 37 weeks' gestation (adjusted odds ratio, 1.07; 95% CI, 0.64-1.77). The results were comparable for the different disease phenotypes (SUP: 6.2% [3 of 48]; OMA: 7.2% [6 of 83]; and DE: 7.4% [25 of 339]; P = .84). CONCLUSIONS AND RELEVANCE This cohort study found no association between endometriosis and preterm birth, and the disease phenotype did not appear to alter the result. Monitoring the pregnancy beyond the normal protocols or changing management strategies for women with endometriosis may not be warranted to prevent preterm birth.
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Affiliation(s)
- Louis Marcellin
- Université de Paris, Paris, France
- Département de Gynécologie Obstétrique II et Médecine de la Reproduction, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre Hospitalier Universitaire (CHU) Cochin, Hôpital Universitaire Paris Centre (HUPC), Paris, France
| | - Francois Goffinet
- Université de Paris, Paris, France
- Port-Royal Maternity, AP-HP, Centre-University of Paris, Federation Hospitalo-Universitaire for Prematurity, Paris, France
| | - Elie Azria
- Maternité Notre-Dame-de-Bon-Secours, Groupe Hospitalier Paris-Saint-Joseph, Paris, France
| | - Anne Thomin
- Sorbonne Université, Paris, France
- Trousseau Hospital, AP-HP, Paris, France
| | - Charles Garabedian
- University Lille, Unité Lilloise de Recherche 2694, Évaluation des Technologies de Santé et des Pratiques Médicales, Lille, France
- CHU Lille, Department of Obstetrics, Lille, France
| | - Jeanne Sibiude
- Université de Paris, Paris, France
- Service de Gynécologie-Obstétrique, AP-HP Hôpital Louis Mourier, Colombes, France
| | - Eric Verspyck
- Service de Gynécologie et Obstétrique, CHU de Rouen, Rouen, France
| | - Martin Koskas
- Université de Paris, Paris, France
- Department of Gynecology, Hôpital Bichat, AP-HP, Paris, France
| | - Pietro Santulli
- Université de Paris, Paris, France
- Département de Gynécologie Obstétrique II et Médecine de la Reproduction, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre Hospitalier Universitaire (CHU) Cochin, Hôpital Universitaire Paris Centre (HUPC), Paris, France
| | - Jessica Rousseau
- Université de Paris, Paris, France
- Clinical Research Unit, Center for Clinical Investigation P1419, AP-HP, Paris, France
- Centre de Recherche Épidémiologiques et Bio Statistiques de Sorbonne Paris Cité, Obstetrical Perinatal and Pediatric Epidemiology Research Team, Institut National de la Santé et de la Recherche Médicale, Institut National de la Recherche Agronomique, Paris, France
| | - Pierre-Yves Ancel
- Université de Paris, Paris, France
- Clinical Research Unit, Center for Clinical Investigation P1419, AP-HP, Paris, France
- Centre de Recherche Épidémiologiques et Bio Statistiques de Sorbonne Paris Cité, Obstetrical Perinatal and Pediatric Epidemiology Research Team, Institut National de la Santé et de la Recherche Médicale, Institut National de la Recherche Agronomique, Paris, France
| | - Charles Chapron
- Université de Paris, Paris, France
- Département de Gynécologie Obstétrique II et Médecine de la Reproduction, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre Hospitalier Universitaire (CHU) Cochin, Hôpital Universitaire Paris Centre (HUPC), Paris, France
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Sabourdin N, Burey J, Tuffet S, Thomin A, Rousseau A, Al-Hawari M, Taconet C, Louvet N, Constant I. Analgesia Nociception Index-Guided Remifentanil versus Standard Care during Propofol Anesthesia: A Randomized Controlled Trial. J Clin Med 2022; 11:jcm11020333. [PMID: 35054027 PMCID: PMC8778406 DOI: 10.3390/jcm11020333] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 12/31/2021] [Accepted: 01/06/2022] [Indexed: 12/30/2022] Open
Abstract
The clinical benefits to be expected from intraoperative nociception monitors are currently under investigation. Among these devices, the Analgesia Nociception-Index (ANI) has shown promising results under sevoflurane anesthesia. Our study investigated ANI-guided remifentanil administration under propofol anesthesia. We hypothesized that ANI guidance would result in reduced remifentanil consumption compared with standard management. This prospective, randomized, controlled, single-blinded, bi-centric study included women undergoing elective gynecologic surgery under target-controlled infusion of propofol and remifentanil. Patients were randomly assigned to an ANI or Standard group. In the ANI group, remifentanil target concentration was adjusted by 0.5 ng mL−1 steps every 5 min according to the ANI value. In the Standard group, remifentanil was managed according to standard practice. Our primary objective was to compare remifentanil consumption between the groups. Our secondary objectives were to compare the quality of anesthesia, postoperative analgesia and the incidence of chronic pain. Eighty patients were included. Remifentanil consumption was lower in the ANI group: 4.4 (3.3; 5.7) vs. 5.8 (4.9; 7.1) µg kg−1 h−1 (difference = −1.4 (95% CI, −2.6 to −0.2), p = 0.0026). Propofol consumption was not different between the groups. Postoperative pain scores were low in both groups. There was no difference in morphine consumption 24 h after surgery. The proportion of patients reporting pain 3 months after surgery was 18.8% in the ANI group and 30.8% in the Standard group (difference = −12.0 (95% CI, −32.2 to 9.2)). ANI guidance resulted in lower remifentanil consumption compared with standard practice under propofol anesthesia. There was no difference in short- or long-term postoperative analgesia.
