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Armengaud C, Fauconnier A, Drioueche H, Campagne Loiseau S, De Tayrac R, Saussine C, Panel L, Cosson M, Deffieux X, Lucot JP, Pizzoferrato AC, Ferry P, Vidart A, Thubert T, Capon G, Debodinance P, Gauthier T, Koebele A, Salet-Lizee D, Hermieu JF, Game X, Ramanah R, Lamblin G, Lecornet E, Carlier-Guérin C, Chartier-Kastler E, Fritel X. Serious complications and recurrences after retropubic vs transobturator midurethral sling procedures for 2682 patients in the VIGI-MESH register. Am J Obstet Gynecol 2024; 230:428.e1-428.e13. [PMID: 38008151 DOI: 10.1016/j.ajog.2023.11.1241] [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: 08/11/2023] [Revised: 11/07/2023] [Accepted: 11/21/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND Midurethral slings are the gold standard for treating stress urinary incontinence, but their complications may raise concerns. Complications may differ by the approach used to place them. OBJECTIVE This study aimed to compare serious complications and reoperations for recurrence after midurethral sling procedures when using the retropubic vs the transobturator route for female stress urinary incontinence. STUDY DESIGN This analysis was of patients included in the French, multicenter VIGI-MESH register since February 2017 who received a midurethral sling for female stress urinary incontinence either by the retropubic or the transobturator route and excluded patients with single-incision slings. Follow-up continued until October 2021. Serious complications (Clavien-Dindo classification ≥ grade III) attributable to the midurethral sling and reoperations for recurrence were compared using Cox proportional hazard models including any associated surgery (hysterectomy or prolapse) and a frailty term to consider the center effect. Baseline differences were balanced by propensity score weighting. Analyses using the propensity score and Cox models were adjusted for baseline differences, center effect, and associated surgery. RESULTS A total of 1830 participants received a retropubic sling and 852 received a transobturator sling in 27 French centers that were placed by 167 surgeons. The cumulative 2-year estimate of serious complications was 5.8% (95% confidence interval, 4.8-7.0) in the retropubic group and 2.9% (95% confidence interval, 1.9-4.3) in the transobturator group, that is, after adjustment, half of the retropubic group was affected (adjusted hazard ratio, 0.41; 95% confidence interval, 0.3-0.6). The cumulative 2-year estimate of reoperation for recurrence of stress urinary incontinence was 2.7% (95% confidence interval, 2.0-3.6) in the retropubic group and 2.8% (95% confidence interval, 1.7-4.2) in the transobturator group with risk for revision for recurrence being higher in the transobturator group after adjustment (adjusted hazard ratio, 1.9; 95% confidence interval, 1.2-2.9); this surplus risk disappeared after exclusion of the patients with a previous surgery for stress urinary incontinence. CONCLUSION The transobturator route for midurethral sling placement is associated with a lower risk for serious complications but a higher risk for surgical reoperation for recurrence than the retropubic route. Despite the large number of surgeons involved, these risks were low. The data are therefore reassuring.
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Affiliation(s)
- Camille Armengaud
- Service de Gynécologie-Obstétrique, CHI Poissy-St-Germain, Poissy, France.
| | - Arnaud Fauconnier
- Université Paris-Saclay, UVSQ, Unité de recherche 7285 "Risques cliniques et sécurité en santé des femmes et en santé périnatale" (RISCQ), Montigny-le-Bretonneux, Service de Gynécologie-Obstétrique, CHI Poissy-Saint-Germain, Poissy, France
| | - Hocine Drioueche
- Service de Gynécologie-Obstétrique, CHI Poissy-St-Germain, Poissy, France
| | | | - Renaud De Tayrac
- Service de Gynécologie-Obstétrique, CHU Carémeau, Nîmes, Université de Montpellier, Montpellier, France
| | - Christian Saussine
- Service d'urologie, CHU de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Laure Panel
- Service de Gynécologie, Clinique Beau-Soleil, Montpellier, France
| | - Michel Cosson
- Service de Gynécologie-Obstétrique, CHU de Lille, Université de Lille, Lille, France
| | - Xavier Deffieux
- Service de Gynécologie-Obstétrique, APHP Antoine-Béclère, Université Paris-Sud, Clamart, France
| | - Jean Philippe Lucot
- Service de Gynécologie-Obstétrique, Hôpital Saint-Vincent-de-Paul, Lille, France; Groupe des hôpitaux de l'institut catholique de Lille (GHICL), Lille, France
| | - Anne Cécile Pizzoferrato
- Service de Gynécologie-Obstétrique et Médecine de la Reproduction, CHU de Poitiers, Poitiers, France; Faculté de Médecine et Pharmacie, Université de Poitiers, Inserm CIC, France
| | - Philippe Ferry
- Service de Gynécologie-Obstétrique, CH de La Rochelle, La Rochelle, France
| | | | - Thibault Thubert
- Service de Gynécologie, CHU de Nantes, Centre d'investigation clinique, CHU de Nantes, Laboratoire Motricité, Interactions, Performances (MIP) - UR 4334 - UFR STAPS - Nantes Université, Nantes, France
| | | | | | - Tristan Gauthier
- Service de Gynécologie-Obsétrique, Hôpital Mère-Enfant, CHU Limoges, Limoges, France
| | - Antoine Koebele
- Service de Gynécologie, Maternité régionale universitaire, Nancy, France
| | - Delphine Salet-Lizee
- Groupe Hospitalier Diaconesses-Croix-Saint-Simon, Service de gynécologie, Paris, France
| | | | - Xavier Game
- Service d'urologie, CHU Rangueil, Toulouse, France
| | | | - Gery Lamblin
- Service de Gynécologie-Obstétrique, Hôpital Femme-Mère-Enfant, Hospices civils de Lyon, Lyon, France
| | - Emilie Lecornet
- Service d'urologie, Polyclinique d'Hénin Beaumont, Groupe AHNAC, Henin-Beaumont, France
| | | | | | - Xavier Fritel
- Faculté de Médecine et Pharmacie, Université de Poitiers, Inserm CIC 1402, Service de Gynécologie-Obstétrique et Médecine de la Reproduction, CHU de Poitiers, Poitiers, France
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Deffieux X, Perrouin-Verbe MA, Campagne-Loiseau S, Donon L, Levesque A, Rigaud J, Stivalet N, Venara A, Thubert T, Vidart A, Bosset PO, Revel-Delhom C, Lucot JP, Hermieu JF. Diagnosis and management of complications following pelvic organ prolapse surgery using a synthetic mesh: French national guidelines for clinical practice. Eur J Obstet Gynecol Reprod Biol 2024; 294:170-179. [PMID: 38280271 DOI: 10.1016/j.ejogrb.2024.01.015] [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: 12/22/2023] [Revised: 12/30/2023] [Accepted: 01/11/2024] [Indexed: 01/29/2024]
Abstract
Complications associated with pelvic organ prolapse (POP) surgery using a synthetic non-absorbable mesh are uncommon (<5%) but may be severe and may hugely diminish the quality of life of some women. In drawing up these multidisciplinary clinical practice recommendations, the French National Authority for Health (Haute Autorité de santé, HAS) conducted an exhaustive review of the literature concerning the diagnosis, prevention, and management of complications associated with POP surgery using a synthetic mesh. Each recommendation for practice was allocated a grade (A,B or C; or expert opinion (EO)), which depends on the level of evidence (clinical practice guidelines). PREOPERATIVE PATIENTS' INFORMATION Each patient must be informed concerning the risks associated with POP surgery (EO). HEMORRHAGE, HEMATOMA Vaginal infiltration using a vasoconstrictive solution is not recommended during POP surgery by the vaginal route (grade C). The placement of vaginal packing is not recommended following POP surgery by the vaginal route (grade C). During laparoscopic sacral colpopexy, when the promontory seems highly dangerous or when severe adhesions prevent access to the anterior vertebral ligament, alternative surgical techniques should be discussed per operatively, including colpopexy by lateral mesh laparoscopic suspension, uterosacral ligament suspension, open abdominal mesh surgery, or surgery by the vaginal route (EO). BLADDER INJURY When a bladder injury is diagnosed, bladder repair by suturing is recommended, using a slow resorption suture thread, plus monitoring of the permeability of the ureters (before and after bladder repair) when the injury is located at the level of the trigone (EO). When a bladder injury is diagnosed, after bladder repair, a prosthetic mesh (polypropylene or polyester material) can be placed between the repaired bladder and the vagina, if the quality of the suturing is good. The recommended duration of bladder catheterization following bladder repair in this context of POP mesh surgery is from 5 to 10 days (EO). URETER INJURY After ureteral repair, it is possible to continue sacral colpopexy and place the mesh if it is located away from the ureteral repair (EO). RECTAL INJURY Regardless of the approach, when a rectal injury occurs, a posterior mesh should not be placed between the rectum and the vagina wall (EO). Concerning the anterior mesh, it is recommended to use a macroporous monofilament polypropylene mesh (EO). A polyester mesh is not recommended in this situation (EO). VAGINAL WALL INJURY After vaginal wall repair, an anterior or a posterior microporous polypropylene mesh can be placed, if the quality of the repair is found to be satisfactory (EO). A polyester mesh should not be used after vaginal wall repair (EO). MESH INFECTION (ABSCESS, CELLULITIS, SPONDYLODISCITIS) Regardless of the surgical approach, intravenous antibiotic prophylaxis is recommended (aminopenicillin + beta-lactamase inhibitor: 30 min before skin incision +/- repeated after 2 h if surgery lasts longer) (EO). When spondylodiscitis is diagnosed following sacral colpopexy, treatment should be discussed by a multidisciplinary group, including especially spine specialists (rheumatologists, orthopedists, neurosurgeons) and infectious disease specialists (EO). When a pelvic abscess occurs following synthetic mesh sacral colpopexy, it is recommended to carry out complete mesh removal as soon as possible, combined with collection of intraoperative bacteriological samples, drainage of the collection and targeted antibiotic therapy (EO). Non-surgical conservative management with antibiotic therapy may be an option (EO) in certain conditions (absence of signs of sepsis, macroporous monofilament polypropylene type 1 mesh, prior microbiological documentation and multidisciplinary consultation for the choice of type and duration of antibiotic therapy), associated with close monitoring of the patient. BOWEL OCCLUSION RELATED TO NON-CLOSURE OF THE PERITONEUM Peritoneal closure is recommended after placement of a synthetic mesh by the abdominal approach (EO). URINARY RETENTION Preoperative urodynamics is recommended in women presenting with urinary symptoms (bladder outlet obstruction symptoms, overactive bladder syndrome or incontinence) (EO). It is recommended to remove the bladder catheter at the end of the procedure or within 48 h after POP surgery (grade B). Bladder emptying and post-void residual should be checked following POP surgery, before discharge (EO). When postoperative urine retention occurs after POP surgery, it is recommended to carry out indwelling catheterization and to prefer intermittent self-catheterization (EO). POSTOPERATIVE PAIN Before POP surgery, the patient should be asked about risk factors for prolonged and chronic postoperative pain (pain sensitization, allodynia, chronic pelvic or non-pelvic pain) (EO). Concerning the prevention of postoperative pain, it is recommended to carry out a pre-, per- and postoperative multimodal pain treatment (grade B). The use of ketamine intraoperatively is recommended for the prevention of chronic postoperative pelvic pain, especially for patients with risk factors (preoperative painful sensitization, allodynia, chronic pelvic or non-pelvic pain) (EO). Postoperative prescription of opioids should be limited in quantity and duration (grade C). When acute neuropathic pain (sciatalgia or pudendal neuralgia) resistant to level I and II analgesics occurs following sacrospinous fixation, a reintervention is recommended for suspension suture removal (EO). When chronic postoperative pain occurs after POP surgery, it is recommended to systematically seek arguments in favor of neuropathic pain with the DN4 questionnaire (EO). When chronic postoperative pelvic pain occurs after POP surgery, central sensitization should be identified since it requires a consultation in a chronic pain department (EO). Concerning myofascial pain syndrome (clinical pain condition associated with increased muscle tension caused by myofascial trigger points), when chronic postoperative pain occurs after POP surgery, it is recommended to examine the levator ani, piriformis and obturator internus muscles, so as to identify trigger points on the pathway of the synthetic mesh (EO). Pelvic floor muscle training with muscle relaxation is recommended when myofascial pain syndrome is associated with chronic postoperative pain following POP surgery (EO). After failure of pelvic floor muscle training (3 months), it is recommended to discuss surgical removal of the synthetic mesh, during a multidisciplinary discussion group meeting (EO). Partial removal of synthetic mesh is indicated when a trigger point is located on the pathway of the mesh (EO). Total removal of synthetic mesh should be discussed during a multidisciplinary discussion group meeting when diffuse (no trigger point) chronic postoperative pain occurs following POP surgery, with or without central sensitization or neuropathic pain syndromes (EO). POSTOPERATIVE DYSPAREUNIA When de novo postoperative dyspareunia occurs after POP surgery, surgical removal of the mesh should be discussed (EO). VAGINAL MESH EXPOSURE To reduce the risk of vaginal mesh exposure, when hysterectomy is required during sacral colpopexy, subtotal hysterectomy is recommended (grade C). When asymptomatic vaginal macroporous monofilament polypropylene mesh exposure occurs, systematic imaging is not recommended. When vaginal polyester mesh exposure occurs, pelvic +/- lumbar MRI (EO) should be used to look for an abscess or spondylodiscitis, given the greater risk of infection associated with this type of material. When asymptomatic vaginal mesh exposure of less than 1 cm2 occurs in a woman with no sexual intercourse, the patient should be offered observation (no treatment) or local estrogen therapy (EO). However, if the patient wishes, partial excision of the mesh can be offered. When asymptomatic vaginal mesh exposure of more than 1 cm2 occurs or if the woman has sexual intercourse, or if it is a polyester prosthesis, partial mesh excision, either immediately or after local estrogen therapy, should be offered (EO). When symptomatic vaginal mesh exposure occurs, but without infectious complications, surgical removal of the exposed part of the mesh by the vaginal route is recommended (EO), and not systematic complete excision of the mesh. Following sacral colpopexy, complete removal of the mesh (by laparoscopy or laparotomy) is only required in the presence of an abscess or spondylodiscitis (EO). When vaginal mesh exposure recurs after a first reoperation, the patient should be treated by an experienced team specialized in this type of complication (EO). SUTURE THREAD VAGINAL EXPOSURE For women presenting with vaginal exposure to non-absorbable suture thread following POP surgery with mesh reinforcement, the suture thread should be removed by the vaginal route (EO). Removal of the surrounding mesh is only recommended when vaginal mesh exposure or associated abscess is diagnosed. BLADDER AND URETERAL MESH EXPOSURE When bladder mesh exposure occurs, removal of the exposed part of the mesh is recommended (grade B). Both alternatives (total or partial mesh removal) should be discussed with the patient and should be debated during a multidisciplinary discussion group meeting (EO).
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Affiliation(s)
- Xavier Deffieux
- Université Paris-Saclay, AP-HP, Hôpital Antoine Béclère, Service de gynécologie obstétrique, Clamart F-92140, France.
| | - Marie-Aimée Perrouin-Verbe
- Université de Nantes, Centre Hospitalier Universitaire de Nantes, Service d'urologie, Nantes F-44000, France
| | - Sandrine Campagne-Loiseau
- Centre Hospitalier Universitaire de Clermont Ferrand, Service de gynécologie obstétrique, Clermont-Ferrand F-63000, France
| | | | - Amélie Levesque
- Centre Hospitalier Universitaire Nantes, Service d'urologie, Nantes F-44093, France
| | - Jérome Rigaud
- Université de Nantes, Centre Hospitalier Universitaire de Nantes, Service d'urologie, Nantes F-44000, France
| | - Nadja Stivalet
- Université Paris-Cité, AP-HP, Hôpital Bichat, Service d'urologie, Paris F-75017, France
| | - Aurélien Venara
- Université d'Angers, Centre Hospitalier Universitaire d'Angers, Service de chirurgie digestive, Angers F-49000, France
| | - Thibault Thubert
- Université de Nantes, Centre Hospitalier Universitaire de Nantes, Service de gynécologie-obstétrique, Nantes F-44000, France
| | - Adrien Vidart
- Hôpital Foch, Service d'urologie, Suresnes F-92150, France
| | | | | | - Jean-Philippe Lucot
- Université catholique de Lille, Service de gynécologie-obstétrique, Lille F-59000, France
| | - Jean François Hermieu
- Université Paris-Cité, AP-HP, Hôpital Bichat, Service d'urologie, Paris F-75017, France
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Dabi Y, Fauconnier A, Rousset-Jablonski C, Tavenet A, Pizzofferrato AC, Deffieux X. Do women with suspected endometriosis benefit from pelvic examination to improve diagnostic and management strategy? J Gynecol Obstet Hum Reprod 2024; 53:102724. [PMID: 38224817 DOI: 10.1016/j.jogoh.2024.102724] [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: 06/14/2023] [Accepted: 01/07/2024] [Indexed: 01/17/2024]
Abstract
OBJECTIVE To analyze the literature and expose best evidence available regarding the benefit of pelvic examination for women with suspected endometriosis METHODS: the AGREE II and GRADE systems for grading scientific evidence. RESULTS Endometriosis is characterized by the heterogeneity in its clinical presentation with many different symptoms reported by patients. In the literature, questioning for each symptom has a high sensitivity, reaching 76-98 %, but lacks specificity (20 - 58 %). The symptom-based approach is limited by its low specificity, the absence of external validation for most of the models developed and the inability to characterize the extent of the disease, which could have major implications in the decision - making process. The latest systematic review and meta-analysis included a total of 30 studies with 4,565 participants, compared the diagnostic performance of several modalities for endometriosis. Physical examination had a pooled sensitivity of 71 % and a specificity of 69 %, with an average diagnostic accuracy of 0.76. Overall, the value of pelvic examination is conferred by its high positive likehood ratio and specificity. Besides its diagnostic value, pelvic examination improves patients' management by allowing the identification of a possible myofascial syndrome as a differential diagnosis. It also increases the quality of the preoperative workup and influences the quality of surgical excision and decreases the time to diagnosis. CONCLUSION Despite the lack of studies in the primary care context, pelvic examination (vaginal speculum and digital vaginal examination) increases the diagnostic value for suspected endometriosis in association with questioning for symptoms.
