[Is vaginal delivery possible for patients with myomectomy? Results of a monocentric study]. / Après myomectomie, les patientes ont-elles le droit d'accoucher par voie basse ? Résultats d'une étude monocentrique.

OBJECTIVE: To compare delivery outcomes according to the scar: myomectomy versus low-segment transverse cesarean. METHODS: A retrospective cohort study was performed in a university type 3 service between 1st January 2006 and 1st January 2012. We compared 18 women who gave birth after myomectomy (exposed group) to 72 women who gave birth after cesarean section (non-exposed group). Women younger than 43 years who underwent laparotomy or laparoscopic myomectomy were included. The primary endpoint was the rate of vaginal delivery. The route of delivery, the rate of uterine rupture, complications of delivery and neonatal outcome were studied. RESULTS: The acceptance rate of vaginal delivery was 55.6% after myomectomies versus 84.7% after cesarean section (P=0.005). The success of vaginal birth was 88.9% after myomectomy versus 73.9% after cesarean (NS). No uterine rupture has occurred after myomectomy against three sub-peritoneal rupture after cesarean. The occurrence of post-partum hemorrhage was not significantly different between the 2 groups (11.1% among exposed group versus 6.9% in the non-exposed group). The cesarean section rate was even higher than the number of hysterotomy was great (P=0.0047). CONCLUSION: This study seems to show that vaginal birth after myomectomy is possible with a success rate similar to vaginal birth after cesarean section.

[Risk of uterine synechiae following uterine compression sutures during postpartum haemorrhage]. / Risque de synéchie utérine après capitonnage utérin pour hémorragie du post-partum.

OBJECTIVES: Uterine compression sutures are highly successful conservative surgical techniques used to treat severe postpartum haemorrhage. These methods can induce subsequent uterine synechiae. To determine this risk of synechiae after conservative uterine compression sutures, which may induce further fertility problems. PATIENTS AND METHODS: We retrospectively reviewed the medical and pathological records of the patients who underwent uterine compression sutures for severe postpartum haemorrhage between January 2003 and March 2013 in a French University Hospital. The Cho's, the B-Lynch's and the Hayman's techniques have been used. The results of the hysteroscopies were detailed. RESULTS: Among the 25 patients included, the B-Lynch or the Hayman's techniques have been used in 13 cases (52%). The Cho's technique has been performed alone for 5 patients (20%) and both techniques have been practiced in 7 situations (28%). In 17 cases (68%), some vascular sutures have been associated and, for 7 patients (28%), a vascular embolisation had been performed before the uterine compressive sutures. Only 19 patients underwent a diagnostic hysteroscopy and among them 13 had a normal uterine cavity (68%), 3 of them had uterine synechiae (16%) and 3 had placental retention (16%). Synechiae and retention have all been successfully removed by operative hysteroscopy. DISCUSSION AND CONCLUSION: The compressive techniques can induce uterine synechiae, which may impair subsequent fertility.

[Surgical treatment for female stress urinary incontinence by transobturator tape (outside in). Study of 70 cases]. / Cure chirurgicale de l'incontinence urinaire d'effort de la femme par bandelette transobturatrice (de dehors en dedans). Etude de 70 cas.

OBJECTIVES: To evaluate the feasibility, the efficacy and the innocuousness of suburethral transobturator support using multifilament polypropylene transobturator tape (TOT) inside out for stress urinary incontinence in women. MATERIALS AND METHODS: The study concerns 70 patients representing our team's first experience of this technique. The inclusion criterion was persistent SUI despite perineal rehabilitation. There were no exclusion criteria. Among the 70 patients, 22 (31%) presented with associated genital prolapse. Mean parity was 2.6 (extremes ranging from 0 to 6). Thirty-five patients were menopaused (50%), of whom 12 (34%) were under hormone replacement therapy. We retained five judgement criteria to evaluate this surgical act: duration of surgery and hospitalisation, per- and postoperative complications and functional results on SUI (via a telephone questionnaire). RESULTS: The rate of positive results (healing or improvement) was 84% with a mean follow-up of 14.5 months. The rate of peroperative complications was very low: 1.4% (only one case of bladder injury). The mean duration of surgery was 23 minutes. The mean duration of hospitalisation in the case of isolated TOT was 1.25 days. CONCLUSION: The transobturator approach is a feasible, safe and efficient short-term surgical technique. Results inferior to those observed in the literature are probably due to the learning curve in a university hospital unit. None of the preoperative data (age, parity, body mass index, history of SUI treatment or hysterectomy, hormonal status, associated prolapse, mean urethral closure pressure, clinical vesical hyperactivity syndrome) appears to influence results; however, the study strength is poor due to the small study population.

[Laparoscopic management of pelvic mass in pregnancy]. / Prise en charge coelioscopique des masses latéro-utérines pendant la grossesse.

OBJECTIVES: To determine the feasibility, safety and limiting factors of laparoscopic management of pelvic mass in pregnancy. MATERIAL: and methods. During a 10-year period, 21 laparoscopic procedures were performed in patients with pelvic masses in pregnancy after exclusion of appendicitis and ectopic pregnancy. Laparoscopic surgery was done during the first trimester of pregnancy in 8 cases, the second trimester in 12 cases and the third trimester in one case. All the procedures were performed with general anesthesia and the laparoscopic cystectomies were performed with the intraperitoneal technique. RESULTS: The indications were: persistent or sonographically abnormal ovarian cyst (12 cases), torsion of ovarian cyst (5 cases), and symptomatic pelvic mass (4 cases: 2 painful cysts and 2 infarction of fibroma). One borderline tumor were discovered. The laparoscopic procedure could not be performed in two cases due to difficulty of access to the lesion. No patient encountered complications during the intra- and post-operative periods. The mean hospital stay was 4.5 days. The outcome of the pregnancy was normal in all cases. CONCLUSION: Laparoscopic management of pelvic masses in pregnancy by an experienced team, is a safe and effective procedure.