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Affiliation(s)
- Nada Sabourdin
- Département d’Anesthésie-Réanimation, Hopital Trousseau, GRC 29, DMU DREAM, Sorbonne Université, AP-HP, 75012 Paris, France; (M.A.-H.); (N.L.); (I.C.)
- EA 7323: Pharmacologie et Evaluation des Thérapeutiques chez L’enfant et la Femme Enceinte, Université de Paris, 75006 Paris, France
- Correspondence:
| | - Julien Burey
- Département d’Anesthésie-Réanimation, Hopital Tenon, GRC 29, DMU DREAM, Sorbonne Université, AP-HP, 75020 Paris, France; (J.B.); (C.T.)
| | - Sophie Tuffet
- Department of Clinical Pharmacology and Clinical Research Platform of the East of Paris (URC-CRC-CRB), Hôpital St Antoine, AP-HP, 75012 Paris, France; (S.T.); (A.R.)
| | - Anne Thomin
- Département de Gynécologie et Obstétrique, Hopital Trousseau, FHU PREMA, Sorbonne Université, AP-HP, 75012 Paris, France;
| | - Alexandra Rousseau
- Department of Clinical Pharmacology and Clinical Research Platform of the East of Paris (URC-CRC-CRB), Hôpital St Antoine, AP-HP, 75012 Paris, France; (S.T.); (A.R.)
| | - Mossab Al-Hawari
- Département d’Anesthésie-Réanimation, Hopital Trousseau, GRC 29, DMU DREAM, Sorbonne Université, AP-HP, 75012 Paris, France; (M.A.-H.); (N.L.); (I.C.)
| | - Clementine Taconet
- Département d’Anesthésie-Réanimation, Hopital Tenon, GRC 29, DMU DREAM, Sorbonne Université, AP-HP, 75020 Paris, France; (J.B.); (C.T.)
| | - Nicolas Louvet
- Département d’Anesthésie-Réanimation, Hopital Trousseau, GRC 29, DMU DREAM, Sorbonne Université, AP-HP, 75012 Paris, France; (M.A.-H.); (N.L.); (I.C.)
| | - Isabelle Constant
- Département d’Anesthésie-Réanimation, Hopital Trousseau, GRC 29, DMU DREAM, Sorbonne Université, AP-HP, 75012 Paris, France; (M.A.-H.); (N.L.); (I.C.)