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Affiliation(s)
- Yohann Dabi
- Sorbonne Université, Hôpital Tenon, Service de Gynécologie Obstétrique et Médecine de la Reproduction, Assistance Publique des Hôpitaux de Paris, Paris, France; Groupe de Recherche Clinique 6 (GRC6), Centre Expert Endométriose (C3E), Sorbonne Université, France.
| | - Arnaud Fauconnier
- Université Paris-Saclay, UVSQ, Unité de recherche 7285 Risques cliniques et sécurité en santé des femmes et en santé périnatale, Montigny-le-Bretonneux, France; Université Department of Obstetrics and Gynecology, intercommunal Hospital of Poissy / Saint-Germain-en-Laye, Poissy, France
| | - Christine Rousset-Jablonski
- Département de chirurgie, Centre Léon Bérard, Lyon, France; Service de Gynécologie Obstétrique, Centre Hospitalier Lyon Sud, Pierre Bénite, France; INSERM U1290 RESHAPE, Université Claude Bernard Lyon 1, Lyon, France
| | - Arounie Tavenet
- Endofrance, Association de lutte contre l'endométriose, 3, rue de la Gare, 70190 Tresilley, France
| | - Anne-Cécile Pizzofferrato
- Faculté de Médecine et Pharmacie, Université de Poitiers, Inserm CIC 1402, Service de Gynécologie-Obstétrique et Médecine de la Reproduction, CHU de Poitiers, Poitiers, France
| | - Xavier Deffieux
- Université Paris Saclay, Service de gynécologie obstétrique, hôpital Antoine Béclère, APHP, Clamart, F-92140 France
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4
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Deffieux X, Pizzoferrato AC, Gaucher L, Rousset-Jablonski C, Le Ray C, Brillac T, Maruani J, Maitrot-Mantelet L, Mignot S, Athiel Y, Baffet H, Bailleul A, Bernard V, Bourdon M, Cardaillac C, Carneiro Y, Chariot P, Corroenne R, Dabi Y, Dahlem L, Frank S, Freyens A, Grouthier V, Hernandez I, Iraola E, Lambert M, Lauchet N, Legendre G, Le Lous M, Louis-Vahdat C, Martinat Sainte-Beuve A, Masson M, Matteo C, Pinton A, Sabbagh E, Sallee C, Thubert T, Heron I, Artzner F, Tavenet A, Gantois A, Fauconnier A. Pelvic exam in Gynecology and Obstetrics: French Guidelines for Clinical Practice. Eur J Obstet Gynecol Reprod Biol 2023; 291:131-140. [PMID: 37871350 DOI: 10.1016/j.ejogrb.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/18/2023] [Accepted: 10/06/2023] [Indexed: 10/25/2023]
Affiliation(s)
- Xavier Deffieux
- Université Paris-Saclay, AP-HP, Hôpital Antoine Béclère, Service de gynécologie obstétrique, Clamart F-92140, France.
| | - Anne-Cécile Pizzoferrato
- Service de Gynécologie Obstétrique, Hôpital Universitaire de La Miletrie, Poitiers F-86000, France; INSERM CIC 1402, Université de Poitiers, Poitiers F-86000, France
| | - Laurent Gaucher
- Collège National des Sages-Femmes de France, CNSF, Paris F-75010, France; Public Health Unit, Hospices Civils de Lyon, Bron F-69500, France; INSERM U1290, Research on Healthcare Performance (RESHAPE), Université Claude Bernard, Lyon 1, Lyon F-69008, France; Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, 1206 Geneva, Switzerland
| | - Christine Rousset-Jablonski
- Centre Léon Bérard, Département de Chirurgie, et Centre Hospitalier Lyon Sud, Service de Gynécologie-Obstétrique, INSERM U1290 RESHAPE, Lyon F-69000, France
| | - Camille Le Ray
- Maternité Port Royal, Groupe Hospitalier Paris Centre, APHP, Université Paris Cité, FHU Prema, Paris F-75014, France
| | | | - Julia Maruani
- Cabinet Médical, 6 Rue Docteur Albert Schweitzer, Marseille F-13006, France
| | - Lorraine Maitrot-Mantelet
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital universitaire Paris Centre (HUPC), Unité de gynécologie médicale, hôpital Port-Royal, Paris F-75014, France
| | | | - Yoann Athiel
- Maternité Port Royal, Groupe Hospitalier Paris Centre, APHP, Université Paris Cité, FHU Prema, Paris F-75014, France
| | - Hortense Baffet
- Service de gynécologie médicale, orthogénie et sexologie, CHU de Lille, Université de Lille, Lille F-59000, France
| | - Alexandre Bailleul
- Service de Gynécologie Obstétrique, Center Hospitalier de Poissy Saint Germain en Laye, Poissy F-78300, France; Equipe RISCQ « Risques cliniques et sécurité en santé des femmes et en santé périnatale », Université Paris Saclay, UVSQ, Montigny le Bretonneux F-78180, France
| | - Valérie Bernard
- Service de chirurgie gynécologique, gynécologie médicale et médecine de la reproduction, centre Aliénor d'Aquitaine, Centre Hospitalo-Universitaire Pellegrin, Bordeaux F-33000, France
| | - Mathilde Bourdon
- Université Paris Cité, APHP, Center Hospitalier Universitaire (CHU) Cochin Port Royal, Service de Gynécologie Obstétrique II et Médecine de la Reproduction, F-75014, France
| | - Claire Cardaillac
- Service de gynécologie-obstétrique, CHU de Nantes, Nantes F-44000, France
| | | | - Patrick Chariot
- Département de médecine légale et sociale, Assistance Publique - Hôpitaux de Paris, Bondy F-93140, France; Institut de Recherche Interdisciplinaire sur Les Enjeux Sociaux, UMR 8156-997, UFR SMBH, Université Sorbonne Paris Nord, Bobigny F-9300, France
| | - Romain Corroenne
- Service de gynécologue-obstétrique, CHU Angers, Angers F-49000, France
| | - Yohann Dabi
- Sorbonne université - APHP - Hôpital Tenon, Service de gynécologie obstétrique et médecine de la reproduction, Paris F75020, France
| | - Laurence Dahlem
- Département universitaire de médecine générale, Faculté de médecine, Université de Bordeaux, 146 rue Léo Saignat, Bordeaux F-33076, France
| | - Sophie Frank
- Service d'oncogénétique, Institut Curie, Paris F-75005, France
| | - Anne Freyens
- DUMG (Département Universitaire de Médecine Générale), Université Paul Sabatier, Toulouse F-31000, France
| | - Virginie Grouthier
- Department of Endocrinology, Diabetes and Nutrition, University of Bordeaux, Bordeaux, France; Univ. Bordeaux, Inserm U1034, Biology of Cardiovascular Diseases, Pessac, France
| | - Isabelle Hernandez
- Département de maïeutique, Center hospitalier de Melun Santepole, Melun F-77000, France
| | - Elisabeth Iraola
- Institut de Recherche interdisciplinaire sur les Enjeux Sociaux (IRIS), UMR 8156-997, CNRS U997 Inserm EHESS UP13 UFR SMBH, Université Sorbonne Paris Nord, Paris, France; Direction de la protection maternelle et infantile et promotion de la santé, Conseil départemental du Val-de-Marne, Créteil F-94000, France
| | - Marie Lambert
- Service de chirurgie gynécologique, gynécologie médicale et médecine de la reproduction, centre Aliénor d'Aquitaine, Centre Hospitalo-Universitaire Pellegrin, Bordeaux F-33000, France; Université de Bordeaux, Bordeaux Institute of Oncology - Unité Inserm 1312, Bordeaux F-33000, France
| | - Nadege Lauchet
- Groupe Médical François Perrin, 9 rue François Perrin, Limoges F-87000, France
| | - Guillaume Legendre
- Service de gynécologue-obstétrique, CHU Angers, Angers F-49000, France; UMR_S1085, Université d'Angers, CHU Angers, University of Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail), Angers, France
| | - Maela Le Lous
- Université de Rennes 1, INSERM, LTSI - UMR 1099, Rennes F-35000, France; Département de gynécologie et obstétrique, CHU de Rennes, Rennes F-35000, France
| | - Christine Louis-Vahdat
- Cabinet de gynécologie et obstétrique, 126 Boulevard Saint Germain, Paris F-75006, France
| | | | - Marine Masson
- Département de médecine générale, Poitiers F-86000, France
| | - Caroline Matteo
- Cabinet de maïeutique, 181 rue du Docteur Cauvin, Marseille F-13015, France
| | - Anne Pinton
- Service de gynécologie obstétrique, Hôpital Trousseau, APHP, 26, avenue du Dr-Arnold-Netter, Paris F-75012, France; Sorbonne Université, Paris F-75013, France
| | - Emmanuelle Sabbagh
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital universitaire Paris Centre (HUPC), Unité de gynécologie médicale, hôpital Port-Royal, Paris F-75014, France
| | - Camille Sallee
- Service de Gynécologie-Obstétrique, Hôpital Mère-Enfant, CHU de Limoges, Limoges F-87000 France
| | - Thibault Thubert
- Service de Gynécologie-Obstétrique, CHU de Nantes, Nantes F- 44000, France; Laboratoire Mouvement, Interactions, Performance (MIP), EA 4334, Nantes Université, Nantes F- 44322, France
| | - Isabelle Heron
- Service d'endocrinologie, Université de Rouen, Hôpital Charles Nicolle, Rouen F-76000, France; Cabinet médical, 7 rue de Lessard, Rouen F-76100, France
| | - France Artzner
- CIANE, Collectif interassociatif autour de la naissance, c/o Anne Evrard, 101 rue Pierre Corneille, Lyon F-69003, France
| | - Arounie Tavenet
- ENDOFRANCE, Association de lutte contre l'endométriose. 3 rue de la Gare, Tresilley F-70190, France
| | - Adrien Gantois
- Collège National des Sages-Femmes de France hébergé au Réseau de Santé Périnatal Parisien (RSPP), Paris F75010, France
| | - Arnaud Fauconnier
- Service de Gynécologie Obstétrique, Center Hospitalier de Poissy Saint Germain en Laye, Poissy F-78300, France; Equipe RISCQ « Risques cliniques et sécurité en santé des femmes et en santé périnatale », Université Paris Saclay, UVSQ, Montigny le Bretonneux F-78180, France
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Crochet P, Mousty E, Le Lous M, Chauleur C, Berveiller P, Ceccaldi PF, Deffieux X, Hanssens S, Gauthier T, Le Ray C, Legendre G, Rabischong B, Winer N, Tsatsaris V, Ghesquiere L, Rubod C. [Simulation training for French obstetrics and gynecology residents: A national survey in 2022]. Gynecol Obstet Fertil Senol 2023; 51:393-399. [PMID: 37295716 DOI: 10.1016/j.gofs.2023.05.003] [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] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 05/15/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To evaluate the use of simulation among French Obstetrics and Gynecology residency programs. METHODS A survey was conducted with all 28 French residency program directors. The questionnaire covered equipment and human resources, training programs, types of simulation tools and time spent. RESULTS Of the cities hosting a residency program, 93% (26/28) responded regarding equipment and human resources, and 75% (21/28) responded regarding training program details. All respondents declared having at least one structure dedicated to simulation. A formal training program was reported by 81% (21/26) of cities. This training program was mandatory in 73% of the cases. There was a median number of seven senior trainers involved, three of whom had received a specific training in medical education. Most of declared simulation activities concerned technical skills in obstetrics and surgery. Simulations to practice breaking bad news were offered by 62% (13/21) of cities. The median number of half-days spent annually on simulation training was 55 (IQR: 38-83). CONCLUSION Simulation training is now widely available among French residency programs. There remains heterogeneity between centers regarding equipment, time spent and content of simulation curricula. The French College of Teachers of Gynecology and Obstetrics has proposed a roadmap for the content of simulation-based training based on the results of this survey. An inventory of all existing "train the trainers" simulation programs in France is also provided.
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Affiliation(s)
- P Crochet
- Service de gynécologie-obstétrique, université de Rouen, CHU Charles-Nicolle, Rouen, France; Univ Rouen Normandie, INSERM, NORDIC UMR 1239 - Team Adrenal and Gonadal Pathophysiology (AGoPath), 76000 Rouen, France.
| | - E Mousty
- Service de gynécologie-obstétrique, université de Montpellier-Nîmes, CHU de Nîmes, Nîmes, France.
| | - M Le Lous
- Service de gynécologie-obstétrique, hôpital Sud, université de Rennes, CHU de Rennes, Rennes, France.
| | - C Chauleur
- Inserm, U 1059, service de gynécologie-obstétrique, université Jean-Monnet, CHU de Saint-Étienne, 42023 Saint-Étienne, France.
| | - P Berveiller
- Service de gynécologie-obstétrique, CHI de Poissy St-Germain, 78300 Poissy, France.
| | - P-F Ceccaldi
- Université Paris Cité, Paris, France; Service de gynécologie-obstétrique, hôpital Beaujon, Assistance publique-Hôpitaux de Paris, Clichy, France.
| | - X Deffieux
- Service de gynécologie-obstétrique, hôpital Antoine-Béclère, AP-HP, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France.
| | - S Hanssens
- Department of neonatology, Jeanne-de-Flandre hospital, université de Lille, CHU de Lille, Lille, France.
| | - T Gauthier
- Service de gynécologie-obstétrique, hôpital mère-enfant, CHU de Limoges, 87000 Limoges, France.
| | - C Le Ray
- Maternité Port-Royal, Groupe hospitalier Paris Centre, FHU Prema, université Paris Cité, AP-HP, 75014 Paris, France.
| | - G Legendre
- Département de médecine, service de gynécologie-obstétrique, faculté de santé, Angers, France.
| | - B Rabischong
- Department of gynecological surgery, CHU Estaing, Clermont-Ferrand, France.
| | - N Winer
- Service de gynécologie-obstétrique, NUN INRAE PhAN, UMR 1280, CHU de Nantes, 44000 Nantes, France.
| | - V Tsatsaris
- Maternité Port-Royal, Groupe hospitalier Paris Centre, FHU Prema, université Paris Cité, AP-HP, 75014 Paris, France.
| | - L Ghesquiere
- Department of neonatology, Jeanne-de-Flandre hospital, université de Lille, CHU de Lille, Lille, France.
| | - C Rubod
- Department of neonatology, Jeanne-de-Flandre hospital, université de Lille, CHU de Lille, Lille, France.
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Dupuis HGA, Berrogain N, Bosset PO, Campagne-Loiseau S, Cardot V, Charles T, Deffieux X, Donon L, Even L, Girard F, Hermieu JF, Hurel S, Klap J, Peyrat L, Meyer F, Peyronnet B, Tibi B, Thuillier C, Vidart A, Wagner L, Cornu JN. [Multidisciplinary meetings in pelvic floor disease in women: A national survey by the CUROPF among French urologists]. Prog Urol 2023; 33:519-525. [PMID: 37295990 DOI: 10.1016/j.purol.2023.05.004] [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: 02/14/2023] [Revised: 05/14/2023] [Accepted: 05/21/2023] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Multidisciplinary team meetings (MTMs) in the field of pelvic floor diseases in women tend to generalize, as they are required as mandatory before mid-urethral sling implantation or sacrocolpopexy by recent decrees published by the French health authorities. However, access to these meetings is variable in the French territory. The goal of the present study was to describe the existence and the settings of these kinds of meetings in France. MATERIEL AND METHODS An on-line survey was conducted between June and July 2020 (stage 1) then between November 2021 and January 2022 (stage 2). A 15-item questionnaire was sent to all members of the Association française d'urologie (AFU). A descriptive analysis was conducted. RESULTS Three hundred and twenty-two completed questionnaires were sent back during stage 1 and 158 during stage 2. Early 2022, 61.3% of respondents had access to a pelviperineology MTM, with important difference according to geographical areas. Main activity of MTMs was case discussion of complex situations (68% of meetings). At the end of 2021, 22% of the respondents declared willing to stop partially or totally their pelviperineology activity, given the new regulations set in place by the authorities. CONCLUSION Despite being absolutely mandatory in current clinical practice, MTMs in pelvic floor disease have spread slowly. MTMs implementation was still insufficient in 2022, and variable on the French territory. Some urologists declare having no access to such resources and about 1 out of 5 were considering to voluntary stop of decrease significantly their activity in this difficult context. LEVEL OF EVIDENCE: 4
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Affiliation(s)
| | | | | | | | | | | | | | | | - Lucie Even
- Cabinet d'urologie, espace santé 3, 521, avenue de Rome, 83500 La Seyne-sur-Mer, France
| | | | | | - Sophie Hurel
- Hôpital européen Georges-Pompidou, AP-HP, Paris, France
| | - Julia Klap
- Hôpital privé Claude-Galien, Quincy-sous-Sénart, France
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Deffieux X, Rousset-Jablonski C, Gantois A, Brillac T, Maruani J, Maitrot-Mantelet L, Mignot S, Gaucher L, Athiel Y, Baffet H, Bailleul A, Bernard V, Bourdon M, Cardaillac C, Carneiro Y, Chariot P, Corroenne R, Dabi Y, Dahlem L, Frank S, Freyens A, Grouthier V, Hernandez I, Iraola E, Lambert M, Lauchet N, Legendre G, Le Lous M, Louis-Vahdat C, Martinat Sainte-Beuve A, Masson M, Matteo C, Pinton A, Sabbagh E, Sallee C, Thubert T, Heron I, Pizzoferrato AC, Artzner F, Tavenet A, Le Ray C, Fauconnier A. [Pelvic exam in gynecology and obstetrics: Guidelines for clinical practice]. Gynecol Obstet Fertil Senol 2023; 51:297-330. [PMID: 37258002 DOI: 10.1016/j.gofs.2023.04.001] [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] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/03/2023] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To provide guidelines for the pelvic clinical exam in gynecology and obstetrics. MATERIAL AND METHODS A multidisciplinary experts consensus committee of 45 experts was formed, including representatives of patients' associations and users of the health system. The entire guidelines process was conducted independently of any funding. The authors were advised to follow the rules of the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) system to guide assessment of quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasized. METHODS The committee studied 40 questions within 4 fields for symptomatic or asymptomatic women (emergency conditions, gynecological consultation, gynecological diseases, obstetrics, and pregnancy). Each question was formulated in a PICO (Patients, Intervention, Comparison, Outcome) format and the evidence profiles were produced. The literature review and recommendations were made according to the GRADE® methodology. RESULTS The experts' synthesis work and the application of the GRADE method resulted in 27 recommendations. Among the formalized recommendations, 17 present a strong agreement, 7 a weak agreement and 3 an expert consensus agreement. Thirteen questions resulted in an absence of recommendation due to lack of evidence in the literature. CONCLUSIONS The need to perform clinical examination in gynecological and obstetrics patients was specified in 27 pre-defined situations based on scientific evidence. More research is required to investigate the benefit in other cases.
