[Pudendal nerve block: local anaesthesia for insertion of suburethral tape: preliminary study of 9 cases]. / Le bloc pudendal: une anesthésie loco-régionale pour la mise en place d'une bandelette sous-urétrale: étude préliminaire.

PURPOSE: The objective of this study is to evaluate the safety of local anaesthesia by pudendal nerve block (PNB) for insertion of TVT or TOT suburethral tape for the treatment of female urinary incontinence. MATERIAL AND METHOD: PNB is performed by bilateral injection between the anus and ischium. The pudendal nerve, detected by electrostimulation, is anaesthetised by a solution of Naropeine and Carbocaine. Anaesthesia is systematically completed by abdominogenital and genitofemoral nerve blocks and by deep infiltration in the vagina. Perioperative and postoperative pain was assessed by visual analogue scale (VAS). RESULTS: Nine patients were treated by suburethral tape under PNB between November 2002 and January 2003. The mean age was 65.5 years (range: 46 to 87 years). TVT was used in 6 cases and TOT was used in 3 cases. PNB was well tolerated by the patient in 66% of cases. Eight patients (88%) did not experience any pain during the operation. The majority of patients (88%) were very satisfied with the anaesthesia. One patient experienced residual pain for 3 weeks. The technique is easy to perform by the anaesthetist and did not modify the surgical technique. This technique is relatively inexpensive. CONCLUSION: This preliminary study on a limited number of cases shows that PNB appears to be a good alternative to the usual anaesthesia techniques for insertion of suburethral tape.

Anatomical and functional results of McCall culdoplasty in the prevention of enteroceles and vaginal vault prolapse after vaginal hysterectomy.

The objective of the study is to evaluate the anatomical and functional results of the McCall culdoplasty in the treatment of moderate hysterocele and the prevention of enterocele and vaginal vault prolapse after vaginal hysterectomy. Using a modified McCall procedure, 185 patients underwent vaginal hysterectomy for mild or moderate uterine prolapse. Pre- and post-operative assessments were carried out using the International Continence Society staging system. The 24-month follow-up showed stable 89.2% incidence of stage 0 vaginal vault prolapse (point C) and a 10% incidence of stage 1 vaginal vault prolapse that was well tolerated and did not require revision surgery. Functional analysis showed satisfactory sexual function at 24 months post-surgery for 81.2% of patients. The McCall culdoplasty did not lead to a disruption of the vaginal axis and gave excellent anatomical and functional results in maintaining support after vaginal hysterectomy, especially in sexually active patients.