Long-term outcomes of primary cystocele repair by transvaginal mesh surgery versus laparoscopic mesh sacropexy: extended follow up of the PROSPERE multicentre randomised trial.

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).

Serious complications and recurrences after pelvic organ prolapse surgery for 2309 women in the VIGI-MESH registry.

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.

Postpartum psychological distress associated with anal incontinence in the EDEN mother-child cohort.

OBJECTIVE: To estimate the prevalence of flatus-only and faecal incontinence, to describe their risk factors and to analyse the association between anal incontinence and psychological distress over the first year postpartum. DESIGN: Cohort study from pregnancy to 12 months postpartum. SETTING: Two university hospital maternity wards in France. POPULATION: A total of 2002 pregnant women were recruited between 2003 and 2006. Data on anal incontinence were available for the 1632 women who comprise the sample for analysis. METHODS: Women were enrolled during pregnancy. A postal questionnaire was sent at 4 and 12 months postpartum. MAIN OUTCOME MEASURES: Anal (flatus-only and faecal) incontinence was assessed at 4 months postpartum. Mental health was assessed at 4 and 12 months postpartum by the Edinburgh Postpartum Depression Scale (EPDS) and use of antidepressant drugs as well as by self-rated mental health. RESULTS: At 4 months postpartum, the prevalence for flatus-only incontinence was 14.4% and for faecal incontinence 1.7%; multivariate analysis, restricted to women reporting no anal incontinence before the index pregnancy, showed that continuing breastfeeding at 4 months was related to a higher risk of de novo postpartum anal incontinence (OR = 2.23). Women who reported anal incontinence at 4 months were more frequently depressed (EPDS ≥10 or antidepressant use) at 12 months postpartum: 36.0% of those with faecal incontinence were depressed, 23.3% of those with flatus-only incontinence and only 14.8% of the continent women. CONCLUSION: Postnatal faecal incontinence was rare but associated with poorer maternal mental health. Postnatal screening should be encouraged, and psychological support offered. TWEETABLE ABSTRACT: Postnatal faecal incontinence was associated with depression; postnatal screening should be encouraged and psychological support offered.

Complications after pelvic floor repair surgery (with and without mesh): short-term incidence after 1873 inclusions in the French VIGI-MESH registry.

OBJECTIVE: To assess the short-term incidence of serious complications of surgery for urinary incontinence or pelvic organ prolapse. DESIGN: Prospective longitudinal cohort study using a surgical registry. SETTING: Thirteen public hospitals in France. POPULATION: A cohort of 1873 women undergoing surgery between February 2017 and August 2018. METHODS: Preliminary analysis of serious complications after a mean follow-up of 7 months (0-18 months), according to type of surgery. Surgeons reported procedures and complications, which were verified by the hospitals' information systems. MAIN OUTCOME MEASURES: Serious complication requiring discontinuation of the procedure or subsequent surgical intervention, life-threatening complication requiring resuscitation, or death. RESULTS: Fifty-two women (2.8%, 95% CI 2.1-3.6%) experienced a serious complication either during surgery, requiring the discontinuation of the procedure, or during the first months of follow-up, necessitating a subsequent reoperation. One woman also required resuscitation; no women died. Of 811 midurethral slings (MUSs), 11 were removed in part or totally (1.4%, 0.7-2.3%), as were two of 391 transvaginal meshes (0.5%, 0.1-1.6%), and four of 611 laparoscopically placed mesh implants (0.7%, 0.2-1.5%). The incidence of serious complications 6 months after the surgical procedure was estimated to be around 3.5% (2.0-5.0%) after MUS alone, 7.0% (2.8-11.3%) after MUS with prolapse surgery, 1.7% (0.0-3.8%) after vaginal native tissue repair, 2.8% (0.9-4.6%) after transvaginal mesh, and 1.0% (0.1-1.9%) after laparoscopy with mesh. CONCLUSIONS: Early serious complications are relatively rare. Monitoring must be continued and expanded to assess the long-term risk associated with mesh use and to identify its risk factors. TWEETABLE ABSTRACT: Short-term serious complications are rare after surgery for urinary incontinence or pelvic organ prolapse, even with mesh.