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Affiliation(s)
- Xavier Deffieux
- Service de gynécologie-obstétrique, hôpital Antoine-Béclère, université Paris-Saclay, AP-HP, 92140 Clamart, France.
| | - Christine Rousset-Jablonski
- Département de chirurgie, Centre Léon Bérard, 28, rue Laënnec, 69008 Lyon, France; Inserm U1290, Research on Healthcare Performance (RESHAPE), université Claude-Bernard Lyon 1, 69008 Lyon, France; Service de Gynécologie-Obstétrique, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | - Adrien Gantois
- Collège national des sages-femmes de France hébergé au Réseau de santé périnatal parisien (RSPP), 75010 Paris, France
| | | | - Julia Maruani
- Cabinet médical, 6, rue Docteur-Albert-Schweitzer, 13006 Marseille, France
| | - Lorraine Maitrot-Mantelet
- Unité de gynécologie médicale, hôpital Port-Royal, Assistance publique-Hôpitaux de Paris (AP-HP), hôpital universitaire Paris centre (HUPC), 75014 Paris, France
| | | | - Laurent Gaucher
- Collège national des sages-femmes de France, CNSF, 75010 Paris, France; Public Health Unit, hospices civils de Lyon, 69500 Bron, France; Inserm U1290, Research on Healthcare Performance (RESHAPE), université Claude-Bernard Lyon 1, 69008 Lyon, France; Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, 1206 Genève, Suisse
| | - Yoann Athiel
- Maternité Port-Royal, groupe hospitalier Paris Centre, AP-HP, université Paris cité, FHU Prema, 75014 Paris, France
| | - Hortense Baffet
- Service de gynécologie médicale, orthogénie et sexologie, CHU de Lille, université de Lille, 59000 Lille, France
| | - Alexandre Bailleul
- Service de gynécologie-obstétrique, centre hospitalier de Poissy Saint-Germain-en-Laye, 78300 Poissy, France; Équipe RISCQ « Risques cliniques et sécurité en santé des femmes et en santé périnatale », université Paris-Saclay, UVSQ, 78180 Montigny-le-Bretonneux, France
| | - Valérie Bernard
- Service de chirurgie gynécologique, gynécologie médicale et médecine de la reproduction, centre Aliénor d'Aquitaine, centre hospitalo-universitaire Pellegrin, 33000 Bordeaux, France; Unité Inserm 1312, université de Bordeaux, Bordeaux Institute of Oncology, 33000 Bordeaux, France
| | - Mathilde Bourdon
- Service de gynécologie-obstétrique II et médecine de la reproduction, université Paris cité, AP-HP, centre hospitalier universitaire (CHU) Cochin Port-Royal, 75014 Paris, France
| | - Claire Cardaillac
- Service de gynécologie-obstétrique, CHU de Nantes, 44000 Nantes, France
| | | | - Patrick Chariot
- Département de médecine légale et sociale, Assistance publique-Hôpitaux de Paris, 93140 Bondy, France; Institut de recherche interdisciplinaire sur les enjeux sociaux, UMR 8156-997, UFR SMBH, université Sorbonne Paris Nord, 93000 Bobigny, France
| | - Romain Corroenne
- Service de gynécologue-obstétrique, CHU d'Angers, 49000 Angers, France
| | - Yohann Dabi
- Service de gynécologie-obstétrique et médecine de la reproduction, Sorbonne université-AP-HP-hôpital Tenon, 75020 Paris, France
| | - Laurence Dahlem
- Département universitaire de médecine générale, faculté de médecine, université de Bordeaux, 146, rue Léo-Saignat, 33076 Bordeaux, France
| | - Sophie Frank
- Service d'oncogénétique, Institut Curie, 75005 Paris, France
| | - Anne Freyens
- Département universitaire de médecine générale (DUMG), université Paul-Sabatier, 31000 Toulouse, France
| | - Virginie Grouthier
- Service d'endocrinologie, diabétologie, nutrition et d'endocrinologie des gonades, Hôpital Haut Lévêque, Centre Hospitalo-universitaire régional de Bordeaux, 31000 Bordeaux, France; Université de Bordeaux, Inserm U1034, Biology of Cardiovascular Diseases, Pessac, France
| | - Isabelle Hernandez
- Collège national des sages-femmes de France hébergé au Réseau de santé périnatal parisien (RSPP), 75010 Paris, France
| | - Elisabeth Iraola
- Institut de recherche interdisciplinaire sur les enjeux sociaux (IRIS), UMR 8156-997, CNRS U997 Inserm EHESS UP13 UFR SMBH, université Sorbonne Paris Nord, Paris, France; Direction de la protection maternelle et infantile et promotion de la santé, conseil départemental du Val-de-Marne, 94000 Créteil, France
| | - Marie Lambert
- Service de chirurgie gynécologique, gynécologie médicale et médecine de la reproduction, centre Aliénor d'Aquitaine, centre hospitalo-universitaire Pellegrin, 33000 Bordeaux, France
| | - Nadege Lauchet
- Groupe médical François-Perrin, 9, rue François-Perrin, 87000 Limoges, France
| | - Guillaume Legendre
- Service de gynécologue-obstétrique, CHU Angers, 49000 Angers, France; UMR_S1085, université d'Angers, CHU d'Angers, université de Rennes, Inserm, EHESP, Irset (institut de recherche en santé, environnement et travail), Angers, France
| | - Maela Le Lous
- Université de Rennes 1, Inserm, LTSI - UMR 1099, 35000 Rennes, France; Département de gynécologie et obstétrique, CHU de Rennes, 35000 Rennes, France
| | - Christine Louis-Vahdat
- Cabinet de gynécologie et obstétrique, 126, boulevard Saint-Germain, 75006 Paris, France
| | | | - Marine Masson
- Département de médecine générale, 86000 Poitiers, France
| | - Caroline Matteo
- Ecole de maïeutique, Aix Marseille Université, 13015 Marseille, France
| | - Anne Pinton
- Service de gynécologie-obstétrique, hôpital Trousseau, AP-HP, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France; Sorbonne université, 75013 Paris, France
| | - Emmanuelle Sabbagh
- Unité de gynécologie médicale, hôpital Port-Royal, Assistance publique-Hôpitaux de Paris (AP-HP), hôpital universitaire Paris centre (HUPC), 75014 Paris, France
| | - Camille Sallee
- Service de gynécologie-obstétrique, hôpital Mère-Enfant, CHU de Limoges, 87000 Limoges, France
| | - Thibault Thubert
- Service de gynecologie-obstétrique, CHU de Nantes, 44000 Nantes, France; EA 4334, laboratoire mouvement, interactions, performance (MIP), Nantes université, 44322 Nantes, France
| | - Isabelle Heron
- Service d'endocrinologie, université de Rouen, hôpital Charles-Nicolle, 76000 Rouen, France; Cabinet médical, Clinique Mathilde, 76100 Rouen, France
| | - Anne-Cécile Pizzoferrato
- Service de gynécologie-obstétrique, hôpital universitaire de La Miletrie, 86000 Poitiers, France; Inserm CIC 1402, université de Poitiers, 86000 Poitiers, France
| | - France Artzner
- Ciane, Collectif interassociatif autour de la naissance, c/o Anne Evrard, 101, rue Pierre-Corneille, 69003 Lyon, France
| | - Arounie Tavenet
- Endofrance, Association de lutte contre l'endométriose, 3, rue de la Gare, 70190 Tresilley, France
| | - Camille Le Ray
- Maternité Port-Royal, groupe hospitalier Paris Centre, AP-HP, université Paris cité, FHU Prema, 75014 Paris, France
| | - Arnaud Fauconnier
- Service de gynécologie-obstétrique, centre hospitalier de Poissy Saint-Germain-en-Laye, 78300 Poissy, France
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de Tayrac R, Antosh DD, Baessler K, Cheon C, Deffieux X, Gutman R, Lee J, Nager C, Schizas A, Sung V, Maher C. Summary: 2021 International Consultation on Incontinence Evidence-Based Surgical Pathway for Pelvic Organ Prolapse. J Clin Med 2022; 11:jcm11206106. [PMID: 36294427 PMCID: PMC9605527 DOI: 10.3390/jcm11206106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/26/2022] [Accepted: 10/10/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: There is wide variation in the reported prevalence rates for pelvic organ prolapse (POP). There is also wide variation in the rate at which surgical interventions for pelvic organ prolapse are performed, as well as the type of interventions undertaken. As part of the International Consultation on Incontinence (ICI), our committee was tasked to produce evidence-based pathways for the surgical management of POP, any associated stress urinary incontinence (SUI), and bowel dysfunction. (2) Methods: To enable us to generate such evidence, we undertook a thorough search for the POP surgery-related, English-language scientific literature published up to April 2021. (3) Results: The committee evaluated the literature and made recommendations based on the Oxford grading system. (4) Conclusions: This review serves to provide a summary of the 2021 ICI surgical management of an evidence-based prolapse pathway and outline the evidence used to inform this guidance.
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Affiliation(s)
- Renaud de Tayrac
- Service de Gynécologie-Obstétrique, CHU de Nîmes, Université de Montpellier, 34000 Nîmes, France
- Correspondence:
| | - Danielle D. Antosh
- Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Kaven Baessler
- Pelvic Floor Centre, Franziskus and St. Joseph Hospitals, Budapester Str. 15-19, 10787 Berlin, Germany
| | - Cecilia Cheon
- Urogynaecology Section of Queen Elizabeth Hospital, Hong Kong and Shenzhen Hong Kong University Hospital, Shenzhen 518009, China
| | - Xavier Deffieux
- Service de Gynécologie-Obstétrique, Hôpital Antoine Béclère, 92140 Clamart, France
| | - Robert Gutman
- Urogynecology & Pelvic Reconstructive Surgery, MedStar Washington Hospital Center, 106 Irving St. NW 405 S, Washington, DC 20010, USA
| | - Joseph Lee
- St. Vincents Clinic, UNSW University of New South Wales, Sydney, NSW 2010, Australia
| | - Charles Nager
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego Health, San Diego, CA 92037, USA
| | - Alexis Schizas
- General Surgery Department, Guy’s and St. Thomas’ NHS Foundation Trust, Monkton Street, London SE11 4TX, UK
| | - Vivian Sung
- Department of Obstetrics and Gynecology, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Christopher Maher
- Royal Brisbane and Womens Hospital, Urogynaecology University QLD, Herston, QLD 4029, Australia
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Laurence J, Nghiem MA, Fernandez H, Luton D, Pelhuche A, Florin M, Deffieux X, Capmas P. Concomitant vesicovaginal fistula and rectovaginal fistula in a patient with a neglected pessary placed for pelvic organ prolapse. Prog Urol 2022; 32:1543-1545. [PMID: 36041957 DOI: 10.1016/j.purol.2022.08.012] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 08/12/2022] [Indexed: 10/15/2022]
Abstract
INTRODUCTION Pelvic organ prolapse is a very frequent affection especially in elderly women. Vaginal pessary is a common conservative treatment and recommended as first line therapy. Guidelines recommend to do a regular follow up every 6 to 12 months with a healthcare professional. We report the case of a patient with neglected vaginal pessary who had a vesicovaginal and a concomitant rectovaginal fistula. CASE REPORT A 84-year-old woman was admitted for chronic pelvic pain and vaginal discharge. An entrapped cube pessary was removed and the diagnostic of a 3cm rectovaginal fistula with a vesicovaginal fistula was made. The patient had a two-stage surgery, vaginal way then open abdominal way, for closing the fistulas. CONCLUSION Although vaginal pessary is a good conservative treatment for POP, it shall not be neglected or serious complications can be caused.
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Affiliation(s)
- Julie Laurence
- Gynecology and Obstetrics Department, Bicetre Hospital, GHU Sud, AP-HP, 94276, Le Kremlin Bicetre, France.
| | - My-Anh Nghiem
- Gynecology and Obstetrics Department, Bicetre Hospital, GHU Sud, AP-HP, 94276, Le Kremlin Bicetre, France
| | - Herve Fernandez
- Gynecology and Obstetrics Department, Bicetre Hospital, GHU Sud, AP-HP, 94276, Le Kremlin Bicetre, France; Inserm, Centre of research in Epidemiology and population health (CESP), U1018, 94276 Villejuif, France; Faculty of medicine, université Paris Sud, 94276 Le Kremlin Bicetre, France
| | - Dominique Luton
- Gynecology and Obstetrics Department, Bicetre Hospital, GHU Sud, AP-HP, 94276, Le Kremlin Bicetre, France
| | - Antoine Pelhuche
- Gynecology and Obstetrics Department, Bicetre Hospital, GHU Sud, AP-HP, 94276, Le Kremlin Bicetre, France; Department of Urology, hôpital de Bicêtre, université Paris-Sud, Paris, France
| | - Marie Florin
- Université de Paris, AP-HP, hôpital Européen Georges Pompidou, Radiology Department, 20, rue Leblanc, 75015 Paris, France
| | - Xavier Deffieux
- AP-HP, GHU Sud, Antoine Béclere Hospital, Department of Obstetrics and Gynaecology, 92140 Clamart, France
| | - Perrine Capmas
- Gynecology and Obstetrics Department, Bicetre Hospital, GHU Sud, AP-HP, 94276, Le Kremlin Bicetre, France; Inserm, Centre of research in Epidemiology and population health (CESP), U1018, 94276 Villejuif, France; Faculty of medicine, université Paris Sud, 94276 Le Kremlin Bicetre, France
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Deffieux X, Amarenco G. Editorial comment: Transcutaneous electrical neurostimulation relieves primary dysmenorrhea: A randomized, double blinded clinical study versus placebo. Prog Urol 2022; 32:498-499. [PMID: 35491313 DOI: 10.1016/j.purol.2022.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- X Deffieux
- Université Paris-Saclay, Assistance Publique Hôpitaux de Paris (AP-HP), Hôpital Antoine Béclère, Service de Gynécologie-Obstétrique, 157, rue de la Porte de Trivaux, 92140 Clamart, France.
| | - G Amarenco
- Université Paris Sorbonne, Assistance Publique Hôpitaux de Paris (AP-HP), Hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
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Vivanti AJ, Nhung NTH, Ha CTT, Cong NH, Bac DV, de Thorey AG, Benachi A, Deffieux X, Le DTH. Successful conservative management of a spontaneous hemorrhagic uterine rupture at 18 weeks of gestation. J Gynecol Obstet Hum Reprod 2022; 51:102396. [PMID: 35489714 DOI: 10.1016/j.jogoh.2022.102396] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/19/2022] [Accepted: 04/13/2022] [Indexed: 10/18/2022]
Abstract
Prelabor uterine rupture is a very rare complication of pregnancy that in most cases occurs when there is a history of uterine surgery. Maternal and neonatal morbidity is significant. Most often, the pregnancy must be terminated to rescue both the mother and the newborn, if possible. We report the case of a patient who had a pre-labor uterine rupture at 18 weeks of gestation (WG) complicated by massive hemoperitoneum. Emergency surgery with conservative management allowed the pregnancy to continue until 32+3 WG. In very rare situations of uterine rupture at a very early term, conservative management appears to be an acceptable solution to allow the pregnancy to continue until a sufficient gestational age to limit complications related to prematurity.
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Affiliation(s)
- Alexandre J Vivanti
- Department of Obstetrics and Gynecology, DMU Santé des Femmes et des Nouveau-nés Antoine Béclère Hospital, Université Paris Saclay, AP-HP, Clamart, France.
| | | | - Cao Thi Thuy Ha
- Department of Obstetrics and Gynecology, Tam Anh Hospital, Hanoi City, Viet Nam
| | - Nguyen Huu Cong
- Department of Obstetrics and Gynecology, Tam Anh Hospital, Hanoi City, Viet Nam
| | - Duong Viet Bac
- Department of Obstetrics and Gynecology, Tam Anh Hospital, Hanoi City, Viet Nam
| | - Axelle Gillet de Thorey
- Department of Obstetrics and Gynecology, DMU Santé des Femmes et des Nouveau-nés Antoine Béclère Hospital, Université Paris Saclay, AP-HP, Clamart, France
| | - Alexandra Benachi
- Department of Obstetrics and Gynecology, DMU Santé des Femmes et des Nouveau-nés Antoine Béclère Hospital, Université Paris Saclay, AP-HP, Clamart, France
| | - Xavier Deffieux
- Department of Obstetrics and Gynecology, DMU Santé des Femmes et des Nouveau-nés Antoine Béclère Hospital, Université Paris Saclay, AP-HP, Clamart, France
| | - Dinh Thi Hien Le
- Department of Obstetrics and Gynecology, Tam Anh Hospital, Hanoi City, Viet Nam
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Cardot V, Campagne-Loiseau S, Roulette P, Peyrat L, Vidart A, Wagner L, Thuillier C, Klap J, Hurel S, Hermieu JF, Girard F, Even L, Donon L, Charles T, Tibi B, Bosset PO, Berrogain N, Meyer F, Cornu JN, Deffieux X. 2021 opinion from the CUROPF on THE efficacy and safety of mid-urethral slings used in women WITH urinary stress incontinence. Prog Urol 2021; 32:247-257. [PMID: 34920924 DOI: 10.1016/j.purol.2021.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 10/23/2021] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To determine the usefulness of mid-urethral slings (MUS) in the surgical management of women presenting with urinary stress incontinence (USI) METHOD: A consensus committee of multidisciplinary experts (CUROPF) was convened and focused on PICO questions concerning the efficacy and safety of MUS surgery compared to other procedures and concerning which approach (retropubic (RP) vs transobturator (TO)) should be proposed as a first-line MUS surgery for specific subpopulations (obese; intrinsic sphincteric deficiency (ISD); elderly) RESULTS: As compared to other procedures (urethral bulking agents, traditional slings and open colposuspension), the MUS procedure should be proposed as the first-line surgical therapy (strong agreement). MUS surgery can be associated with complications and proper pre-operative informed consent is mandatory (strong agreement). Mini-slings (SIS/SIMS) should only be proposed in clinical trials (strong agreement). Both RP and TO approaches may be proposed for the insertion of MUS (strong agreement). However, if the woman is willing to accept a moderate increase in per-operative risk, the RP approach should be preferred (strong agreement) since it is associated with higher very long-term cure rates and as it is possible to completely remove the sling surgically if a severe complication occurs. The RP approach should be used for the insertion of MUS in a woman presenting with ISD (strong agreement). Either the RP or TO approach should be used for the insertion of MUS in an obese woman presenting with USI (strong agreement). In very obese women (BMI ≥35-40kg/m2), weight loss should be preferred prior to MUS surgery and bariatric surgery should be discussed (strong agreement) CONCLUSION: The current Opinion provides an appropriate strategy for both the selection of patients and the best therapeutic approach in women presenting with USI.