- EA 7323: Pharmacologie et Evaluation des Thérapeutiques chez L’enfant et la Femme Enceinte, Université de Paris, 75006 Paris, France
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Thomin A, Bakkar S, Trafi M, Champeaux-Orange E. Analyse dosimétrique chez 50 patientes prises en charge par curiethérapie de haut débit de dose de la voûte vaginale. Cancer Radiother 2018. [DOI: 10.1016/j.canrad.2018.07.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Thomin A, Belghiti J, David C, Marty O, Bornes M, Ballester M, Roman H, Daraï E. Maternal and neonatal outcomes in women with colorectal endometriosis. BJOG 2016; 125:711-718. [DOI: 10.1111/1471-0528.14221] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2016] [Indexed: 11/30/2022]
Affiliation(s)
- A Thomin
- Department of Gynaecology and Obstetrics; Hôpital Tenon; Assistance Publique des Hôpitaux de Paris; Université Pierre et Marie Curie; Paris France
- GRC 6 UPMC (C3E) Centre Expert en Endométriose; Paris France
| | - J Belghiti
- Department of Gynaecology and Obstetrics; Hôpital Tenon; Assistance Publique des Hôpitaux de Paris; Université Pierre et Marie Curie; Paris France
- GRC 6 UPMC (C3E) Centre Expert en Endométriose; Paris France
| | - C David
- Department of Gynaecology and Obstetrics; Rouen University Hospital; Hospital-Charles Nicolle; Rouen France
| | - O Marty
- Department of Gynaecology and Obstetrics; Hôpital Tenon; Assistance Publique des Hôpitaux de Paris; Université Pierre et Marie Curie; Paris France
- GRC 6 UPMC (C3E) Centre Expert en Endométriose; Paris France
| | - M Bornes
- Department of Gynaecology and Obstetrics; Hôpital Tenon; Assistance Publique des Hôpitaux de Paris; Université Pierre et Marie Curie; Paris France
- GRC 6 UPMC (C3E) Centre Expert en Endométriose; Paris France
| | - M Ballester
- Department of Gynaecology and Obstetrics; Hôpital Tenon; Assistance Publique des Hôpitaux de Paris; Université Pierre et Marie Curie; Paris France
- GRC 6 UPMC (C3E) Centre Expert en Endométriose; Paris France
- UMRS938; Université Pierre et Marie Curie; Paris France
| | - H Roman
- Department of Gynaecology and Obstetrics; Rouen University Hospital; Rouen France
- Research Group 4308, Spermatogenesis and Gamete Quality; IHU Rouen Normandy; IFRMP23; Reproductive Biology Laboratory; Rouen University Hospital; Rouen France
| | - E Daraï
- Department of Gynaecology and Obstetrics; Hôpital Tenon; Assistance Publique des Hôpitaux de Paris; Université Pierre et Marie Curie; Paris France
- GRC 6 UPMC (C3E) Centre Expert en Endométriose; Paris France
- UMRS938; Université Pierre et Marie Curie; Paris France
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Cohen J, Thomin A, Mathieu D'Argent E, Laas E, Canlorbe G, Zilberman S, Belghiti J, Thomassin-Naggara I, Bazot M, Ballester M, Daraï E. Fertility before and after surgery for deep infiltrating endometriosis with and without bowel involvement: a literature review. Minerva Ginecol 2014; 66:575-587. [PMID: 25373015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIM Endometriosis affects from 10% to 15% of women of childbearing age and 20% of these women have deep infiltrating endometriosis (DIE). The goal of this review was to assess the impact of various locations of DIE on spontaneous fertility and the benefit of surgery and Medically Assisted Reproduction (MAR) (in vitro fertilization and intrauterine insemination) on fertility outcomes. METHODS MEDLINE search for articles on fertility in women with DIE published between 1990 and April 2013 using the following terms: "deep infiltrative endometriosis", "colorectal", "bowel", "rectovaginal", "uterosacral", "vaginal", "bladder" and "fertility" or "infertility". Twenty-nine articles reporting fertility outcomes in 2730 women with DIE were analysed. RESULTS Among the women with DIE and no bowel involvement (N.=1295), no preoperative data on spontaneous pregnancy rate (PR) were available. The postoperative spontaneous PR rate in these women was 50.5% (95% Confidence Interval [CI] =46.8-54.1) and overall PR (spontaneous pregnancies and after MAR) was 68.3% (95% CI=64.9-71.7). No evaluation of fertility outcome according to locations of DIE was feasible. For women with DIE with bowel involvement without surgical management (N.=115), PR after MAR was 29%; 95% CI=20.7-37.4). For those with bowel involvement who were surgically managed (N.=1320), postoperative spontaneous PR was 28.6% (95% CI=25-32.3) and overall postoperative PR was 46.9% (95% CI=42.9-50.9). CONCLUSION For women with DIE without bowel involvement, surgery alone offers a high spontaneous PR. For those with bowel involvement, the low spontaneous and relatively high overall PR suggests the potential benefit of combining surgery and MAR.