[Bonney maneuver and its derivatives: History, technique, significance and prognostic value]. / Manœuvre de Bonney et ses dérivés : histoire, technique, signification et valeur pronostique.

INTRODUCTION: Historically a positive Bonney maneuver indicates the need for surgical management of stress urinary incontinence. This maneuver is regularly used in French daily practice without formal proof of its predictive value. MATERIAL: A Medline search was performed with the terms "Bonney test" and "urinary incontinence" to include 10 relevant articles in this review. RESULTS: Eight articles study the mechanism of the maneuver or its derivatives, evoking a direct pressure on the urethra. Two studies are interested in the real predictivity of the maneuvers on the success of surgical treatment by urethral strip, reporting a positive predictive value of the Bonney maneuver between 96.2 and 100%. CONCLUSION: Further studies are needed to objectify the utility of this maneuver.

[Benefits of pelvic floor education in perineal re-education in women]. / Intérêt de l'éducation périnéale en rééducation périnéale chez la femme.

AIM: Evaluate the impact of pelvic floor education on the symptoms of female patients referred for pelvic floor muscle training (PFMT). METHODS: Forty female patients suffering from pelvic floor disorders and referred to independent practice for PFME between February and May 2019 answered a survey on symptoms and quality of life before PFME, after four sessions of pelvic floor education and at the end of PFME. The ICIQ-SF, USP, Contilife, PDFI 20, Kess, and Wexner scores were used to evaluate the results. The protocol consisted in four initial sessions of pelvic floor education including information on each field of perineology ; the fifth session was dedicated to visual feedback using a mirror ; the following five sessions were tailored according to the care objectives established based on the initial assessment. RESULTS: The scores were significantly improved after the four initial sessions of pelvic floor education. The improvement was significant at the end of the re-education program. The PFDI-20 score dropped from 66,9 to 20,9 (P=0,002), the ICIQ-SF score from 8,4 to 1,5 (P<10-3), the Wexner score from 7,4 to 5,1 (P<10-3) and the Kess score from 14,2 to 8,7 (P=0,05). CONCLUSION: The results showed that female patients undergoing perineal re-education including pelvic floor education sessions show a significant improvement in their symptoms already immediately after the pelvic floor education sessions.

[Antibiotic prophylaxis in urodynamics: Clinical practice guidelines using a formal consensus method]. / Antibioprophylaxie et bilan urodynamique : recommandations de bonne pratique par consensus formalisé.

OBJECTIVE: The aim of this work was to issue clinical practice guidelines on antibiotic prophylaxis in urodynamics (urodynamic studies, UDS). MATERIALS AND METHODS: Clinical practice guidelines were provided using a formal consensus method. Guidelines proposals were drew up by a multidisciplinary experts group (pilot group = steering group), then rated by a panel of 12 experts (rating group) using a formal consensus method, and then peer reviewed by a reviewing/reading group of experts (different from the rating group). RESULTS: Urine (bacterial) culture with antimicrobial susceptibility testing is recommended for all patients before UDS (strong agreement). In patients with no neurologic disease, the risk factors for tract urinary infection (UTI) after UDS are age > 70 years, recurrent UTI, and post-void residual volume > 100ml. In patients with neurologic disease, the risk factors for UTI after UDS are recurrent UTI, vesicoureteral reflux, and intermicturition pressure > 40cmH2O. If the urine culture is negative before UDS and there is no risk factor for UTI, antibiotic prophylaxis is not recommended (Strong agreement). If the urine culture is negative before UDS, but there are one or more risk factors for UTI, antibiotic prophylaxis is optional. If antibiotic prophylaxis is initiated, a single oral dose (3g) of fosfomycin-tromethamine two hours before UDS is recommended (Strong agreement). If there is bacterial colonization on UCB before UDS, antibiotic therapy is optional (Undecided). If prescribed, it should be adapted to the antimicrobial susceptibility of the identified bacterium or bacteria, started the day before and stopped after UDS (except for fosfomycin-tromethamine: a single dose the day before UDS is necessary and sufficient) (Strong agreement). In the event of UTI before UDS, the UTI should be treated and UDS postponed (Strong agreement). The proposed recommendations should not be changed for patients with a hip or knee replacement (Strong agreement). No antibiotic prophylaxis of bacterial endocarditis is necessary, including in high-risk patients with valvular heart disease (Strong agreement). CONCLUSION: These new guidelines should help to harmonize clinical practice and limit exposure to antibiotics. LEVEL OF EVIDENCE: 4.