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Affiliation(s)
- V Cardot
- Clinique de Meudon-Clamart, 3, avenue de Villacoublay, 92360 Meudon, France
| | - S Campagne-Loiseau
- Service de gynécologie obstétrique, CHU Estaing, Clermont Ferrand, 1, place Lucie et Raymond-Aubrac, 63000 Clermont Ferrand, France
| | - P Roulette
- Service d'urologie, CH Cahors, 30, avenue de la voie Romaine, 06000 Nice, France
| | - L Peyrat
- Service d'urologie, Clinique de Turin, 13, rue de Turin, 75008 Paris, France
| | - A Vidart
- Service d'urologie, hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - L Wagner
- Servie d'urologie, CHU Carémeau, place du Pr Robert Debré, 30029 Nîmes, France
| | - C Thuillier
- Service d'urologie, CHU Grenoble-Alpes, 38000 Grenoble, France
| | - J Klap
- Service d'urologie, hôpital Privé Claude Galien, 20, route de Boussy Saint-Antoine, 91480 Quincy sous Sénart, France
| | - S Hurel
- Service d'urologie, hôpital Européen Georges-Pompidou (AP-HP), 20, rue Leblanc, 75015 Paris, France
| | - J F Hermieu
- Service d'urologie, hôpital Bichat (AP-HP), 46, rue Henri-Huchard, 75018 Paris, France
| | - F Girard
- Service d'urologie, clinique oudinot fondation Cognacq-Jay, 2 rue Rousselet, 75007 Paris, France
| | - L Even
- Cabinet d'urologie, Espace Santé 3, 521, avenue de Rome, 83500 La Seyne-sur-Mer, France
| | - L Donon
- Service d'urologie, Polyclinique de la Côte Basque Sud, 7, rue Léonce Goyetche, 64500 Saint Jean de Luz, France
| | - T Charles
- Service d'urologie, CHU La Miletrie, 2, rue de la Milétrie, 86021 Poitiers, France
| | - B Tibi
- Service d'urologie, CH Cahors, 30, avenue de la voie Romaine, 06000 Nice, France
| | - P O Bosset
- Service d'urologie, Clinique de Turin, 13, rue de Turin, 75008 Paris, France
| | - N Berrogain
- Service d'URologie, Clinique Ambroise Pare, 387, route de Saint-Simon, 31100 Toulouse, France
| | - F Meyer
- Service d'urologie, hôpital Saint Louis (APHP), 1, avenue Claude Vellefaux, 75010 Paris, France
| | - J-N Cornu
- Service d'urologie, hôpital Charles-Nicolle, université de Rouen, 1, rue de Germont, 76000 Rouen, France
| | - X Deffieux
- Service de gynécologie obstétrique, hôpital Antoine-Béclère (APHP), 157, rue de la Porte de Trivaux, 92140 Clamart, France.
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Even L, Tibi B, Bentellis I, Treacy PJ, Berrogain N, Bosset PO, Campagne-Loiseau S, Cardot V, Charles T, Deffieux X, Donon L, Girard F, Hermieu JF, Hurel S, Klap J, Meyer F, Peyrat L, Thuillier C, Vidart A, Wagner L, Cornu JN. [Complications of mid-urethral sling - A review from the Committee for Female Urology and Pelviperineology for the French Association of Urology]. Prog Urol 2021; 31:1141-1166. [PMID: 34794867 DOI: 10.1016/j.purol.2021.09.007] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/22/2021] [Accepted: 09/23/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Placement of a mid-urethral sling is the gold standard in the surgical management of stress urinary incontinence in women in France. The cure rate of this material is no longer to be demonstrated, but the per- and post-operative complications are currently the subject of a growing controversy not only in Europe but also across the Channel and across the Atlantic, having led to the modification of operative indications. In France, recommendations are also evolving with a stricter framework for indications for surgery by multidisciplinary consultation meeting and an obligation for postoperative follow-up in the short and long term. OBJECTIVES In this context, CUROPF realized a review of the literature bringing together the available scientific evidence concerning the occurrence of per- and post-operative complications relating to the installation of mid urethral sling. The bibliographic search was carried out using the Medline database and 123 articles were selected. RESULTS Analysis of the data highlights various complications, depending on the implanted material, the patient and the indication for surgery. The retro-pubic mid urethral sling provides more bladder erosion during surgery (up to 14%), more suprapubic pain (up to 4%) and more acute urinary retention (up to 19,7%) and postoperative dysuria (up to 26%). The trans obturator mid-urethral sling is responsible for more vaginal erosion during the operation (up to 10,9%), more lower limb pain of neurological origin (up to 26,7%). The risk of developing over active bladder is similar in both procedures (up to 33%). But these risks of complications must be balanced by the strong impact of urinary incontinence surgery on the overall quality of life of these women. CONCLUSION Thus, surgical failure and long term complications exist but should not limit the surgical management of stress urinary incontinence with mid urethral tape. Women should be treated with individualized decision-making process and long-term follow -up is necessary.
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Affiliation(s)
- L Even
- Cabinet d'urologie, espace santé 3 83500 La Seyne sur Mer, clinique du Cap d'Or, 83500 La Seyne sur mer, Polyclinique Les Fleurs, 83190 Ollioules, France
| | - B Tibi
- Service d'urologie, université de Nice-Sophia Antipolis, hôpital Pasteur 2, CHU de Nice, 06000 Nice, France
| | - I Bentellis
- Service d'urologie, université de Nice-Sophia Antipolis, hôpital Pasteur 2, CHU de Nice, 06000 Nice, France
| | - P J Treacy
- Service d'urologie, université de Nice-Sophia Antipolis, hôpital Pasteur 2, CHU de Nice, 06000 Nice, France
| | - N Berrogain
- Clinique Ambroise-Paré, 31100 Toulouse, France
| | - P O Bosset
- Service d'urologie, hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - S Campagne-Loiseau
- Service de gynécologie-obstétrique, CHU Estaing, Clermont-Ferrand, France
| | - V Cardot
- Clinique de Meudon-Clamart, 3, avenue de Villacoublay, 92360 Meudon, France
| | - T Charles
- Service d'urologie, CHU La Miletrie, 86000 Poitiers, France
| | - X Deffieux
- Service de gynécologie-obstétrique, hôpital Antoine-Béclère (AP-HP), 92140 Clamart, France
| | - L Donon
- Clinique de la Côte Basque, 64100 Bayonne, France
| | - F Girard
- Service d'urologie, clinique Oudinot Fondation Cognac-Jay, 2, rue Rousselet, 75007 Paris, France
| | - J-F Hermieu
- Service d'urologie, hôpital Bichat, AP-HP, Paris, France
| | - S Hurel
- Service d'urologie, hôpital européen Georges-Pompidou, AP-HP, Paris, France
| | - J Klap
- Service d'urologie, hôpital Privé Claude Galien, 91480 Quincy-sous-Sénart, France
| | - F Meyer
- Service d'urologie, hôpital Saint-Louis, AP-HP, Paris, France
| | - L Peyrat
- Service d'urologie, clinique Turin, 75008 Paris, France
| | - C Thuillier
- Service d'urologie, CHU Grenoble-Alpes, 38000 Grenoble, France
| | - A Vidart
- Service d'urologie, hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - L Wagner
- Service d'urologie, CHU de Nîmes, place du Pr-Robert-Debré, 30029 Nîmes cedex 9, France
| | - J N Cornu
- Service d'urologie, université de Rouen, hôpital Charles-Nicolle, 1, rue de Germont, 76000 Rouen, France.
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Hermieu N, Hermieu J, Schoentgen N, Aoun R, Xylinas E, Deffieux X, Fernandez H, Cosson M, Gamé X, Peyronnet B, Ouzaid I. Évolution des pratiques après l’arrêté encadrant les bandelettes sous-urétrales : résultats d’une enquête nationale. Prog Urol 2021. [DOI: 10.1016/j.purol.2021.08.087] [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: 11/25/2022]
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Levesque A, Bautrant E, Quistrebert V, Valancogne G, Riant T, Beer Gabel M, Leroi AM, Jottard K, Bruyninx L, Amarenco G, Quintas L, Picard P, Vancaillie T, Leveque C, Mohy F, Rioult B, Ploteau S, Labat JJ, Guinet-Lacoste A, Quinio B, Cosson M, Haddad R, Deffieux X, Perrouin-Verbe MA, Garreau C, Robert R. Recommendations on the management of pudendal nerve entrapment syndrome: A formalised expert consensus. Eur J Pain 2021; 26:7-17. [PMID: 34643963 DOI: 10.1002/ejp.1861] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 09/09/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Since the development and publication of diagnostic criteria for pudendal nerve entrapment (PNE) syndrome in 2008, no comprehensive work has been published on the clinical knowledge in the management of this condition. The aim of this work was to develop recommendations on the diagnosis and the management of PNE. METHODS The methodology of this study was based on French High Authority for Health Method for the development of good practice and the literature review was based on the PRISMA method. The selected articles have all been evaluated according to the American Society of Interventional Pain Physicians assessment grid. RESULTS The results of the literature review and expert consensus are incorporated into 10 sections to describe diagnosis and management of PNE: (1) diagnosis of PNE, (2) patients advice and precautions, (3) drugs treatments, (4) physiotherapy, (5) transcutaneous electrostimulations (TENS), (6) psychotherapy, (7) injections, (8) surgery, (9) pulsed radiofrequency, and (10) Neuromodulation. The following major points should be noted: (i) the relevance of 4+1 Nantes criteria for diagnosis; (ii) the preference for initial monotherapy with tri-tetracyclics or gabapentinoids; (iii) the lack of effect of opiates, (iv) the likely relevance (pending more controlled studies) of physiotherapy, TENS and cognitive behavioural therapy; (v) the incertitudes (lack of data) regarding corticoid injections, (vi) surgery is a long term effective treatment and (vii) radiofrequency needs a longer follow-up to be currently proposed in this indication. CONCLUSION These recommendations should allow rational and homogeneous management of patients suffering from PNE. They should also allow to shorten the delays of management by directing the primary care. SIGNIFICANCE Pudendal nerve entrapment (PNE) has only been known for about 20 years and its management is heterogeneous from one practitioner to another. This work offers a synthesis of the literature and international experts' opinions on the diagnosis and management of PNE.
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Affiliation(s)
- Amélie Levesque
- Urology Department, Nantes University Hospital, Nantes, France
| | - Eric Bautrant
- Pelvi-Perineal Surgery and Rehabilitation Department, Private Medical Centre "l'Avancée-Clinique Axium", Aix en Provence, France
| | | | | | - Thibault Riant
- Maurice Bensignor Multidisciplinary Pain Center, Centre Catherine de Sienne, Nantes, France
| | - Marc Beer Gabel
- Neurogastroenterology and Pelvic Floor Unit, Sheba Medical Center, Tel Hashomer, Israel
| | | | | | - Luc Bruyninx
- Department of Surgery, Brugmann Hospital, Brussels, Belgium
| | - Gerard Amarenco
- GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Sorbonne Université, Paris, France
| | - Lara Quintas
- Department of Gynecology, Clinical Institute of Gynecology, Obstetrics, and Neonatology, Faculty of Medicine, Barcelona, Spain
| | - Pascale Picard
- Neurology Department, Clermont-Ferrand University Hospital, Inserm, Clermont-Ferrand, France
| | - Thierry Vancaillie
- School of Women and Children, University of New South Wales, Sydney, New South Wales, Australia
| | - Christine Leveque
- Pelvi-Perineal Surgery and Rehabilitation Department, Private Medical Centre "l'Avancée-Clinique Axium", Aix en Provence, France
| | - Frédérique Mohy
- Pain Management Center, University Hospital Felix Guyon, SAINT DENIS, La Reunion, France
| | - Bruno Rioult
- Maurice Bensignor Multidisciplinary Pain Center, Centre Catherine de Sienne, Nantes, France
| | - Stéphane Ploteau
- Department of Gynecology-Obstetrics and Reproductive Medicine, Nantes University Hospital, Nantes, France
| | | | - Amandine Guinet-Lacoste
- Hospices Civils de Lyon, Hôpital Henry Gabrielle, Plate-forme Mouvement et Handicap, Lyon, France
| | - Bertrand Quinio
- Pain Center, Regional University Hospital la Cavale Blanche, Brest, France
| | - Michel Cosson
- Departement of Gynecology, University Hopsital Jeanne De Flandre, Lille, France
| | - Rebecca Haddad
- GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Sorbonne Université, Paris, France
| | - Xavier Deffieux
- Department of Obstetrics and Gynecology, Antoine Beclere Hospital, Assistance Publique Hopitaux de Paris, Clamart University Paris-Saclay, Clamart, France
| | | | | | - Roger Robert
- Maurice Bensignor Multidisciplinary Pain Center, Centre Catherine de Sienne, Nantes, France
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Fritel X, de Tayrac R, de Keizer J, Campagne-Loiseau S, Cosson M, Ferry P, Deffieux X, Lucot JP, Wagner L, Debodinance P, Saussine C, Pizzoferrato AC, Carlier-Guérin C, Thubert T, Panel L, Bosset PO, Nkounkou E, Ramanah R, Boisramé T, Charles T, Raiffort C, Charvériat A, Ragot S, Fauconnier A. Serious complications and recurrences after pelvic organ prolapse surgery for 2309 women in the VIGI-MESH registry. BJOG 2021; 129:656-663. [PMID: 34541781 DOI: 10.1111/1471-0528.16892] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess the incidence of serious complications and reoperations for recurrence after surgery for pelvic organ prolapse (POP) and compare the three most common types of repair. DESIGN Prospective cohort study using a registry. SETTING Nineteen French surgical centres. POPULATION A total of 2309 women participated between 2017 and 2019. METHODS A multivariate analysis including an inverse probability of treatment weighting approach was used to obtain three comparable groups. MAIN OUTCOME MEASURES Serious complications and subsequent reoperations for POP recurrence. RESULTS The median follow-up time was 17.6 months. Surgeries were native tissue vaginal repairs (n = 504), transvaginal mesh placements (n = 692) and laparoscopic sacropexies with mesh (n = 1113). Serious complications occurred among 52 women (2.3%), and reoperation for POP recurrence was required for 32 women (1.4%). At 1 year the cumulative weighted incidence of serious complications was 1.8% for native tissue vaginal repair, 3.9% for transvaginal mesh and 2.2% for sacropexy, and the rates for reoperation for recurrence of POP were 1.5, 0.7 and 1.1%, respectively. Compared with native tissue vaginal repair, the risk of serious complications was higher in the transvaginal mesh group (weighted hazard ratio, wHR 3.84, 95% CI 2.43-6.08) and the sacropexy group (wHR 2.48, 95% CI 1.45-4.23), whereas the risk of reoperation for prolapse recurrence was lower in both the transvaginal mesh (wHR 0.22, 95% CI 0.13-0.39) and sacropexy (wHR 0.29, 95% CI 0.18-0.47) groups. CONCLUSIONS Our results suggest that native tissue vaginal repairs have the lowest risk of serious complications but the highest risk of reoperation for recurrence. These results are useful for informing women and for shared decision making. TWEETABLE ABSTRACT Laparoscopic sacropexy had fewer serious complications than transvaginal mesh and fewer reoperations for recurrence than vaginal repair.
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Affiliation(s)
- X Fritel
- Service de Gynécologie, CHU de Poitiers, Poitiers, France.,Université de Poitiers, INSERM CIC 1402, Poitiers, France
| | - R de Tayrac
- Service de Gynécologie, CHU Carémeau, Nîmes, France
| | - J de Keizer
- Université de Poitiers, INSERM CIC 1402, Poitiers, France
| | | | - M Cosson
- Service de Gynécologie, CHU de Lille, Lille, France
| | - P Ferry
- Service de Gynécologie, CH de La Rochelle, La Rochelle, France
| | - X Deffieux
- Service de Gynécologie, APHP Antoine-Béclère, Clamart, France
| | - J-P Lucot
- Service de Gynécologie, Hôpital Saint-Vincent-de-Paul, Lille, France
| | - L Wagner
- Service d'Urologie, CHU Carémeau, Nîmes, France
| | - P Debodinance
- Service de Gynécologie, CH de Dunkerque, Dunkerque, France
| | - C Saussine
- Service d'Urologie, CHU de Strasbourg, Strasbourg, France
| | | | - C Carlier-Guérin
- Service de Gynécologie, CH de Châtellerault, Châtellerault, France
| | - T Thubert
- Service de Gynécologie, CHU de Nantes, Nantes, France
| | - L Panel
- Service de Gynécologie, Clinique Beau-Soleil, Montpellier, France
| | - P-O Bosset
- Service d'Urologie, Hôpital Foch, Suresnes, France
| | - E Nkounkou
- Service de Gynécologie, CH de Béthune, Béthune, France
| | - R Ramanah
- Université de Franche-Comté, CHU de Besançon, Besançon, France
| | - T Boisramé
- Service de Gynécologie, CHU de Strasbourg, Strasbourg, France
| | - T Charles
- Service d'Urologie, CHU de Poitiers, Poitiers, France
| | - C Raiffort
- Service de Gynécologie, Groupe Hospitalier Diaconesses-Croix-Saint-Simon, Paris, France
| | - A Charvériat
- Service de Gynécologie, CHU de Poitiers, Poitiers, France
| | - S Ragot
- Université de Poitiers, INSERM CIC 1402, Poitiers, France
| | - A Fauconnier
- Service de Gynécologie, CHI Poissy-Saint-Germain, Poissy, France
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Touboul C, Legendre G, Agostini A, Akladios C, Bendifallah S, Bolze PA, Bouet PE, Chauvet P, Collinet P, Dabi Y, Delotte J, Deffieux X, Dion L, Gauthier T, Kerbage Y, Koskas M, Millet P, Narducci F, Ouldamer L, Ploteau S, Santulli P, Golfier F. [Guidelines for Clinical Practice of the French College of Obstetricians and Gynecologists 2021: Prophylactic procedures associated with gynecologic surgery]. ACTA ACUST UNITED AC 2021; 49:805-815. [PMID: 34520857 DOI: 10.1016/j.gofs.2021.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 04/02/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To draw up recommendations on the use of prophylactic gynecologic procedures during surgery for other indications. DESIGN A consensus panel of 19 experts was convened. A formal conflict of interest policy was established at the onset of the process and applied throughout. The entire study was performed independently without funding from pharmaceutical companies or medical device manufacturers. The panel applied the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system to evaluate the quality of evidence on which the recommendations were based. The authors were advised against making strong recommendations in the presence of low-quality evidence. Some recommendations were ungraded. METHODS The panel studied 22 key questions on seven prophylactic procedures: 1) salpingectomy, 2) fimbriectomy, 3) salpingo-oophorectomy, 4) ablation of peritoneal endometriosis, 5) adhesiolysis, 6) endometrial excision or ablation, and 7) cervical ablation. RESULTS The literature search and application of the GRADE system resulted in 34 recommendations. Six were supported by high-quality evidence (GRADE 1+/-) and 28 by low-quality evidence (GRADE 2+/-). Recommendations on two questions were left ungraded due to a lack of evidence in the literature. CONCLUSIONS A high level of consensus was achieved among the experts regarding the use of prophylactic gynecologic procedures. The ensuing recommendations should result in improved current practice.