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Affiliation(s)
- J Cohen
- Department of Gynecology and Obstetrics Hôpital Tenon, Assistance Publique des Hôpitaux de Paris Université Pierre et Marie Curie Paris 6 GRC 6-UPMC Centre Expert en Endométriose (C3E), Paris, France -
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Touboul C, Ballester M, Dubernard G, Zilberman S, Thomin A, Daraï E. Long-term symptoms, quality of life, and fertility after colorectal resection for endometriosis: extended analysis of a randomized controlled trial comparing laparoscopically assisted to open surgery. Surg Endosc 2014; 29:1879-87. [PMID: 25294552 DOI: 10.1007/s00464-014-3880-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Accepted: 09/02/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND To evaluate the long-term symptoms, quality of life (QOL), and fertility after colorectal resection for endometriosis. METHODS Extended analysis of a randomized controlled trial including 52 patients with colorectal endometriosis, comparing laparoscopically assisted to open colorectal resection. All included patients were invited to complete questionnaires evaluating the presence and intensity of symptoms and QOL using the SF-36 and fertility at a mean (SD) follow-up of 50.7 (13.8) months. We compared symptoms intensity and QOL before and after surgery at short- (mean follow-up of 19 months) and long-term (mean follow-up of 51 months). RESULTS Persistent improvement in QOL was noted after surgery without differences between short and long term. Self-catheterization >6 months was the sole factor decreasing the long-term QOL (P = 0.02). No difference in symptoms and QOL was noted according to the route. Among the 28 patients (53.8%) wishing to conceive, 12 (42.9%) conceived within a mean (SD) time of 17 (13) months. No difference in fertility including pregnancy after IVF was noted between the routes, but spontaneous pregnancy occurred only after laparoscopy (P = 0.016). CONCLUSIONS Symptoms and QOL improvements after colorectal resection last for over 4 years without difference between the routes. Thank to a lower intra- and postoperative complications and higher spontaneous pregnancy rate, laparoscopic colorectal resection should be the first surgical approach.
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Affiliation(s)
- Cyril Touboul
- Department of Obstetrics and Gynecology, GRC-UPMC 6 (Centre Expert En Endometriose (C3E)), UMRS938, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Université Pierre et Marie Curie Paris VI, Paris, France,
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Belghiti J, Ballester M, Zilberman S, Thomin A, Zacharopoulou C, Bazot M, Thomassin-Naggara I, Daraï E. Role of Protective Defunctioning Stoma in Colorectal Resection for Endometriosis. J Minim Invasive Gynecol 2014; 21:472-9. [DOI: 10.1016/j.jmig.2013.12.094] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 12/03/2013] [Accepted: 12/04/2013] [Indexed: 10/25/2022]
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Thomin A, Torre A, Daraï É, Chabbert-Buffet N. [Role of GnRH agonists in preserving female fertility]. ACTA ACUST UNITED AC 2013; 43:267-74. [PMID: 24321862 DOI: 10.1016/j.jgyn.2013.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 10/30/2013] [Accepted: 11/06/2013] [Indexed: 11/18/2022]
Abstract
The impact of cancer treatment on ovarian function and fertility has been known since the 70s. Preservation of fertility is now an important focus of care for patients of reproductive age with cancer. The beneficial role of GnRH agonists in fertility preservation is controversial since the early 2000s. Recent randomized studies come to overturn this role. The POEMS multicenter randomized trial with long-term follow-up is ongoing and will provide results that could help clarify the current uncertain indication of these compounds in this context.
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Affiliation(s)
- A Thomin
- Service de gynécologie obstétrique, médecine de la reproduction, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France.
| | - A Torre
- Service de gynécologie obstétrique, médecine de la reproduction, centre hospitalier intercommunal Poissy, 78300 Saint-Germain-en-Laye, France
| | - É Daraï
- Service de gynécologie obstétrique, médecine de la reproduction, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - N Chabbert-Buffet
- Service de gynécologie obstétrique, médecine de la reproduction, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
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Bonneau C, Zilberman S, Ballester M, Thomin A, Thomassin-Naggara I, Bazot M, Daraï E. Incidence of pre- and postoperative urinary dysfunction associated with deep infiltrating endometriosis: relevance of urodynamic tests and therapeutic implications. Minerva Ginecol 2013; 65:385-405. [PMID: 24051939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Although many series have been published on the management of digestive or urinary deep infiltrating endometriosis (DIE), few data exist on pre- and postoperative urinary dysfunction (UD) and urodynamic tests. Hence, the objective of this review was to evaluate the pre- and postoperative incidence of UD and the contribution of urodynamic tests as well as their therapeutic implications. Studies published between January 1995 and April 2012, available in the databases Medline, Embase or the Cochrane Library and responding to a key word algorithm were selected. Studies were classified according to their level of evidence in the Canadian Task Force classification. Sixty-three studies were included in this review. The incidence of preoperative UD is unknown in patients with DIE without colorectal involvement but ranges from 2% to 48% in patients with colorectal endometriosis. About half of all the patients had abnormal urodynamic test results. DIE surgery is associated with a risk of urinary dysfunction mainly corresponding to de novo voiding dysfunction in 1.4% to 29.2% of cases with a mean value of 4.8%. The rate of persistent voiding dysfunction ranges from 0 to 14.7% with a mean value of 4.6%. Risk factors of postoperative UD are the need for partial colpectomy, parametrectomy and patients requiring colo-anal anastomosis. For patients with urinary tract endometriosis, the incidence of preoperative UD is comprised between 24.4% and 79.2% with a rate of postoperative voiding dysfunction ranging from 0% to 16.9% with a mean value of 11.1%. Prevention of postoperative UD is based on nerve-sparing surgery. Treatment of voiding dysfunction requires self-catheterization. There is a lack of data on medical treatment and surgical techniques to manage postoperative UD. More effort needs to be made to detect preoperative UD associated with DIE. Preoperative evaluation by urodynamic tests and possibly electrophysiology could be of interest especially in patients with risk factors. The current review underlines the difficulties of establishing clear recommendations due to heterogeneity of the studies and the absence of a consensual definition of UD.