Improving the clinical management of women with borderline tumours: a recurrence risk scoring system from a French multicentre study.

OBJECTIVE: To develop a risk scoring system (RSS) for predicting recurrence in women with borderline ovarian tumours (BOTs). DESIGN: Cohort study of women with BOTs. SETTING: French multicentre tertiary care centres. POPULATION: A cohort of 360 women with BOTs who received primary surgical treatment between January 2000 and December 2013. METHODS: Clinical and pathological factors affecting recurrence in women with BOTs. MAIN OUTCOME MEASURE: The development of a model for the prediction of recurrence in women with BOTs. RESULTS: Overall the recurrence rate was 20.0% (72/360). Recurrence was associated with five variables: age < 45 years; preoperative serum tumour marker CA125 > 150 IU/mL; a serous histological subtype; International Federation of Gynecology and Obstetrics (FIGO) stage other than IA; and ovarian surgery other than bilateral salpingo-oophorectomy (BSO; i.e. cystectomy and unilateral salpingo-oophorectomy). These variables were included in the RSS and assigned scores ranging from 0 to 6. The discrimination of the RSS was 0.82 (95% confidence interval, 95% CI 0.79-0.85). A total score of 8 points corresponded to the optimal threshold of the RSS, with a rate of recurrence of 11.8% (35/297) and 58.7% (37/63) for women at low risk (<8 points) and women at high risk (≥8 points), respectively. The diagnostic accuracy was 85.0%. CONCLUSIONS: This study shows that the risk of BOT recurrence can be accurately predicted so that women at high risk can benefit from adapted surgical treatment. TWEETABLE ABSTRACT: Our RSS permitted women with BOTs at low risk to be distinguished from women with BOTs at high risk of recurrence.

[Cultural adaptation of the female pelvic floor questionnaire (FPFQ) into French]. / Adaptation culturelle du Female Pelvic Floor Questionnaire (FPFQ) en langue française.

AIMS: The Female Pelvic Floor Questionnaire (FPFQ) is a self-administered tool on pelvic floor function. Our aim was to carry out a cultural adaptation of the FPFQ into French and to assess its psychometric properties. METHODS: After cross-cultural adaptation into French, acceptability and reliability of the questionnaire were assessed through a sample of 56 women in a test-retest. Discriminative construct validity was evaluated by comparing the results obtained by the FPFQ to those of other validated questionnaires. Longitudinal follow-up of the 282 pregnant women included in the PreNatal Pelvic floor Prevention trial (3PN) was used to analyze responsiveness. RESULTS: The proportion of missing data did not exceed 4 % for questions about bladder function, bowel function and pelvic organ prolapse; 10 % for issues related to sexual function. Question 9 was considered difficult to understand by 14 % of women. After rewriting, this issue was retested in a new sample of 52 women and presented no further problems. The intra-class correlation coefficient was greater than or equal to 0.7 for all domains during the test-retest. The FPFQ was strongly and significantly correlated (Spearman r>0.5) with the other validated questionnaires. The French version of FPFQ recorded changes in urinary and sexual symptoms for the women involved in 3PN trial with a standardized response mean equal to 0.83 and 0.44, respectively. CONCLUSION: The French version of the FPFQ is self-administered, reliable, valid, and can detect a change in symptoms during follow-up. LEVEL OF EVIDENCE: Level 4.

Trends in urinary incontinence in women between 4 and 24 months postpartum in the EDEN cohort.