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Affiliation(s)
- C Touboul
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'Hôpital Tenon (AP-HP), Sorbonne Université, 4, rue de la Chine, 75020 Paris, France.
| | - G Legendre
- Service de Gynécologie Obstétrique et Médecine de la Reproduction du CHU Anger, 4, rue Larrey, 49933 Angers cedex 9, France
| | - A Agostini
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'Hôpital de la Conception (AP-HM), Marseille, France
| | - C Akladios
- Service de Gynécologie Obstétrique et Médecine de la Reproduction des hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - S Bendifallah
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'Hôpital Tenon (AP-HP), Sorbonne Université, 4, rue de la Chine, 75020 Paris, France
| | - P A Bolze
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'hôpital Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
| | - P E Bouet
- Service de Gynécologie Obstétrique et Médecine de la Reproduction du CHU Anger, 4, rue Larrey, 49933 Angers cedex 9, France
| | - P Chauvet
- Service de Gynécologie Obstétrique et Médecine de la Reproduction du CHU Estaing, 1, place Lucie-Aubrac, 63000 Clermont-Ferrand, France
| | - P Collinet
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'Hôpital Jeanne-de-Flandre, avenue Eugène-Avinée, 59000 Lille, France
| | - Y Dabi
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'Hôpital Tenon (AP-HP), Sorbonne Université, 4, rue de la Chine, 75020 Paris, France
| | - J Delotte
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'Hôpital de l'Archet 2, 151, route de Saint-Antoine, 06200 Nice, France
| | - X Deffieux
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'hôpital A.-Béclêre (AP-HP), 157, rue de la Porte-de-Trivaux, 92140 Clamart, France
| | - L Dion
- Service de Gynécologie Obstétrique et Médecine de la Reproduction du Centre Hospitalier Universitaire de Rennes, 16, boulevard de Bulgarie, 35200 Rennes, France
| | - T Gauthier
- Service de Gynécologie Obstétrique et Médecine de la Reproduction du CHU de Limoges, 8, avenue Dominique-Larrey, 87000 Limoges, France
| | - Y Kerbage
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'Hôpital Jeanne-de-Flandre, avenue Eugène-Avinée, 59000 Lille, France
| | - M Koskas
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de de l'hôpital Bichat (AP-HP), 46, rue Henri-Huchard, 75018 Paris, France
| | - P Millet
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'Hôpital de l'Archet 2, 151, route de Saint-Antoine, 06200 Nice, France
| | - F Narducci
- Département de Cancérologie Gynécologique, Centre de Lutte Contre le Cancer Oscar-Lambret, Lille, France
| | - L Ouldamer
- Service de Gynécologie Obstétrique et Médecine de la Reproduction du CHU de Tours, 2, boulevard Tonnellé, 37000 Tours, France
| | - S Ploteau
- Service de Gynécologie Obstétrique et Médecine de la Reproduction du CHU de Nantes, 38 bd Jean-Monnet, 44093 Nantes cedex 1, France
| | - P Santulli
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'Hôpital Cochin (AP-HP), 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - F Golfier
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'hôpital Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
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Lucot JP, Cosson M, Verdun S, Debodinance P, Bader G, Campagne-Loiseau S, Salet-Lizee D, Akladios C, Ferry P, De Tayrac R, Delporte P, Curinier S, Deffieux X, Blanc S, Capmas P, Duhamel A, Fritel X, Fauconnier A. Long-term outcomes of primary cystocele repair by transvaginal mesh surgery versus laparoscopic mesh sacropexy: extended follow up of the PROSPERE multicentre randomised trial. BJOG 2021; 129:127-137. [PMID: 34264001 DOI: 10.1111/1471-0528.16847] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 05/22/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the effectiveness and safety of laparoscopic sacropexy (LS) and transvaginal mesh (TVM) at 4 years. DESIGN Extended follow up of a randomised trial. SETTING Eleven centres. POPULATION Women with cystocele stage ≥2 (pelvic organ prolapse quantification [POP-Q], aged 45-75 years without previous prolapse surgery. METHODS Synthetic non-absorbable mesh placed in the vesicovaginal space and sutured to the promontory (LS) or maintained by arms through pelvic ligaments and/or muscles (TVM). MAIN OUTCOME MEASURES Functional outcomes (pelvic floor distress inventory [PFDI-20] as primary outcome); anatomical assessment (POP-Q), composite outcome of success; re-interventions for complications. RESULTS A total of 220 out of 262 randomised patients have been followed at 4 years. PFDI-20 significantly improved in both groups and was better (but below the minimal clinically important difference) after LS (mean difference -7.2 points; 95% CI -14.0 to -0.05; P = 0.029). The improvement in quality of life and the success rate (LS 70%, 61-81% versus TVM 71%, 62-81%; hazard ratio 0.92, 95% CI 0.55-1.54; P = 0.75) were similar. POP-Q measurements did not differ, except for point C (LS -57 mm versus TVM -48 mm, P = 0.0093). The grade III or higher complication rate was lower after LS (2%, 0-4.7%) than after TVM (8.7%, 3.4-13.7%; hazard ratio 4.6, 95% CI 1.007-21.0, P = 0.049)). CONCLUSIONS Both techniques provided improvement and similar success rates. LS had a better benefit-harm balance with fewer re-interventions due to complications. TVM remains an option when LS is not feasible. TWEETABLE ABSTRACT At 4 years, Laparoscopic Sacropexy (LS) had a better benefit-harm balance with fewer re-interventions due to complications than Trans-Vaginal Mesh (TVM).
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Affiliation(s)
- J-P Lucot
- Service de gynécologie-obstétrique, Hôpital Saint Vincent de Paul, Groupe des Hôpitaux de l'Institut Catholique de Lille (GHICL), Lille, France
| | - M Cosson
- Service de Gynécologie médico chirurgicale Pôle Femme, mère, nouveau-né, Hôpital Jeanne de Flandre, CHRU de Lille, France
| | - S Verdun
- Biostatistics Department-Delegation for Clinical Research and Innovation, Lille Catholic Hospitals, Lille Catholic University, Lille, France
| | | | - G Bader
- Service de gynécologie-obstétrique CHI Poissy-St-Germain, Université Versailles Saint-Quentin, Poissy, France
| | | | - D Salet-Lizee
- Groupe Hospitalier Diaconesses Croix St-Simon, Paris, France
| | | | - P Ferry
- Service de Gynécologie Obstétrique, Centre Hospitalier, La Rochelle, France
| | - R De Tayrac
- Hôpital Carémeau CHU de Nîmes, Nîmes, France
| | - P Delporte
- Centre Hospitalier de Dunkerque, Dunkerque, France
| | | | - X Deffieux
- Hôpital Antoine Béclère, Clamart, France
| | - S Blanc
- Service de Gynécologie, Centre Hospitalier de la Région d'Annecy, Pringy, France
| | - P Capmas
- Service de Gynécologie Obstétrique Hôpital Bicêtre, Le Kremlin Bicêtre, France
| | - A Duhamel
- Univ Lille, CHU Lille, ULR 2694 METRICS, Lille, France
| | - X Fritel
- Université de Poitiers, INSERM CIC 1402, CHU de Poitiers, Poitiers, France
| | - A Fauconnier
- Centre Hospitalier de Dunkerque, Dunkerque, France.,Unité de recherche EA 7285, Université Versailles St-Quentin, Montigny-le-Bretonneux, France
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19
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Charles T, De Tayrac R, Campagne-Loiseau S, Cosson M, Ferry P, Deffieux X, Lucot JP, Wagner L, Debodinance P, Saussine C, Pizzoferrato AC, Carlier-Guérin C, Thubert T, Panel L, Bosset PO, Nkounkou E, Ramanah R, Boisramé T, Raiffort C, Chavériat A, Fauconnier A, Fritel X. Serious complications and recurrences after pelvic organ prolapse surgery for 2,309 women in the VIGI-MESH registry. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00763-6] [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: 11/30/2022]
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20
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Charles T, Wagner L, Campagne-Loiseau S, Ferry P, Saussine C, Cosson M, Deffieux X, Hummel M, Panel L, Lucot JP, Debodinance P, Carlier-Guérin C, Pizzoferrato AC, Vidart A, Thubert T, Ramanah R, Nkounkou E, Fauconnier A, Fritel X. Complications, revision and perceived health after surgery for stress urinary incontinence by mid urethra sling inthe VIGI-MESH register: Description and medium-term incidence for 1814 women. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00491-7] [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: 10/20/2022]
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Gauthier T, Lacorre A, Legendre G, Golfier F, Touboul C, Deffieux X, Sallee C. Should we perform subtotal hysterectomy associated with sacral colpopexy for genital prolapse to prevent the risk of endometrial cancer? Prog Urol 2021; 31:439-443. [PMID: 33867213 DOI: 10.1016/j.purol.2021.03.006] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 03/20/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE In a menopausal woman scheduled for curative surgery for pelvic organ prolapse (POP) by sacral colpopexy (SC), the question of concomitant hysterectomy is frequently considered by the surgeon. The risk of endometrial cancer (EC) exists in this population, and increases with age and body mass index. The French college of gynecologists and obstetricians (CNGOF) decided to issue good practice guidelines on subtotal hysterectomy (SH) for postmenopausal women scheduled for SC for POP. METHODS The CNGOF has decided to adopt the AGREE II and GRADE systems for grading scientific evidence. Each recommendation for practice was allocated a grade, which depends on the quality of evidence (QE) (clinical practice guidelines). RESULTS The prevalence of occult endometrial cancer (EC) found on pathological analysis after SH in this context (concomitant SH associated with SC) is low (<1%) (QE: high). Few studies have assessed the value of preoperative uterine exploration. Performing SH during SC is associated with its own risks, which may diminish the potential "carcinological prevention benefit". Uterine morcellation, performed by laparoscopy or a robot-assisted procedure, is associated with a low risk (<0.6%) of dissemination of an unknown sarcoma/EC (QE: moderate) A risk of dissemination of parasitic myomas (<0.5%) is also possible (QE: moderate). CONCLUSION It is not recommended to perform a subtotal hysterectomy associated with sacral colpopexy for the sole purpose of reducing the occurrence of endometrial cancer (Recommendation: STRONG [GRADE 1-]; the level of evidence was considered to be low and the risk-benefit balance was considered not to be favorable).
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Affiliation(s)
- T Gauthier
- Département de gynécologie et obstétrique, CHU de Limoges, INSERM, UMR-1248, 8, avenue Dominique-Larrey, 87000 Limoges, France.
| | - A Lacorre
- Département de gynécologie et obstétrique, CHU de Limoges, INSERM, UMR-1248, 8, avenue Dominique-Larrey, 87000 Limoges, France
| | - G Legendre
- Department of obstetrics and gynaecology, CHU d'Angers, 49000 Angers, France
| | - F Golfier
- Department of obstetrics and gynaecology, CHU de Lyon, 69000 Lyon, France
| | - C Touboul
- Department of obstetrics and gynaecology, AP-HP, GHU East, Tenon Hospital, 4, rue de la Chine, 75020 Paris, France
| | - X Deffieux
- Department of obstetrics and gynaecology, AP-HP, GHU South, Antoine-Béclere Hospital, 157, rue de la porte de Trivaux, 92140 Clamart, France
| | - C Sallee
- Département de gynécologie et obstétrique, CHU de Limoges, INSERM, UMR-1248, 8, avenue Dominique-Larrey, 87000 Limoges, France
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Hermieu N, Hermieu JF, Schoentgen N, Aoun R, Xylinas E, Deffieux X, Fernandez H, Cosson M, Gamé X, Peyronnet B, Ouzaid I. [Trends in the use of midurethral slings after the new legislation: A nationwide survey]. Prog Urol 2021; 31:422-429. [PMID: 33863637 DOI: 10.1016/j.purol.2021.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 03/22/2021] [Accepted: 03/24/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The French Department of Health published on October 23, 2020 a decree governing acts associated with mid-urethral sling (MUS) operations. The aim of this study was to evaluate the changes in practice following this new legislation. METHODS A cross-sectional study was carried out among French urologists and gynecologists using an online survey to collect changes in practices since the publication of the decree. RESULTS From January to February 2021, 436 surgeons participated in the survey. Among these surgeons, 87% were aware of the new legislation and 56% of them considered the decree as useless. The order resulted in an increase in working time in 81% of cases. Among these surgeons, 66% of the surgeons worked in tertiary referral centers for the management of incontinence, of which 55% had a multidisciplinary meeting in urogynecology. Among the surgeons, 31% considered this meeting to be useful but 80% considered that it did not lead to any change in surgical indications, even though 33% of complications of BSU were discussed there. In conclusion, 61% of surgeons felt more reluctant to schedule a BSU placement with this new legislation. CONCLUSION The majority of questioned surgeons considered the decree as useless. It generated few changes in practices which already respected the law on information, consultation, consent, experience and training. Most urologists and gynecologists are more reluctant to offer MUS after this new legislation. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- N Hermieu
- Service de chirurgie urologique, hôpital Bichat Claude-Bernard, AP-HP, Université de Paris, Paris, France
| | - J-F Hermieu
- Service de chirurgie urologique, hôpital Bichat Claude-Bernard, AP-HP, Université de Paris, Paris, France
| | - N Schoentgen
- Service de chirurgie urologique, hôpital Bichat Claude-Bernard, AP-HP, Université de Paris, Paris, France
| | - R Aoun
- Service de chirurgie urologique, hôpital Bichat Claude-Bernard, AP-HP, Université de Paris, Paris, France
| | - E Xylinas
- Service de chirurgie urologique, hôpital Bichat Claude-Bernard, AP-HP, Université de Paris, Paris, France
| | - X Deffieux
- Service de gynécologie obstétrique et médecine de la reproduction, hôpital Antoine-Béclère, AP-HP, Clamart, France
| | - H Fernandez
- Service de gynécologie et obstétrique, hôpital de Bicêtre, AP-HP, Le Kremlin Bicêtre, France
| | - M Cosson
- Service de gynécologie, CHU Jeanne-de-Flandre, Lille, France
| | - X Gamé
- Département d'urologie, transplantation rénale et andrologie, CHU Rangueil, Toulouse, France
| | - B Peyronnet
- Service de chirurgie urologique, CHU de Rennes, Rennes, France
| | - I Ouzaid
- Service de chirurgie urologique, hôpital Bichat Claude-Bernard, AP-HP, Université de Paris, Paris, France.
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Millet P, Gauthier T, Vieillefosse S, Dewaele P, Rivain AL, Legendre G, Golfier F, Touboul C, Deffieux X. Should we perform cervix removal during hysterectomy for benign uterine disease? Clinical practice guidelines from the French College of Gynecologists and Obstetricians (CNGOF). J Gynecol Obstet Hum Reprod 2021; 50:102134. [PMID: 33794370 DOI: 10.1016/j.jogoh.2021.102134] [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: 03/02/2021] [Accepted: 03/25/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To provide guidelines from the French College of Obstetricians and Gynecologists (CNGOF), based on the best evidence available, concerning subtotal or total hysterectomy, for benign disease. METHODS The CNGOF has decided to adopt the AGREE II and GRADE systems for grading scientific evidence. Each recommendation for practice was allocated a grade, which depends on the quality of evidence (QE) (clinical practice guidelines). RESULTS Conservation of the uterine cervix is associated with an increased risk of cervical cancer (0.05 to 0.27%) and an increased risk of reoperation for cervical bleeding (QE: high). Uterine cervix removal is associated with a moderate (about 11 min) increase in operative time when hysterectomy is performed by the open abdominal route (laparotomy), but is not associated with longer operative time when the hysterectomy is performed by laparoscopy (QE: moderate). Removal of the uterine cervix is not associated with increased prevalence of short-term follow-up complications (blood transfusion, ureteral or bladder injury) (QE: low) or of long-term follow-up complications (pelvic organ prolapse, sexual disorders, urinary incontinence (QE: moderate). CONCLUSION Removal of the uterine cervix is recommended for hysterectomy in women presenting with benign uterine disease (Recommendation: STRONG [GRADE 1-]; the level of evidence was considered to be sufficient and the risk-benefit balance was considered to be favorable).