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Affiliation(s)
- C Bonneau
- Department of Gynecology and Obstetrics Hôpital Tenon, Assistance Publique des Hôpitaux de Paris Université Pierre et Marie Curie Paris VI, Paris, France -
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Thomin A, Touboul C, Hequet D, Zilberman S, Ballester M, Daraï E. Genital prolapse repair with Avaulta Plus mesh: functional results and quality of life. Prog Urol 2013; 23:270-5. [PMID: 23544985 DOI: 10.1016/j.purol.2013.01.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Revised: 01/23/2013] [Accepted: 01/25/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE Evaluate anatomic and functional outcomes of genital prolapse repair by vaginal route using a mixed polypropylene and porcine skin mesh. PATIENTS AND METHODS Prospective pilot study from January 2009 to January 2011 in the gynecologic department of a tertiary university hospital. Twenty patients with stage II-III genital prolapse underwent anterior wall prolapse repair with anterior Avaulta Plus mesh. Functional results were evaluated using the pelvic floor distress inventory-short form (PFDI-20), the pelvic floor impact questionnaire-7 (PFIQ-7) and the Pelvic Organ Prolapse/Urinary Incontinence Sexual questionnaires (PISQ-12). RESULTS No per-operative complications occurred. One postoperative hematoma (5%) occurred requiring a second surgery. At a mean follow-up of 19.7 months, three patients had vaginal mesh exposure (15%) requiring a second surgery for two of them. Of the 20 women, 17 (85%) had optimal anatomic results and three (15%) had residual genital prolapse (Ba=-2 in two cases and Bp = -2 in the one). No recurrence was observed during the study period. A significant improvement in the PFDI-20 (P<0.001) and PFIQ-7 scores (P<0.001) was observed but no improvement in the PISQ-12 score. CONCLUSION In this series, we reported that genital prolapse repair using Avaulta Plus mesh resulted in a high success rate and improved quality of life but with an important prevalence of vaginal mesh exposure.
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Affiliation(s)
- A Thomin
- Department of obstetrics and gynecology, université Pierre et Marie Curie Paris VI, hôpital Tenon Paris, 4, rue de Chine, 75020 Paris, France.
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Salama S, Torre A, Paillusson B, Thomin A, Ben Brahim F, Muratorio C, Bailly M, Wainer R. [Ovarian stimulation monitoring: past, present and perspectives]. Gynecol Obstet Fertil 2011; 39:245-254. [PMID: 21439884 DOI: 10.1016/j.gyobfe.2011.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2010] [Accepted: 12/13/2010] [Indexed: 05/30/2023]
Abstract
Since the inception of Assisted Reproductive Technology (ART), knowing the moment of ovulation has always been a priority. Initially, the monitoring was accomplished by observing the luteinizing hormone (LH) surge just before ovulation. Currently, in all ART facilities, the monitoring of all stimulated ovulatory cycles is done by using the conventional two-dimensional (2D) ultrasound to measure follicle diameter and by drawing blood tests that measure estradiol, progesterone, and luteinizing hormone levels. These exams allow determination of the numbers and quality of growing ovarian follicles and evaluation of follicle maturity before choosing the appropriate time for ovulation triggering. The monitoring of ovulatory cycles has now become enhanced with the arrival of new software called SonoAVC. This software allows the utilization of 3D blocks to immediately calculate the total number and volume of the follicles inside the ovary. This automatic approach is faster, precise, and more efficient. It also has better reproducibility than the classical 2D diameters. Furthermore, certain ART professionals envision that by using the SonoVac technology, patients will no longer need to be monitored with regular ultrasounds and with systematic hormonal testing.
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Affiliation(s)
- S Salama
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpital de Poissy-Saint-Germain-en-Laye, Poissy cedex, France.
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