OBJECTIVE: Our aim was to study risk factors associated with the prevalence, incidence and remission of urinary incontinence (UI) between 4 and 24 months postpartum. DESIGN: Longitudinal study (EDEN cohort). SETTING: Two French university hospitals. POPULATION: 1643 women completed the questionnaire at 4 months and 1409 at 24 months, including 1354 who completed it both times. METHODS: Multivariate analyses identified risk factors for UI prevalence at 24 months postpartum, persistent UI versus remission, de novo UI versus continence, de novo UI versus persistent UI, and changes in IU severity between 4 and 24 months postpartum. MAIN OUTCOME MEASURES: Postnatal UI and Sandvik UI severity score. RESULTS: UI prevalence was 20.7% (340/1643) at 4 months and 19.9% (280/1409) at 24 months. Significant factors associated with UI at 24 months were older age [OR = 1.07/year (95%CI 1.04-1.11)], BMI [2.35 (1.44-3.85) ≥30 versus <25 kg/m²], higher parity [1.77 (1.14-2.76) ≥3 versus 1], breastfeeding [1.54 (1.08-2.19) ≥3 versus < 3 months], pregnant at follow up [3.44 (2.25-5.26)], and caesarean delivery [0.62 (0.40-0.97) versus vaginal] [OR, odds ratio (CI, confidence interval)]. The likelihood of UI remission at 24 months was 51.9% (149/287). Caesarean delivery was associated with increased likelihood of UI remission [0.43 (0.19-0.97)]. The risk of de novo UI at 24 months was 12.5% (135/1067) and was associated with a new pregnancy [3.63 (2.13-6.20)]. CONCLUSIONS: Between 4 and 24 months postpartum UI, remission occurred in half of the cases. These postnatal UI changes were essentially related to mode of delivery and subsequent pregnancy. TWEETABLE ABSTRACT: Postnatal urinary incontinence progression is mostly related with mode of delivery and subsequent pregnancy.

[Sexual function after transobturator tape procedure for stress urinary incontinence and overall patients' satisfaction]. / Sexualité après cure d'incontinence urinaire par bandelette sous-urétrale transobturatrice et satisfaction des patientes.

OBJECTIVE: To evaluate the quality of sexual activity after a transobturator tape procedure for urinary incontinence and to examine the global satisfaction reported by patients. MATERIALS AND METHODS: This is a bicentric retrospective study, postoperative questionnaires were sent to 247 women operated for urinary incontinence by TOT/TVT-O surgery, after 1 year, prolaps were excluded. Patients' overall improvement was assessed using the French version of Patient Global Impression and Improvement (PGI-I), urinary symptoms were assessed with the use of ICIQ-Fluts and quality of sexual function using Lemack and Zimmern questionnaire and ICIQ-Fluts-Sex. A logistic regression analysis was run to analyse the factors associated with women overall improvement. RESULTS: One hundred and sixty-five patients answered the questionnaire (66.8%). Average age was 55 (±11), and the average postoperative period was 39 months (±17.9). After surgery, according to the PGI-I: 135 women (81.8%) found an overall improvement, 22 (13.4%) found their condition unchanged and 8 (4.8%) women found it worse. Among the 165 women, 118 were sexually active, 37 (31.4%) reported improvement in intercourse satisfaction whereas 11 (9.3%) complained about sexual function deterioration and 70 (59.3%) felt unchanged. The 37 women who reported sexual improvement described decreased coital incontinence in 54% of the cases. Eleven women who felt sexually worse, reported dyspareunia. Results of the logistic regression analysis suggested that overall improvement after surgery depended not only on the incontinence score (OR 0.83) but also on the quality of the postoperative sexual activity (OR 12.96). CONCLUSION: One third of the women reported improvement of their sexuality after transobturator tape procedure. In fact, global satisfaction after surgery was as related to the improvement of urinary symptoms as it was to the quality of the sexual activity. LEVEL OF EVIDENCE: 5.

[Changes in pelvic organ mobility and ligamentous laxity during pregnancy and postpartum. Review of literature and prospects]. / Modifications de la statique pelvienne et de la laxité ligamentaire pendant la grossesse et le post-partum. Revue de la littérature et perspectives.

INTRODUCTION: The role of pregnancy in pelvic floor disorders occurrence remains poorly known. It might exist a link between changes in ligamentous laxity and changes in pelvic organ mobility during this period. Our objective was to conduct a non-systematic review of literature about changes in pelvic organ mobility as well as in ligamentous laxity during pregnancy and postpartum. METHODS: From the PubMed, Medline, Cochrane Library and Web of Science database we have selected works which pertains clinical assessment of pelvic organ mobility (pelvic organ prolapse quantification), ultrasound assessment of levator hiatus and urethral mobility, ligamentous laxity assessment during pregnancy and postpartum. RESULTS: Clinical assessments performed in these works show an increase of pelvic organ mobility and perineal distension during pregnancy followed by a recovery phase during postpartum. Pelvic floor imaging shows an increase of levator hiatus area and urethral mobility during pregnancy then a recovery phase in postpartum. Different authors also report an increase of ligamentous laxity (upper and lower limbs) during pregnancy followed by a decrease phase in postpartum. CONCLUSION: Pelvic organ mobility, ligamentous laxity, levator hiatus and urethral mobility change in a similarly way during pregnancy (increase of mobility or distension) and postpartum (recovery). LEVEL OF EVIDENCE: 3.