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Affiliation(s)
- Pierre Millet
- APHP, GHU South, Antoione Béclere Hospital, Department of Obstetrics and Gynaecology, 157 rue de la porte de Trivaux, F-92140, Clamart, France
| | - Tristan Gauthier
- Département de Gynécologie et Obstétrique, CHU Limoges, 8 av Dominique Larrey, 87000 Limoges, France; INSERM, UMR-1248, CHU Limoges, 87000 Limoges, France
| | - Sarah Vieillefosse
- APHP, GHU South, Antoione Béclere Hospital, Department of Obstetrics and Gynaecology, 157 rue de la porte de Trivaux, F-92140, Clamart, France
| | - Pauline Dewaele
- APHP, GHU South, Antoione Béclere Hospital, Department of Obstetrics and Gynaecology, 157 rue de la porte de Trivaux, F-92140, Clamart, France
| | - Anne-Laure Rivain
- APHP, GHU South, Antoione Béclere Hospital, Department of Obstetrics and Gynaecology, 157 rue de la porte de Trivaux, F-92140, Clamart, France
| | - Guillaume Legendre
- CHU Angers, Department of Obstetrics and Gynaecology, F-49000, Angers, France
| | - François Golfier
- CHU Lyon, Department of Obstetrics and Gynaecology, F-69000, Lyon, France
| | - Cyril Touboul
- APHP, GHU East, Tenon Hospital, Department of Obstetrics and Gynaecology, 4 rue de la Chine, F-75020, Paris, France
| | - Xavier Deffieux
- APHP, GHU South, Antoione Béclere Hospital, Department of Obstetrics and Gynaecology, 157 rue de la porte de Trivaux, F-92140, Clamart, France; University Paris-Saclay, Faculté de Médecine, F94270, Le Kremlin-Bicêtre, France.
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Deffieux X. [TVT and concomitant intra-detrusor botox injection for women with mixed urinary incontinence: Is it a good idea?]. Prog Urol 2021; 31:184-185. [PMID: 33714425 DOI: 10.1016/j.purol.2021.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 02/11/2021] [Indexed: 10/21/2022]
Affiliation(s)
- X Deffieux
- AP-HP, hôpital Antoine-Béclère, service de gynécologie-obstétrique, Clamart, 92141, France; Université Paris-Saclay, faculté de médecine, Orsay, 91405, France.
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25
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Tsilanizara A, Karila L, Sallee C, Denys P, Fechner A, Benistan K, Cardot V, Deffieux X. Obsessive-compulsive disorder and pelvic organ prolapse. Prog Urol 2021; 31:445-446. [PMID: 33648828 DOI: 10.1016/j.purol.2021.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/08/2021] [Accepted: 02/10/2021] [Indexed: 10/22/2022]
Affiliation(s)
- A Tsilanizara
- Assistance publique-Hôpitaux de Paris, Groupe hospitalier universitaire Paris Saclay, hôpital Antoine-Béclère, Service de gynécologie obstétrique, 92140 Clamart, France; Université Paris Saclay, 94270 Le Kremlin-Bicêtre, France
| | - L Karila
- Université Paris Saclay, 94270 Le Kremlin-Bicêtre, France; Assistance publique-Hôpitaux de Paris, Groupe hospitalier universitaire Paris Saclay, hôpital Paul-Brousse, UR PSYCOMADD, 94800 Villejuif, France
| | - C Sallee
- Assistance publique-Hôpitaux de Paris, Groupe hospitalier universitaire Paris Saclay, hôpital Antoine-Béclère, Service de gynécologie obstétrique, 92140 Clamart, France; Université Paris Saclay, 94270 Le Kremlin-Bicêtre, France
| | - P Denys
- Université Paris Saclay, 94270 Le Kremlin-Bicêtre, France; Assistance publique-Hôpitaux de Paris, Groupe hospitalier universitaire Paris Saclay, hôpital R.-Poincaré, Service de neurourologie, 92380 Garches, France
| | - A Fechner
- Université Paris Saclay, 94270 Le Kremlin-Bicêtre, France; Assistance Publique-Hôpitaux de Paris, Groupe hospitalier universitaire Paris Saclay, hôpital Antoine-Béclère, Service de radiologie, 92140 Clamart, France
| | - K Benistan
- Centre de référence des syndromes d'Ehlers-Danlos non vasculaires, Assistance publique-Hôpitaux de Paris, Groupe hospitalier universitaire Paris Saclay, hôpital R.-Poincaré, 92380 Garches, France; Université Paris Saclay, UMR 1179 Inserm-Université de Versailles-Saint-Quentin, France
| | - V Cardot
- Pôle de santé du plateau-Meudon, service d'urologie, clinique de Meudon, 3, avenue de Villacoublay, 92360 Meudon-La-Forêt, France
| | - X Deffieux
- Assistance publique-Hôpitaux de Paris, Groupe hospitalier universitaire Paris Saclay, hôpital Antoine-Béclère, Service de gynécologie obstétrique, 92140 Clamart, France; Université Paris Saclay, 94270 Le Kremlin-Bicêtre, France.
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Tsilanizara A, Deffieux X. Vaginal suture/knot exposure following laparoscopic sacral colpo/cervicopexy. Acta Obstet Gynecol Scand 2021; 100:1355. [PMID: 33638161 DOI: 10.1111/aogs.14123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 02/05/2021] [Indexed: 12/13/2022]
Affiliation(s)
- Audrey Tsilanizara
- Department of Obstetrics and Gynecology, Antoine Beclere Hospital, Assistance Publique Hopitaux de Paris, Clamart; University Paris-Saclay, Clamart, France
| | - Xavier Deffieux
- Department of Obstetrics and Gynecology, Antoine Beclere Hospital, Assistance Publique Hopitaux de Paris, Clamart; University Paris-Saclay, Clamart, France
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Klap J, Campagne-Loiseau S, Berrogain N, Bosset PO, Cardot V, Charles T, Deffieux X, Donon L, Girard F, Peyrat L, Roulette P, Thuillier C, Tibi B, Vidart A, Wagner L, Hermieu JF, Cornu JN. [Vaginal LASER therapy for genito-urinary disorders: A systematic review and statement from the Committee for Female Urology and Pelviperineology of the French Association of Urology]. Prog Urol 2021; 31:634-650. [PMID: 33516611 DOI: 10.1016/j.purol.2020.11.003] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 11/08/2020] [Accepted: 11/09/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Vaginal LASER therapy is increasingly used in the field of urogynecology, but several points remain unclear. Our goal was to produce a systematic review of available evidence and provide a critical appraisal of available data. METHODS A systematic review until march 2020 was conducted using PubMed/MEDLINE, Cochrane and Embase databases. All studies about vaginal LASER use in the field of urogynecology were included. RESULTS Forty studies have been included (8 for genitourinary syndrome of menopause, 19 for stress urinary incontinence, 3 for overactive bladder, 7 for urogenital prolapse, 3 for other indications). Data were heterogeneous, and level of evidence was weak or very weak. Few studies were comparative, and only 3 were randomized). Mild improvement of symptoms and quality of life and limited satisfaction were seen for genitourinary syndrome, stress urinary incontinence, overactive bladder and prolapse. Few adverse events were reported. However, major methodological biases were noted regarding efficacy and safety evaluation. No long-term results were available. CONCLUSIONS While Vaginal LASER therapy seem to provide encouraging results, the level of evidence supporting its use was weak, especially regarding long-term outcomes. Studies of better quality are warranted before any recommendation can be made. Current use should be limited to clinical research.
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Affiliation(s)
- J Klap
- Service d'urologie, hôpital privé Claude-Galien, 91480 Quincy-sous-Senart, France
| | - S Campagne-Loiseau
- Service de gynécologie-obstétrique, CHU d'Estaing, Clermont-Ferrand, France
| | - N Berrogain
- Clinique Ambroise-Paré, 31100 Toulouse, France
| | - P O Bosset
- Service d'urologie, hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - V Cardot
- Clinique de Meudon-Clamart, 3, avenue de Villacoublay, 92360 Meudon, France
| | - T Charles
- Service d'urologie, CHU de La-Miletrie, 86000 Poitiers, France
| | - X Deffieux
- Service de gynécologie-obstétrique, hôpital Antoine-Béclère, AP-HP, 92140 Clamart, France
| | - L Donon
- Clinique de la Côte Basque, 64100 Bayonne, France
| | - F Girard
- Service d'urologie, clinique Oudinot fondation Cognac-Jay, 2, rue Rousselet, 75007 Paris, France
| | - L Peyrat
- Service d'urologie, clinique Turin, 75008 Paris, France
| | - P Roulette
- Service d'urologie, centre hospitalier de Cahors, 335, rue Wilson, 46005 Cahors cedex, France
| | - C Thuillier
- Service d'urologie, CHU de Grenoble-Alpes, 38000 Grenoble, France
| | - B Tibi
- Service d'urologie, hôpital Pasteur 2, CHU de Nice, 30, voie Romaine - CS 51069, 06001 Nice cedex 1, France
| | - A Vidart
- Service d'urologie, hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - L Wagner
- Service d'urologie, CHU de Nîmes, place du Pr-Robert-Debré, 30029 Nîmes cedex 9, France
| | - J-F Hermieu
- Service d'urologie, hôpital Bichat, AP-HP, Paris, France
| | - J-N Cornu
- Service d'urologie, hôpital Charles-Nicolle, université de Rouen, 76000 Rouen, France.
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Soued M, Vivanti AJ, Smiljkovski D, Deffieux X, Benachi A, Le Gouez A, Mercier FJ. Efficacy of Intra-Uterine Tamponade Balloon in Post-Partum Hemorrhage after Cesarean Delivery: An Impact Study. J Clin Med 2020; 10:jcm10010081. [PMID: 33379355 PMCID: PMC7795364 DOI: 10.3390/jcm10010081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/02/2020] [Revised: 12/20/2020] [Accepted: 12/23/2020] [Indexed: 11/16/2022] Open
Abstract
Invasive therapies (surgery or radiological embolization) are used to control severe post-partum hemorrhage. The intra-uterine tamponade balloon is a potential alternative, well documented after vaginal delivery. However, available data on its use after cesarean delivery remain scarce. This study assessed the efficacy of the intra-uterine tamponade balloon during post-partum hemorrhage in a cesarean delivery setting. Using a retrospective impact design, post-partum hemorrhage-related outcomes before (“pre-balloon” period) versus after implementation of intra-uterine tamponade balloon (“post-balloon” period) were compared. All women with post-partum hemorrhage requiring potent uterotonic treatment with prostaglandins after cesarean delivery over a 9-year period were eligible. The primary outcome was the rate of invasive procedure (conservative surgery, radiological embolization and/or hysterectomy). p < 0.05 was considered statistically significant. A total of 279 patients were included (140 vs. 139). Most baseline characteristics were comparable between the two studied periods. The success rate of the intra-uterine tamponade balloon was 82%, and no related complications occurred. Rates of invasive procedures and transfusion were significantly reduced (28.6% vs. 11.5%, p < 0.001 and 44.3% vs. 28.1%, p = 0.006 respectively) during the “post-balloon” period, and length of hospital stay was shorter (p < 0.001). Implementation of intra-uterine tamponade balloon during post-partum hemorrhage after cesarean delivery appears to be safe and effective, with a decrease in both invasive procedures and transfusion rates.
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Affiliation(s)
- Mickaël Soued
- Department of Anesthesia, Hôpital Antoine Béclère, APHP, Université Paris Saclay, 157 rue de la Porte de Trivaux, 92140 Clamart, France; (D.S.); (A.L.G.); (F.J.M.)
- Correspondence:
| | - Alexandre J. Vivanti
- Department of Gynecology and Obstetrics, Hôpital Antoine Béclère, APHP, Université Paris Saclay, 157 rue de la Porte de Trivaux, 92140 Clamart, France; (A.J.V.); (X.D.); (A.B.)
| | - Daniel Smiljkovski
- Department of Anesthesia, Hôpital Antoine Béclère, APHP, Université Paris Saclay, 157 rue de la Porte de Trivaux, 92140 Clamart, France; (D.S.); (A.L.G.); (F.J.M.)
| | - Xavier Deffieux
- Department of Gynecology and Obstetrics, Hôpital Antoine Béclère, APHP, Université Paris Saclay, 157 rue de la Porte de Trivaux, 92140 Clamart, France; (A.J.V.); (X.D.); (A.B.)
| | - Alexandra Benachi
- Department of Gynecology and Obstetrics, Hôpital Antoine Béclère, APHP, Université Paris Saclay, 157 rue de la Porte de Trivaux, 92140 Clamart, France; (A.J.V.); (X.D.); (A.B.)
| | - Agnès Le Gouez
- Department of Anesthesia, Hôpital Antoine Béclère, APHP, Université Paris Saclay, 157 rue de la Porte de Trivaux, 92140 Clamart, France; (D.S.); (A.L.G.); (F.J.M.)
| | - Frédéric J. Mercier
- Department of Anesthesia, Hôpital Antoine Béclère, APHP, Université Paris Saclay, 157 rue de la Porte de Trivaux, 92140 Clamart, France; (D.S.); (A.L.G.); (F.J.M.)
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Charles T, Wagner L, Campagne-Loiseau S, Ferry P, Saussine C, Cosson M, Deffieux X, Hummel M, Panel L, Lucot J, Debodinance P, Carlier C, Pizzoferrato A, Vidart A, Hubert T, Ramanah R, Nkounkou E, Fauconnier A, De Tayrac R, Fritel X. Complications, révisions et qualité de vie à moyen terme après 1814 chirurgies de l’incontinence urinaire d’effort par bandelette sous-urétrale : données du registre VIGI-MESH. Prog Urol 2020. [DOI: 10.1016/j.purol.2020.07.105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Cornu J, Berrogain N, Bosset P, Campagne-Loiseau S, Cardot V, Charles T, Deffieux X, Donon L, Girard F, Hermieu J, Klap J, Peyrat L, Meurette G, Ragni E, Roulette P, Tibi B, Thuillier C, Vidart A, Wagner L. Réunions de concertation en pelvi-périnéologie en France : une enquête nationale auprès des urologues français. Prog Urol 2020. [DOI: 10.1016/j.purol.2020.07.196] [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: 11/29/2022]
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Wagner L, Campagne-Loiseau S, De Tayrac R, Ferry P, Deffieux X, Lucot J, Fauconnier A, De Bodinance P, Saussine C, Pizzoferrato A, Carlier C, Thubert T, Panel L, Bosset P, Nkounkou E, Ramanah R, Charles T, Bressler L, Cosson M, Fritel X. Taux de complications et de récidives après chirurgie des prolapsus des organes pelviens : résultats à moyen terme d’une étude prospective chez 2341 patientes (Registre VIGI-MESH). Prog Urol 2020. [DOI: 10.1016/j.purol.2020.07.111] [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: 11/29/2022]
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Deffieux X, Cosson M. [Pelvic organ prolapse surgery: The end of an era …against the interests of some of our patients?]. Prog Urol 2020; 30:551-553. [PMID: 32646839 DOI: 10.1016/j.purol.2020.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 06/09/2020] [Indexed: 11/26/2022]
Affiliation(s)
- X Deffieux
- Service de gynécologie-obstétrique, hôpital Antoine-Béclère, université Paris-Saclay & Assistance publique-Hôpitaux de Paris (AP-HP), GHU du Sud, 157, rue de la-Porte-de-Trivaux, 92140 Clamart, France.
| | - M Cosson
- Service de gynécologie-obstétrique, faculté de médecine & CHU de Jeanne-de-Flandres, université de Lille, 59000 Lille, France; University Lille, CNRS, Centrale Lille, UMR 9013-LaMcube-laboratoire de mécanique, multiphysique, multi-échelle, 59000 Lille, France
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Charles T, Campagne-Loiseau S, Cosson M, Ferry P, Saussine C, Lucot JP, Salet-Lizee D, Barussaud ML, Boisramé T, Carlier-Guérin C, Debodinance P, Deffieux X, Pizzoferrato AC, Curinier S, Ragot S, Ringa V, De Tayrac R, Fauconnier A, Fritel X. Complications after perineal surgery (with or without implantation of material): First results of the French multicenter observatory VIGIMESH after 1873 inclusions. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33670-3] [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: 11/30/2022] Open
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Oppenheimer A, Panel P, Rouquette A, du Cheyron J, Deffieux X, Fauconnier A. Validation of the Sexual Activity Questionnaire in women with endometriosis. Hum Reprod 2020; 34:824-833. [PMID: 30989214 DOI: 10.1093/humrep/dez037] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 02/12/2019] [Accepted: 02/23/2019] [Indexed: 11/12/2022] Open
Abstract
STUDY QUESTION Is the Sexual Activity Questionnaire (SAQ) a valid tool for patients treated for symptomatic endometriosis? SUMMARY ANSWER For women having surgical treatment for endometriosis, we determined that the SAQ is a valid and responsive tool. WHAT IS KNOWN ALREADY Endometriosis adversely affects sexual quality of life. Suitable validated sexual quality of life instruments for endometriosis are lacking both in clinical practice and for research. STUDY, DESIGN, SIZE, DURATION A total of 367 women with proven endometriosis undergoing medical or surgical treatment were included in an observational study conducted between 1 January 2012 and 31 December 2014 in two French tertiary care centers. Both hospitals are reference centers for endometriosis treatment. Of these 367 women, 267 were sexually active and constituted the baseline population. PARTICPANTS/MATERIALS, SETTINGS, METHODS Women >18 years old with histological or radiological proven endometriosis, consulting for painful symptoms of at least 3 months duration, infertility, or other symptoms (bleeding, cysts) were invited to complete self-administered questionnaires before (T0) and 12 months after treatment (T1). Tests of data quality included descriptive statistics of the data, missing data levels, floor and ceiling effects, structural validity and internal consistency.The construct validity was obtained by testing presupposed relationships between previously established SAQ scores and prespecified characteristics of the patients by comparing different subgroups of patients at T0. Sensitivity to change was subsequently calculated by comparing the SAQ score between T1 and T0 overall and for different subgroups of treatment. Effect sizes (to T1) were calculated according to Cohen's method. The minimally important difference was estimated by a step-wise triangulation approach (including anchor-based method). MAIN RESULTS AND THE ROLE OF CHANCE In total, 267 sexually active patients (204 surgical and 63 medical treatment) completed the SAQ at T0 and 136 (50.9%) at T1. The SAQ score ranged from 2.0 to 28.0 (mean ± SD: 16.8 ± 5.7).The SAQ score was one-dimensional according to the scree plot with good internal consistency (Cronbach alpha = 0.78, 95% CI 0.74-0.81) and had good discriminative ability according to pain descriptors and quality of life in endometriosis. The SAQ was responsive in patients treated by surgery but the effect size was low (0.3, 95% CI (0.0-0.6), P = 0.01). The minimally important difference was determined at 2.2. LIMITATIONS, REASONS FOR CAUTION The effect size for medical treatment was non-significant. Other effect sizes were low but statistically significant. This could be explained by lower libido due to progestin intake, which was used for both surgically and medically treated patients. WIDER IMPLICATIONS OF THE FINDINGS The SAQ is easy to use, valid and effective in assessing sexual quality of life in patients with endometriosis. This patient-reported score could be used as a primary outcome for future clinical studies. The minimally important difference estimation will be useful for future research. We recommend using 2.2 for the minimally important difference of the SAQ. STUDY FUNDING/COMPETING INTEREST(S) This work was funded by the 'Direction à la Recherche Clinique et à l'Innovation' of Versailles, France and the 'Institut de Recherche en Santé de la Femme' (IRSF). The authors have no conflicts of interest to declare.
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Affiliation(s)
- A Oppenheimer
- EA 7285 Research Unit 'Risk and Safety in Clinical Medicine for Women and Perinatal Health', Versailles-Saint-Quentin University (UVSQ), Montigny-le-Bretonneux, France.,Department of Reproductive Medicine and Fertility Preservation, Hôpital universitaire Antoine Béclère, 157, rue de la Porte de Trivaux, Clamart, France
| | - P Panel
- Department of Gynecology and Obstetrics, Centre Hospitalier de Versailles, Le Chesnay, France
| | - A Rouquette
- CESP, Faculté de Médecine, Université Paris Sud, Faculté de Médecine UVSQ, INSERM, Université Paris-Saclay, Villejuif, France.,AP-HP, Bicêtre Hôpitaux Universitaires Paris Sud, Public Health and Epidemiology Department, Le Kremlin-Bicêtre, France
| | - J du Cheyron
- Department of Gynecology and Obstetrics, Centre Hospitalier Intercommunal de Poissy-Saint-Germain-en-Laye, Poissy, France
| | - X Deffieux
- EA 7285 Research Unit 'Risk and Safety in Clinical Medicine for Women and Perinatal Health', Versailles-Saint-Quentin University (UVSQ), Montigny-le-Bretonneux, France.,Department of Gynecology and Obstetrics, Hôpital universitaire Antoine-Béclère, AP-HP, Clamart, France
| | - A Fauconnier
- EA 7285 Research Unit 'Risk and Safety in Clinical Medicine for Women and Perinatal Health', Versailles-Saint-Quentin University (UVSQ), Montigny-le-Bretonneux, France.,Department of Gynecology and Obstetrics, Centre Hospitalier Intercommunal de Poissy-Saint-Germain-en-Laye, Poissy, France
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Favre-Inhofer A, Dewaele P, Millet P, Deffieux X. Systematic review of guidelines for urinary incontinence in women. J Gynecol Obstet Hum Reprod 2020; 49:101842. [PMID: 32592767 DOI: 10.1016/j.jogoh.2020.101842] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 06/16/2020] [Accepted: 06/19/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND OBJECTIVE Urinary incontinence in women is the subject of multiple recommendations all over the world. The aim of our study was to compare methodologies and search for inconsistencies in texts and grades in these guidelines. METHODS Seventeen recommendations from different medical societies in English, French and German were included. Their methodologies were analyzed, including writing methods, cyclicity, level of evidence (LE) and grades. The recommendations were synthesized and inconsistencies in texts and grades were studied. The quality of recommendations was evaluated with the Appraisal of Guidelines for Research and Evaluation (AGREE II) scale. RESULTS Methods, rigour and cyclicity varied depending on societies. LE and grades are broadly consensual for higher LE and grades and less so for lower LE and grades. The Collège National des Gynécologues et Obstétriciens Français, the Deutsche Gesellschaft für Gynäkologie und Geburtshilfe, the European Association of Urology, the International Consultation on Urological Diseases and the National Institute for Health and Care Excellence have an AGREE score ≥ 80 % (third quartile). Grading and textual inconsistencies are explained by the order of studies or the absence of high LE. CONCLUSION With the present study we closely explored comparatively the methods and semantics of recommendations for urinary incontinence in women.
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Affiliation(s)
- A Favre-Inhofer
- Service de gynécologie-obstétrique et médecine de la reproduction, Hôpital Foch, Suresnes, France; Université de Versailles Saint Quentin en Yvelines, Versailles, France.
| | - P Dewaele
- Université Paris-Saclay & Assistance Publique Hôpitaux de Paris (APHP), GHU Sud, Hôpital Antoine Béclère, Service de Gynécologie-Obstétrique, F-92140 Clamart, France
| | - P Millet
- Université Paris-Saclay & Assistance Publique Hôpitaux de Paris (APHP), GHU Sud, Hôpital Antoine Béclère, Service de Gynécologie-Obstétrique, F-92140 Clamart, France
| | - X Deffieux
- Université Paris-Saclay & Assistance Publique Hôpitaux de Paris (APHP), GHU Sud, Hôpital Antoine Béclère, Service de Gynécologie-Obstétrique, F-92140 Clamart, France
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Athiel Y, Civadier MS, Luton D, Ceccaldi PF, Bourret A, Sroussi J, Mandelbrot L, Ville Y, Nizard J, Sibony O, Darai E, Delorme P, Fernandez H, Le Begat G, Nublat M, Benachi A, Deffieux X. Impact of the outbreak of SARS-CoV-2 infection on urgent gynecological care. J Gynecol Obstet Hum Reprod 2020; 49:101841. [PMID: 32590109 PMCID: PMC7309710 DOI: 10.1016/j.jogoh.2020.101841] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 06/15/2020] [Indexed: 12/03/2022]
Affiliation(s)
- Yoann Athiel
- Department of Obstetrics and Gynaecology, Hôpital Antoine Béclère, 157 rue de la porte de Trivaux, 92140 Clamart, APHP, France
| | - Marie-Sophie Civadier
- Medical Informatics Unit, Hôpital Antoine Béclère, 157 rue de la porte de Trivaux, 92140 Clamart, APHP, France
| | - Dominique Luton
- Department of Obstetrics and Gynaecology, Hôpital Bichat - Claude Bernard, 46 rue Henri Huchard, 75018 Paris, APHP, France
| | - Pierre-François Ceccaldi
- Department of Obstetrics and Gynaecology, Hôpital Beaujon, 100 boulevard du Général Leclerc, 92110 Clichy, APHP, France
| | - Antoine Bourret
- Department of Obstetrics and Gynaecology, Hôpital Cochin Port-Royal, 123 Boulevard de Port-Royal, 74014 Paris, APHP, France
| | - Jeremy Sroussi
- Department of Obstetrics and Gynaecology, Hôpital Lariboisière, 2 rue Ambroisé Paré, 75010 Paris, APHP, France
| | - Laurent Mandelbrot
- Department of Obstetrics and Gynaecology, Hôpital Louis Mourier, 178 rue des renouillers, 92700 Colombes, APHP, France
| | - Yves Ville
- Department of Obstetrics and Gynaecology, Hôpital Necker, 149 Rue de Sèvres, 75015 Pairs, APHP, France
| | - Jacky Nizard
- Department of Obstetrics and Gynaecology, Hôpital Pitié-Salpétrière, 47-83 Boulevard de l'Hôpital, 75013 Paris, APHP, France
| | - Olivier Sibony
- Department of Obstetrics and Gynaecology, Hôpital Robert-Debré, 48 Boulevard Sérurier, 75019 Paris, APHP, France
| | - Emile Darai
- Department of Obstetrics and Gynaecology, Hôpital Tenon, 4 rue de la Chine, 75020 Paris, APHP, France
| | - Pierre Delorme
- Department of Obstetrics and Gynaecology, Hôpital Trousseau, 26 Avenue du Dr Arnold Netter, 75012 Paris, APHP, France
| | - Hervé Fernandez
- Department of Obstetrics and Gynaecology, Hôpital Bicêtre, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, APHP, France
| | | | | | - Alexandra Benachi
- Department of Obstetrics and Gynaecology, Hôpital Antoine Béclère, 157 rue de la porte de Trivaux, 92140 Clamart, APHP, France
| | - Xavier Deffieux
- Department of Obstetrics and Gynaecology, Hôpital Antoine Béclère, 157 rue de la porte de Trivaux, 92140 Clamart, APHP, France.
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Cardaillac C, Vieillefosse S, Oppenheimer A, Joueidi Y, Thubert T, Deffieux X. Diastasis of the rectus abdominis muscles in postpartum: Concordance of patient and clinician evaluations, prevalence, associated pelvic floor symptoms and quality of life. Eur J Obstet Gynecol Reprod Biol 2020; 252:228-232. [PMID: 32623254 DOI: 10.1016/j.ejogrb.2020.06.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/15/2020] [Accepted: 06/19/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The main objective was to assess the reliability of the patient's measurement of diastasis. The secondary aims were the estimation postpartum diastasis prevalence, of diastasis-associated pelvic floor symptoms and quality of life immediately after childbirth and at 3-6 months postpartum. STUDY DESIGN Using a prospective observational design, women who gave birth in a French university hospital were eligible. After a learning phase, both clinician and patient conducted a clinical evaluation of diastasis. Then, patients were asked to complete the HerQLes, the FPFQ and a general questionnaire. Three to 6 months later, patients completed the same questionnaires online and performed a clinical evaluation of diastasis at home, as learned previously. RESULTS Of 253 patients included in the study, 139 (54.9 %) completed the questionnaires at 3-6 months of follow-up. There was good correlation between clinician and patient evaluations of diastasis (kappa coefficient 0.76 [95 % CI, 0.5-0.7]). Immediately after childbirth, 210 (83 %) of the women presented diastasis including 116/210 (55 %) cases of severe diastasis and 51 (42 %) of those had persistent diastasis at 3-6 months of follow-up. Cesarean section (p = 0.05) and multiparity (p = 0.04) were factors of persistent diastasis. Severe diastasis had a significant impact on quality of life (HerQLes score) at birth (p = 0.001) and at 3-6 months (p = 0.01), but no effect on pelvic floor symptoms according the FPFQ. The occurrence and severity of diastasis did not significantly impact lumbar or pubic symphysis pain. Furthermore, the aesthetic discomfort felt by patients was significantly increased by the presence of diastasis on a numerical scale at 3-6 months (p = 0.03). CONCLUSION Good agreement between clinician and patient evaluations of postpartum diastasis indicated that the evaluation method is reliable. Persistent diastasis was associated with impaired quality of life.
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Affiliation(s)
- Claire Cardaillac
- Department of Gynecology-Obstetrics and Reproductive Medicine, Nantes University Hospital, 38 Boulevard Jean Monnet, 44000, Nantes, France; Department of Gynecology-Obstetrics, Antoine Béclère University Hospital, 157 Rue de la Porte de Trivaux, 92140, Clamart, France
| | - Sarah Vieillefosse
- Department of Gynecology-Obstetrics, Antoine Béclère University Hospital, 157 Rue de la Porte de Trivaux, 92140, Clamart, France
| | - Anne Oppenheimer
- Department of Gynecology-Obstetrics, Antoine Béclère University Hospital, 157 Rue de la Porte de Trivaux, 92140, Clamart, France
| | - Yolaine Joueidi
- Department of Gynecology-Obstetrics and Reproductive Medicine, Nantes University Hospital, 38 Boulevard Jean Monnet, 44000, Nantes, France
| | - Thibault Thubert
- Department of Gynecology-Obstetrics and Reproductive Medicine, Nantes University Hospital, 38 Boulevard Jean Monnet, 44000, Nantes, France
| | - Xavier Deffieux
- Department of Gynecology-Obstetrics, Antoine Béclère University Hospital, 157 Rue de la Porte de Trivaux, 92140, Clamart, France.
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Salhi Y, Vieillefosse S, Vandekerckhove M, Vinchant M, Deffieux X. [Predictive factors of immediate post-operative acute urinary retention or voiding dysfunction following mid-urethral sling surgery: A literature review]. Prog Urol 2020; 30:1118-1125. [PMID: 32493661 DOI: 10.1016/j.purol.2020.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/10/2020] [Accepted: 05/13/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Immediate postoperative urinary retention (UR) and voiding dysfunction (VD) are some factors limiting outpatient procedure for mid-urethral sling (MUS) surgery in women presenting with stress urinary incontinence. The objective of the current review was to report the main predictive factors associated with immediate postoperative UR/VD following MUS surgery in women. METHODS A systematic review was performed using Medline database, according to PRISMA methodology, using following keywords midurethral sling; tension-free vaginal tape; TVT; transobturator tape; TOT; predicting factor; voiding dysfunction; urinary retention; postvoid residual; postoperative residue of urine. RESULTS Thirteen studies were included. Main clinical predictive factors associated with immediate postoperative urinary retention (UR) and voiding dysfunction (VD) were: previous pelvic surgery (hysterectomy, incontinence or pelvic organ prolapse surgery) [OR: from 3.7 ((CI95%: 1.14-12.33); P=0.029)] to 8.93 [(CI95%:1.17-61.1); P=0.035)], previous UR [OR: 415 (CI95%: 20-8619); P<0.001], age over 65 y/o [OR: 3,72 (CI95%:1.40-9.9); P<0.01], and general anesthesia [OR: 4.5 (CI95%:1.1-18.9); P=0.02]. Urodynamic predictive factors were underactive bladder at cystometry [OR: from 2.52 ([CI95%: 1.03-6.13]; P=0.042) to 5.6 ([IC95%: 1.6-19.2]; P=0.02] and preoperative maximum flow rate (Qmax) (the prevalence of UR was ranging from 12 to 35% when Qmax was under 15ml/s, versus 0% when Qmax was over 30ml/s). CONCLUSION Predictive factors associated with immediate postoperative UR/VD following MUS surgery in women were age over 65 y/o, previous pelvic surgery or previous UR, underactive bladder and preoperative Qmax under 15ml/s.
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Affiliation(s)
- Y Salhi
- Université Paris-Saclay, faculté de médecine, 94270 Le Kremlin Bicêtre, France; Assistance publique Hôpitaux de Paris (AP-HP), GHU Sud, hôpital Antoine-Béclère, service de gynécologie-obstétrique, 157, rue de la porte de Trivaux, 92140 Clamart, France
| | - S Vieillefosse
- Université Paris-Saclay, faculté de médecine, 94270 Le Kremlin Bicêtre, France; Assistance publique Hôpitaux de Paris (AP-HP), GHU Sud, hôpital Antoine-Béclère, service de gynécologie-obstétrique, 157, rue de la porte de Trivaux, 92140 Clamart, France
| | - M Vandekerckhove
- Université Paris-Saclay, faculté de médecine, 94270 Le Kremlin Bicêtre, France; Assistance publique Hôpitaux de Paris (AP-HP), GHU Sud, hôpital Antoine-Béclère, service de gynécologie-obstétrique, 157, rue de la porte de Trivaux, 92140 Clamart, France
| | - M Vinchant
- Université Paris-Saclay, faculté de médecine, 94270 Le Kremlin Bicêtre, France; Assistance publique Hôpitaux de Paris (AP-HP), GHU Sud, hôpital Antoine-Béclère, service de gynécologie-obstétrique, 157, rue de la porte de Trivaux, 92140 Clamart, France
| | - X Deffieux
- Université Paris-Saclay, faculté de médecine, 94270 Le Kremlin Bicêtre, France; Assistance publique Hôpitaux de Paris (AP-HP), GHU Sud, hôpital Antoine-Béclère, service de gynécologie-obstétrique, 157, rue de la porte de Trivaux, 92140 Clamart, France.
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Lebreton C, Deffieux X, Vieillefosse S, Maitre S, Vivanti AJ. An arterio-venous malformation related to a uterine scar defect, an unusual association. J Gynecol Obstet Hum Reprod 2020; 49:101733. [PMID: 32234561 DOI: 10.1016/j.jogoh.2020.101733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 02/24/2020] [Accepted: 03/17/2020] [Indexed: 10/24/2022]
Affiliation(s)
- C Lebreton
- Service de Gynécologie-Obstétrique, CHU Antoine Béclère, Clamart, Université Paris Saclay, France
| | - X Deffieux
- Service de Gynécologie-Obstétrique, CHU Antoine Béclère, Clamart, Université Paris Saclay, France
| | - S Vieillefosse
- Service de Gynécologie-Obstétrique, CHU Antoine Béclère, Clamart, Université Paris Saclay, France
| | - S Maitre
- Service de Radiologie, CHU Antoine Béclère, Clamart, Université Paris Saclay, France
| | - A J Vivanti
- Service de Gynécologie-Obstétrique, CHU Antoine Béclère, Clamart, Université Paris Saclay, France.
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Charles T, Campagne Loiseau S, Cosson M, Ferry P, Saussine C, Lucot J, Salet-Lizee D, Barussaud M, Boisramé T, Carlier-Guérin C, Debodinance J, Deffieux X, Hummel M, Pizzoferrato A, Ragot S, Ringa V, De Tayrac R, Fauconnier A, Fritel X. Complications après chirurgie du périnée (avec ou sans implantation de matériel) : premiers résultats de l’observatoire multicentrique français VIGIMESH après 1873 inclusions. Prog Urol 2019. [DOI: 10.1016/j.purol.2019.08.155] [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: 10/25/2022]
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Fritel X, Campagne‐Loiseau S, Cosson M, Ferry P, Saussine C, Lucot J, Salet‐Lizee D, Barussaud M, Boisramé T, Carlier‐Guérin C, Charles T, Debodinance P, Deffieux X, Pizzoferrato A, Curinier S, Ragot S, Ringa V, Tayrac R, Fauconnier A. Complications after pelvic floor repair surgery (with and without mesh): short‐term incidence after 1873 inclusions in the French VIGI‐MESH registry. BJOG 2019; 127:88-97. [DOI: 10.1111/1471-0528.15956] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2019] [Indexed: 11/29/2022]
Affiliation(s)
- X Fritel
- INSERM CIC 1402 CHU de Poitiers Service de gynécologie‐obstétrique Université de Poitiers Poitiers France
- CESP Inserm U1018 Paris France
| | | | - M Cosson
- CHU de Lille Service de gynécologie‐obstétrique Université de Lille Lille France
| | - P Ferry
- CH de La Rochelle Service de gynécologie‐obstétrique La Rochelle France
| | - C Saussine
- CHU de Strasbourg Service d’urologie Université de Strasbourg Strasbourg France
| | - J‐P Lucot
- Hôpital Saint‐Vincent‐de‐Paul Service de gynécologie‐obstétrique Lille France
| | - D Salet‐Lizee
- Groupe Hospitalier Diaconesses‐Croix‐Saint‐Simon Service de gynécologie Paris France
| | - M‐L Barussaud
- CHU de Poitiers Service de chirurgie viscérale Poitiers France
| | - T Boisramé
- CHU de Strasbourg Service de gynécologie‐obstétrique Strasbourg France
| | - C Carlier‐Guérin
- CH de Châtellerault Service de gynécologie‐obstétrique Châtellerault France
| | - T Charles
- CHU de Poitiers Service d’urologie Poitiers France
| | - P Debodinance
- CH de Dunkerque Service de gynécologie‐obstétrique Dunkerque France
| | - X Deffieux
- APHP Antoine‐Béclère Service de gynécologie‐obstétrique Université Paris‐Sud Clamart France
| | | | - S Curinier
- CHU Estaing Service de gynécologie‐obstétrique Clermont‐Ferrand France
| | - S Ragot
- INSERM CIC 1402 Université de Poitiers Poitiers France
| | - V Ringa
- CESP Inserm U1018 Paris France
| | - R Tayrac
- CHU Carémeau Service de gynécologie‐obstétrique Université de Nîmes Nîmes France
| | - A Fauconnier
- CHI Poissy‐Saint‐Germain Service de gynécologie‐obstétrique UVSQ Poissy France
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Deffieux X, S V, E S, A C. Successful Management of an Extremely Large Uterine Scar Defect. Surg Case Rep 2019. [DOI: 10.31487/j.scr.2019.04.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Cesarean section is one of the most common surgical procedures in young women. Cesarean scar defects may occur postoperatively and may cause symptoms such as chronic pain, postmenstrual bleeding as well as secondary infertility.