[Clinical practice guidelines: Summary of recommendations for first surgical treatment of female pelvic organ prolapse by 5 French academic societies: AFU, CNGOF, SIFUD-PP, SNFCP, and SCGP]. / Recommandations pour la pratique clinique : Synthèse des recommandations pour le traitement chirurgical du prolapsus génital non récidivé de la femme par l´AFU, le CNGOF, la SIFUD-PP, la SNFCP et la SCGP.

OBJECTIVE: Providing clinical practice guidelines for first surgical treatment of female pelvic organ prolapse. METHODS: Systematic literature review, level of evidence rating, external proofreading, and grading of recommendations by 5 French academic societies: Association française d'urologie, Collège national des gynécologues et obstétriciens français, Société interdisciplinaire d'urodynamique et de pelvi-périnéologie, Société nationale française de coloproctologie, and Société de chirurgie gynécologique et pelvienne. RESULTS: It is useful to evaluate symptoms, their impact, women's expectations, and to describe the prolapse prior to surgery (Grade C). In the absence of any spontaneous or occult urinary sign, there is no reason to perform urodynamics (Grade C). When a sacrocolpopexy is indicated, laparoscopy is recommended (Grade B). A bowel preparation before vaginal (Grade B) or abdominal surgery (Grade C) is not recommended. There is no argument to systematically use a rectovaginal mesh to prevent rectocele (Grade C). The use of a vesicovaginal mesh by vaginal route should be discussed taking into account an uncertain long-term risk-benefit ratio (Grade B). Levator myorrhaphy is not recommended as a first-line rectocele treatment (Grade C). There is no indication for a vaginal mesh as a first-line rectocele treatment (Grade C). There is no reason to systematically perform a hysterectomy during prolapse repair (Grade C). It is possible to not treat stress incontinence at the time of prolapse repair, if the woman is advised of the possibility of a 2-step surgical treatment (Grade C). Clinical practice guidelines. © 2016 Published by Elsevier Masson SAS.

Incidence and remission of urinary incontinence at midlife: a cohort study.

OBJECTIVE: Urinary incontinence (UI) is often considered to be an age-related disease that develops gradually as women grow older. Much remains to be learnt about factors that promote its incidence or its remission. Our objective was to assess its incidence and risk factors. DESIGN: Longitudinal cohort study. SETTING: French GAZEL cohort. POPULATION: A cohort of 4127 middle-aged women (aged 47-52 years at baseline) over an 18-year period (1990-2008). METHODS: UI was defined as 'difficulty retaining urine'. The question was asked at baseline and repeated every 3 years over an 18-year period. Two groups (UI incidence and remission) were analysed according to status at baseline (continent or incontinent). A multivariable analysis (Cox model) was used to estimate the risk factors for UI incidence and remission. MAIN OUTCOME MEASURES: Annual incidence and remission rates and risk factors for UI incidence and remission. RESULTS: The annual incidence and remission rates for UI were 3.3% and 6.2%, respectively. High educational level (hazard ratio [HR] = 1.28; 95% confidence interval [95% CI] = 1.05-1.55), parity, i.e. at least one baby versus no baby (HR = 1.64; 95% CI = 1.19-2.27), menopause (HR = 5.44; 95% CI = 4.47-6.63), weight gain, i.e. for each kilogram change in weight (HR = 1.00; 95% CI = 1.00-1.02), onset of depressive symptoms (HR = 1.31; 95% CI = 1.09-1.57) and impairment in health-related quality of life incidence (social isolation dimension [HR = 1.29; 95% CI = 1.04-1.60] and energy dimension [HR = 1.41; 95% CI = 1.17-1.70]) were associated with an increased probability of UI. The factors associated with persistent UI were age (HR = 0.58; 95% CI = 0.55-0.61), weight gain (HR = 0.99; 95% CI = 0.98-0.99) and transition to menopausal status (HR = 1.54; 95% CI = 1.19-1.99). CONCLUSIONS: Our study suggests that, in our population of middle-aged women, age, menopause, weight gain, onset of depression and impaired health-related quality of life may promote UI.