Case presentation: We report the case of a 35-year-old woman who was referred to our center for the management of a large cesarean scar defect. She had history of two cesarean sections and presented with abnormal uterine bleeding, chronic pain and dyspareunia. Hysteroscopic examination showed the presence of a little isthmocele on the anterior uterine wall. Hysteroscopic resection with electrocoagulation was performed. The patient remained symptomatic and, unfortunately, five years later, magnetic resonance imaging (MRI) revealed a large anterior isthmocele (50x80 mm). A complete repair of the large defect was achieved by laparotomy.Postoperative MRI as well as hysteroscopic examination showed no signs of residual isthmocele.
Conclusion: There are three main surgical options for isthmocele repair: vaginal approach, hysteroscopic resection or laparoscopic resection and repair of the uterine wall. While there is no clear consensus about general management of isthmocele, there are very few cases the medical literature of large isthmoceles, such as the one we describe. This case is interesting since no case of worsening of isthmocele following hysteroscopic treatment has been described so far.
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Joueidi Y, Vieillefosse S, Cardaillac C, Mortier A, Oppenheimer A, Deffieux X, Thubert T. Impact du diastasis des muscles droits de l’abdomen sur les symptômes pelvi-périnéaux : revue de la littérature. Prog Urol 2019; 29:544-559. [DOI: 10.1016/j.purol.2019.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 05/01/2019] [Accepted: 05/02/2019] [Indexed: 10/26/2022]
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Affiliation(s)
- X Deffieux
- Service de gynécologie-obstétrique, AP-HP, GHU Paris Sud, hôpital Antoine-Béclère, 92141 Clamart, France; Faculté de médecine, université Paris-Sud (Paris Saclay), 91405 Orsay, France.
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Affiliation(s)
- X Deffieux
- Service de gynécologie-obstétrique, hôpital Antoine-Béclère, AP-HP, 157, rue de la Porte-de-Trivaux, 92141 Clamart, France; Faculté de médecine Paris-Sud, université Paris-Saclay, 94276 Le Kremlin-Bicêtre, France.
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Chattot C, Deffieux X, Lucot JP, Fritel X, Fauconnier A. Preoperative predictors and a prediction score for perception of improvement after mesh prolapse surgery. Int Urogynecol J 2019; 31:1393-1400. [PMID: 31115611 DOI: 10.1007/s00192-019-03953-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 02/07/2019] [Accepted: 04/08/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Pelvic organ prolapse (POP) surgery using a mesh has a complication rate of 26%, and an estimated 10% of those operated on do not consider it brings improvement. The objective of this study was to identify preoperative predictors of improvement after POP repair with mesh to develop a predictive score. METHODS This is a secondary analysis of the randomized multicenter trial PROSPERE, which compared morbidity after prolapse repair with mesh according to the vaginal or laparoscopic approach. Improved women [PGI-I score at 1-year follow-up = 1 (much better) or 2 (better)] were compared with unimproved women. Two hundred fifty-five women were included to derive the prediction score based on multiple logistic regression. An internal validation by bootstrapping estimated the unbiased performance of the model. RESULTS Criteria independently related to improvement were: (1) cystocele stage > II [OR: 2.93 95% CI (1.22-7.04), p = 0.015]; (2) preoperative expectation related to bulge symptom improvement [OR: 2.57 95% CI (1.07-6.04), p = 0.031] and (3) absence of chronic pelvic pain [OR: 4.55 95% CI (1.77-11.46), p = 0.001]. A score (scored from 0 to 11) was constructed from the aOR of the predictive model: the ROC-AUC of the score was 0.75, and a score ≥ 9 predicted a 97% chance of improvement (95% CI 92-99), with a specificity of 85% (95% CI 68-94). The ROC-AUC corrected for optimism by the bootstrap procedure was 0.70. CONCLUSIONS This score could be used by surgeons in preoperative counseling of women.
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Affiliation(s)
- Chloé Chattot
- EA 7285 Research Unit "Risk and Safety in Clinical Medicine for Women and Perinatal Health", Versailles-Saint-Quentin University (UVSQ), 78180, Montigny-le-Bretonneux, France.
- Department of Gynecology and Obstetrics, Intercommunal Hospital Centre of Poissy-Saint-Germain-en-Laye, 10 rue du Champ Gaillard, BP 3082, 78300, Poissy Cedex, France.
| | - Xavier Deffieux
- EA 7285 Research Unit "Risk and Safety in Clinical Medicine for Women and Perinatal Health", Versailles-Saint-Quentin University (UVSQ), 78180, Montigny-le-Bretonneux, France
- Department of Gynecology and Obstetrics and Reproductive Medicine, APHP, Hôpital Antoine Béclère, 92140, Clamart, France
| | - Jean-Philippe Lucot
- Gynecological Surgery Unit, Centre Hospitalier Universitaire Jeanne de Flandre, 59 000, Lille, France
| | - Xavier Fritel
- Department of Obstetrics and Gynecology and Reproductive Medicine, Centre Hospitalier Universitaire de Poitiers, 86021, Poitier, France
| | - Arnaud Fauconnier
- EA 7285 Research Unit "Risk and Safety in Clinical Medicine for Women and Perinatal Health", Versailles-Saint-Quentin University (UVSQ), 78180, Montigny-le-Bretonneux, France
- Department of Gynecology and Obstetrics, Intercommunal Hospital Centre of Poissy-Saint-Germain-en-Laye, 10 rue du Champ Gaillard, BP 3082, 78300, Poissy Cedex, France
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Vieillefosse S, Conté C, Deffieux X. Symptom associated with diastasis recti in the early postpartum period. Eur J Obstet Gynecol Reprod Biol 2019. [DOI: 10.1016/j.ejogrb.2018.08.450] [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: 10/27/2022]
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Billecocq S, Bo K, Dumoulin C, Aigon A, Amarenco G, Bakker E, Cornillet-Bernard M, Crétinon S, Deffieux X, Lartigues G, Loobuick M, Steenstrup B, de Tayrac R. [An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for the conservative and non-pharmacological management of female pelvic floor dysfunction]. Prog Urol 2019; 29:183-208. [PMID: 30803873 DOI: 10.1016/j.purol.2018.12.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 10/30/2018] [Accepted: 12/12/2018] [Indexed: 12/01/2022]
Abstract
INTRODUCTION There has been an increasing need for the terminology for the conservative management of female pelvic floor dysfunction to be collated in a clinically-based consensus report. METHODS This report combines the input of members and elected nominees of the Standardization and Terminology Committees of two International Organizations, the International Urogynecological Association (IUGA) and the International Continence Society (ICS), assisted at intervals by many external referees. An extensive process of nine rounds of internal and external review was developed to exhaustively examine each definition, with decision-making by collective opinion (consensus). Before opening up for comments on the webpages of ICS and IUGA, five experts from physiotherapy, neurology, urology, urogynecology and nursing were invited to comment on the paper. RESULTS A terminology report for the conservative management of female pelvic floor dysfunction, encompassing over 200 separate definitions, has been developed. It is clinically-based with the most common symptoms, signs, assessments, diagnoses and treatments defined. Clarity and user-friendliness have been key aims to make it interpretable by practitioners and trainees in all the different specialty groups involved in female pelvic floor dysfunction. Ongoing review is not only anticipated but will be required to keep the document updated and as widely acceptable as possible. CONCLUSION A consensus-based terminology report for the conservative management of female pelvic floor dysfunction has been produced aimed at being a significant aid to clinical practice and a stimulus for research.
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Affiliation(s)
- S Billecocq
- Maternité Notre-Dame-de-Bon-Secours, groupe hospitalier Paris-Saint-Joseph, 75014 Paris, France.
| | - K Bo
- Department of sports medecine, Norwegian school of sports sciences, PO Box Ulleval Stadion, 0806 Oslo, Norvège
| | - C Dumoulin
- Programme de physiothérapie, faculté de médecine, université de Montréal, Montréal, Canada
| | - A Aigon
- Cabinet kinésithérapie libéral, 44000 Nantes, France
| | - G Amarenco
- Service de neuro-urologie et exploration périnéale, hôpital Tenon, 75020 Paris, France
| | - E Bakker
- HEL de Vinci, Parnasse-ISEI, 1200 Bruxelles, Belgique
| | | | - S Crétinon
- Hôpital Foch, école de sages-femmes, 92150 Suresnes, France
| | - X Deffieux
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Antoine-Béclère, 92140 Clamart, France
| | | | - M Loobuick
- Cabinet kinésithérapie libéral, 75017 Paris, France
| | - B Steenstrup
- Service d'urologie, CHU de Rouen Charles-Nicolle, 1, rue de Germont, 76031 Rouen cedex, France
| | - R de Tayrac
- Service de gynécologie-obstétrique, CHRU Caremeau, place du Pr-R.-Debré, 30029 Nîmes cedex 9, France
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Dewaele P, Deffieux X, Villot A, Amarenco G, Billecocq S, Thubert T. Pelvic floor muscle activation in stress urinary incontinent women: Impact of a distraction task. Neurourol Urodyn 2019; 38:950-957. [PMID: 30779380 DOI: 10.1002/nau.23936] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 12/13/2018] [Accepted: 01/09/2019] [Indexed: 11/10/2022]
Abstract
AIMS Our purpose was to explore the involvement of cognition in voluntary and involuntary pelvic floor muscle (PFM) contraction in stress urinary incontinent women. METHODS PFM contraction monitored by surface electromyography (EMG) was measured without a mental distraction task (DT), and with a DT called "paced auditory serial additional test" (PASAT). Forty stress incontinent women performed voluntary contractions of the external anal sphincter (EAS), and reflex EAS contractions induced by means of coughing were studied using the external intercostal muscle (EIC) EMG pattern. RESULTS A DT altered PFM pre-activation when coughing: the reaction time between EIC muscle contraction and EAS contraction (called RT3) was respectively -54.94 ms (IQR -87.12; 3.12) without the PASAT and -3.99 ms (IQR: -47.92; 18.69) with a DT (P = 0.02, Wilcoxon's test). Concerning voluntary contraction, women activated their PFM sooner without than with a DT. CONCLUSION The PASAT altered voluntary and reflex contractions of the PFM in stress urinary incontinent women. Our study suggests that cognition plays a role in urinary pathophysiology. Future studies should investigate rehabilitation programs that consider the role of cognition in stress urinary incontinent women.
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Affiliation(s)
- Pauline Dewaele
- GRC-UPMC 01, GREEN (Group of Clinical Research in Neuro-Urology, University Pierre and Marie Curie), Paris, France.,APHP, Hopital Antoine Béclère, Service de gynécologie obstétrique et biologie de la reproduction, Clamart, France
| | - Xavier Deffieux
- GRC-UPMC 01, GREEN (Group of Clinical Research in Neuro-Urology, University Pierre and Marie Curie), Paris, France.,APHP, Hopital Antoine Béclère, Service de gynécologie obstétrique et biologie de la reproduction, Clamart, France
| | - Anne Villot
- GRC-UPMC 01, GREEN (Group of Clinical Research in Neuro-Urology, University Pierre and Marie Curie), Paris, France
| | - Gérard Amarenco
- GRC-UPMC 01, GREEN (Group of Clinical Research in Neuro-Urology, University Pierre and Marie Curie), Paris, France.,Neuro-Urology Department, Tenon Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Sylvie Billecocq
- GRC-UPMC 01, GREEN (Group of Clinical Research in Neuro-Urology, University Pierre and Marie Curie), Paris, France.,Cabinet de rééducation périnéale, Paris, France
| | - Thibault Thubert
- GRC-UPMC 01, GREEN (Group of Clinical Research in Neuro-Urology, University Pierre and Marie Curie), Paris, France.,Centre Hospitalier Universitaire de Nantes, Hôtel Dieu, Service de Gynécologie Obstétrique Nantes, Nantes, France
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50
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Biardeau X, Haddad R, Chesnel C, Charlanes A, Hentzen C, Turmel N, Campagne S, Capon G, Fatton B, Gamé X, Jeandel C, Kerdraon J, Mares P, Mezzadri M, Petit AC, Peyronnet B, Soler JM, Thuillier C, Deffieux X, Robain G, Amarenco G, Manceau P. [Use of botulinum toxin A in pelvic floor dysfunctions in the elderly: A review]. Prog Urol 2019; 29:216-225. [PMID: 30621961 DOI: 10.1016/j.purol.2018.11.001] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 11/14/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The present article is the final report of a multi-disciplinary meeting supported by the GRAPPPA (group for research applied to pelvic floor dysfunctions in the elderly). The objective was to conduct a comprehensive review on the role of botulinum toxin A (BonTA) in the treatment of pelvic floor dysfunctions in the elderly. METHODS The present article, written as a comprehensive review of the literature, combines data issued from the scientific literature with expert's opinions. Review of the literature was performed using the online bibliographic database MedLine (National Library of Medicine). Regarding intra-detrusor BonTA injections, only articles focusing on elderly patients (>65 yo) were included. Regarding other localizations, given the limited number of data, all articles reporting outcomes of BonTA were included, regardless of studies population age. In case of missing or insufficient data, expert's opinions were formulated. RESULTS Although, available data are lacking in this specific population, it appears that BonTA could be used in the non-fraily elderly patients to treat overactive bladder or even neurogenic detrusor overactivity, with a success rate comparable to younger population at 3 months (88.9% vs. 91.2%), 6 months (49.4% vs. 52.1%) and 12 months (23.1% vs. 22.3%), as well as a significant decrease in number of voids per day (11.4 vs. 5.29 P<0.001) and in the number of pads per day (4.0 vs. 1.3, P<0.01). Furthermore, BonTA is likely to be offered in the future as a treatment of fecal incontinence and obstructed defecation syndrome symptoms. Concerning bladder outlet obstruction/voiding dysfunction symptoms, intra-urethral sphincter BonTA should not be recommended. CONCLUSION BonTA injections are of interest in the management of various pelvic floor dysfunctions in the elderly, and its various applications should be better evaluated in this specific population in order to further determine its safety and efficacy.
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Affiliation(s)
- X Biardeau
- Service d'urologie et d'andrologie, hôpital Claude-Huriez, université Lille, CHU Lille, 59000 Lille, France.
| | - R Haddad
- Service de médecine physique et réadaptation, hôpital Rotschild, 75012 Paris, France
| | - C Chesnel
- GRC 01, Green-groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne universités, AP-HP, 75020 Paris, France; Service de neuro-urologie, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - A Charlanes
- GRC 01, Green-groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne universités, AP-HP, 75020 Paris, France; Service de neuro-urologie, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - C Hentzen
- GRC 01, Green-groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne universités, AP-HP, 75020 Paris, France; Service de neuro-urologie, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - N Turmel
- GRC 01, Green-groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne universités, AP-HP, 75020 Paris, France; Service de neuro-urologie, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - S Campagne
- Service de gynécologie, CHU Estaing, 63003 Clermont-Ferrand, France
| | - G Capon
- Service d'urologie, centre hospitalier Pellegrin, 33076 Bordeaux, France
| | - B Fatton
- Service de gynécologie, CHU de Nîmes, 30000 Nîmes, France
| | - X Gamé
- Service d'urologie, transplantation rénale et andrologie, CHU Rangueil, 31000 Toulouse, France
| | - C Jeandel
- Service de gériatrie, CHU de Montpellier, 34000 Montpellier, France
| | - J Kerdraon
- GRC 01, Green-groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne universités, AP-HP, 75020 Paris, France; Centre mutualiste de rééducation et réadaptation Kerpape, BP 78, 56275 Ploemeur cedex, France
| | - P Mares
- Service d'urologie, CHRU Carémeau, 30029 Nîmes cedex 9, France
| | - M Mezzadri
- Service de gynécologie, hôpital Lariboisière, AP-HP, 75010 Paris, France
| | - A-C Petit
- Centre de santé, 8, rue Neibecker, 93440 Dugny, France
| | - B Peyronnet
- Service d'urologie, CHU de Rennes, 35000 Rennes, France
| | - J-M Soler
- GRC 01, Green-groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne universités, AP-HP, 75020 Paris, France; Service de médecine physique et réadaptation, centre Bouffard-Vercelli, 66290 Cerbère, France
| | - C Thuillier
- Service d'urologie, CHU de Grenoble, 38700 La Tronche, France
| | - X Deffieux
- GRC 01, Green-groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne universités, AP-HP, 75020 Paris, France; Service de gynécologie, hôpital Antoine-Béclère, AP-HP, 92140 Clamart, France
| | - G Robain
- Service de médecine physique et réadaptation, hôpital Rotschild, 75012 Paris, France; GRC 01, Green-groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne universités, AP-HP, 75020 Paris, France
| | - G Amarenco
- GRC 01, Green-groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne universités, AP-HP, 75020 Paris, France; Service de neuro-urologie, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - P Manceau
- GRC 01, Green-groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne universités, AP-HP, 75020 Paris, France; Service de neuro-urologie, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France; Service de neurologie, hôpital Avicennes, 93000 Bobigny, France
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- Groupe de recherche appliquée à la pathologie pelvi-périnéale des personnes âgées (GRAPPPA), 75020 Paris, France
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