[Pelvic floor muscle contraction and maximum urethral closure pressure]. / Contraction des muscles du plancher pelvien et pression de clôture urétrale maximale.

OBJECTIVES: The aim of this study was to precise the relationship between the pelvic floor muscle (PFM) contraction and the maximum urethral closure pressure (MUCP) at rest and during a containing effort. MATERIALS: Longitudinal study, observational, single-center retrospective performed in successively 358 women addressed for urodynamics. MUCP at rest and during a containing effort, gain of MUCP, functional urethral length (FUL), scores USP and ICQ-SF, cervico-urethral mobility (CUM) according to POP-Q classification and leak point pressure were analyzed according to the PFM contraction. RESULTS: One hundred and seventy-three had genuine stress urinary incontinence, 25 urge urinary incontinence, 148 mixed incontinence and 12 had no urinary incontinence. PFM contraction was not associated with a hysterectomy, age, parity, BMI, CUM, FUL, MUCP at rest, the severity of the incontinence assessed by ICIQ-SF score and leak point pressure. There was a proportional relationship between PFM contraction and the value of MUCP measured during this contraction (P<0.0001) on the one hand, and the gain of MUCP (P<0.0001) on the other. MUCP at rest was independent from the MUCP during the containing effort and the gain of MUCP. CONCLUSIONS: The strength of contraction of the PFM is not correlated with MUCP at rest but proportional to the augmentation of the MUCP during the containing effort.

Mobility impairment is associated with urge but not stress urinary incontinence in community-dwelling older women: results from the Ossébo study.

OBJECTIVE: To assess the association between functional limitations related to mobility and urinary incontinence (UI) in elderly women. DESIGN: An observational cross-sectional study. SETTING: Nine 'balance' workshops in France. POPULATION: A total of 1942 community-dwelling women aged 75-85 years, who were invited, based on voter registration lists, to a 'balance assessment'. METHODS: Mobility and balance test results for incontinent women were compared with those for continent women according to the severity and type of incontinence. MAIN OUTCOME MEASURES: Data on UI were collected using a self-administered questionnaire (International Consultation on Incontinence Questionnaire-Short Form). Motor-related physical abilities were assessed using standardised balance and functional gait tests. RESULTS: Forty-two per cent of women had involuntary urine leakage, with daily leaks in 57% of them; 24% had stress UI, 31% had urge UI, and 37% had mixed UI. Results for each functional test were poorer for women with UI and the limitation was more pronounced when the incontinence was severe. Multivariate logistic regression analyses showed that balance and gait impairments were significantly and independently associated with urge UI (walking speed, lower versus higher quartile, odds ratio (OR) 2.2; 95% confidence interval (95% CI) 1.4-3.5; walking balance, unable versus able to do four tandem steps (OR 1.6; 95% CI 1.2-2.2) but not with stress UI. CONCLUSIONS: In this large population of older women living at home, there was a strong association between limitation of motor and balance skills and UI, which was proportional to the severity of incontinence and related specifically to urge incontinence. These results offer new perspectives on the prevention and treatment of urge incontinence in elderly women.

Urinary incontinence in women: study of surgical practice in France.

OBJECTIVE: To assess the number and the types of surgical intervention for urinary incontinence among women in France. We are assuming that techniques by suburethral sling (SUS) have replaced Burch colposuspension. MATERIAL: Using French hospital discharge data from the 2009 medical information system program (PMSI), we analyzed with regard to three relatively homogeneous diagnosis-related groups of patients (DRG) comprising the majority of stress urinary incontinence surgical interventions (cervicocystopexy, repair of the female genital apparatus, and hysterectomy) the detailed distribution of the different operations indexed in that information system. RESULTS: More than 42,000 cervicocystopexies (42,223) were carried out in France in 2009, and a SUS was used in 92% of the procedures (n=38,929). In 58% of the cases (n=24,387) this surgery was the only one, and in the others, it was associated with static pelvic intervention in 25% of the cases (n=10,741) or with a hysterectomy in 16% (n=6671). When a cervicocystopexy was the only operation performed, the average age of the women was 56.5 years and the average stay in hospital was 12.9 days. Fifty-seven percent of the cervicocystopexies by SUS (n=24,037) were carried out in private sector. Mean durations of stay were significantly shorter in the private sector than in the public sector for the diagnosis-related groups undergoing cervicocystopexy or repair of the female genital apparatus. CONCLUSION: In 2009, 10 years after its introduction in France, the suburethral sling is used in the overwhelming majority of cervicocystopexies in France. Among an estimated 4,000,000 incontinent women in France in 2009, this surgery was undergone by approximately 1% of them each year.

Specific obstetrical risk factors for urinary versus anal incontinence 4 years after first delivery.

AIM: Delivery can be complicated by urinary or anal incontinence (UI or AI). We hypothesized that the mechanisms of injury may differ for UI and AI. Hence, obstetrical risk factors may be specific for different types of incontinence. DESIGN: Data on maternal characteristics were collected at first delivery. Data on incontinence were obtained by a questionnaire completed by 627 women 4 years after first delivery. UI was defined by "Do you have involuntary loss of urine" and AI by "Do you have involuntary loss of flatus or stool". A multinomial logistic regression analysis was conducted to assess risk factors for UI only, AI only, and UI+AI. RESULTS: Twenty-two percent of women reported UI only, 6.5% AI only, and 6.5% both. Risk factors associated with UI only were age (at first delivery)≥ 30 (OR 2.27 [95% CI 1.47-3.49]), pre-existing UI (6.44 [2.19-19.0]) and pregnancy UI (3.64 [2.25-5.91]). Risk factors associated with AI only were length of the second active stage> 20minutes (2.86 [1.15-7.13]) and third degree perineal tear (20.9 [1.73-252]). Significant predictors of UI+AI were age ≥ 30 (2.65 [1.29-5.46]), no epidural (4.29 [1.65-11.1]), third degree perineal tear (20.0 [1.28-314]), and UI before pregnancy (32.9 [9.00-120]). Cesarean delivery was not significantly associated with UI, AI, or UI+AI, although for all three outcomes, the adjusted odds ratios were substantially less than one. CONCLUSION: We found specific associations between obstetrical risk factors and urinary versus anal incontinence 4 years after first delivery. Our results are consistent with the hypothesis that the underlying mechanisms of injury differ for UI and AI.

[Levator ani trauma after childbirth, from stretch injury to avulsion: review of the literature]. / Traumatismes du levator ani après l'accouchement, de l'étirement à l'avulsion : revue de la littérature.

OBJECTIVE: Pelvic floor injuries as avulsion (disruption of the muscle) or overdistension were identified in 15 to 35% of deliveries. Our objective is to clarify the consequences of these muscles trauma on pelvic floor symptoms, pelvic organ prolapse and the management of postnatal assessment of pelvic floor function. METHOD: The literature search was conducted over a period from 2000 to January 2013 using the PubMed database and the following keywords: levator ani, ultrasound, magnetic resonance imaging, pelvic floor, obstetric trauma, pelvic organ prolapse, incontinence, delivery, avulsion. Seventy-four articles were identified, 43 were selected. The level of evidence was determined using the Oxford table. RESULTS: The instrumental extraction was found as the main risk factor with a prevalence of avulsions from 35% (NP3) to 72% (NP3) and an odd-ratio of 3.4 (NP3). Whatever the mode of assessment, the strength of the pelvic floor was reduced in 100% of cases of avulsion. Avulsions were diagnosed clinically and could be confirmed by ultrasound or MRI (correlation palpation imaging/k=0.497 (NP2) to 86% (NP3). An association was found with the risk of genital prolapse (odd-ratio from 2 [NP4] to 7 for prolapse grade 1 [NP4]) and fecal incontinence (16% [NP3] to 72% [NP4] with an odd-ratio of 14 [NP4]). CONCLUSION: This review has shown that obstetric muscle avulsions had an impact on pelvic organ prolapse and anal continence. The mode of the pelvic floor muscle postnatal assessment remains to be defined.