Postoperative evaluation of chronic pain in patients with Mayer - Rokitansky - Küster - Hauser (MRKH) syndrome and uterine horn remnant: Experience of a tertiary referring gynaecological department.

INTRODUCTION: Patients with Mayer - Rokitansky - Küster - Hauser (MRKH) syndrome often experience chronic pelvic pain negatively impacting their life's quality. Our understanding of the factors involved in this symptom remains poor. The aim of our study was to further investigate the different components of this pelvic pain in patients with MRKH undergoing pelvic surgery. Our second objective was to assess the evolution of this pain in patients undergoing surgical removal of their uterine horn remnant. MATERIAL AND METHODS: We conducted a retrospective analysis of a cohort of patients treated in our tertiary referring gynaecological department. Patients included had a MRKH syndrome with at least one uterine horn remnant and all underwent at least one surgical procedure in our centre. Descriptive analysis of the main characteristics and of the management of these patients was conducted. Postoperative pain was evaluated using simple words and / or analgesic consumption evaluation. RESULTS: Between 1991 and 2013, twenty-one patients were included in our centre. Out of them, 20 (95 %) had chronic pelvic pain, mostly cyclic pain lasting 2-3 days. Fourteen patients had surgical removal of their uterine horns remnant and only 3 patients (21 %) had persistent pain at their postoperative visit. Surgical findings included peritoneal endometriosis in 8 patients (38 %) and other unexpected findings in 6. At pathological analysis, secretary endometrium in the uterine horn remnant was found in 11 patients (79 %). CONCLUSION: The origin of chronic pain in MRKH is combining several factors such as endometriosis or secretary endometrium. Surgical removal of uterine horn remnant improved most of our patients' pelvic chronic pain. Further studies should help improve our understanding of this specific entity.

[Indications and surgical technique of subtotal hysterectomy for a general surgeon practicing in austere environment with limited resources]. / Indications et technique chirurgicale de l'hystérectomie subtotale pour un chirurgien généraliste en situation isolée avec des ressources limitées.

Uterine fibromyomata in Africa, which represents the most frequent benign uterine disease, is a real public health. This pathology is frequent and most of times discovered at a late stage where the volume of the uterus is responsible for invalidating symptoms that impairs patients' quality of life. Subtotal hysterectomy, which preserves the cervix, is faster than total hysterectomy and reduces intraoperative (duration of operation, blood loss) and postoperative morbidity (urinary infection, vaginal cicatrization). Subtotal hysterectomy is adapted to countries with limited resources. Its realization requires the preoperative assessment of normal cervix and a regular post-operative follow-up of the cervix left in place.

[Mid-uretral retropubic TVT sling procedure complicated by intraoperative cystotomy (bladder injury): Is it possible to avoid postoperative indwelling catheter?]. / Bandelette sous-urétrale TVT rétropubienne compliquée d'une plaie vésicale peropératoire : peut-on se passer du sondage urinaire postoperatoire ?

OBJECTIVE: Retropubic mid-uretral sling (MUS) procedure may be complicated by bladder injury (intraoperative cystotomy). There is no scientific consensus on the length of catheter drainage following bladder injury during MUS procedure: it varies from hours to days. We have made it our policy to immediately remove the catheter. The objective of the current study was to assess the results associated with immediate removal of catheter drainage following intraoperative bladder injury during retropubic MUS procedure. METHODS: Retrospective case-control study. Group 1 (cases): 8 women who have experienced bladder injury during retropubic MUS procedure and group 2 (controls): 32 women (ratio of controls to cases: 4:1). RESULTS: Mean (sd) age, BMI and MUCP were 62(13) vs. 59(10), 25(4) vs. 26(4) and 42(18) vs. 43(16), in group 1 and group 2, respectively (P=0.55, 0.56 and 0.92). Minimum follow-up duration was 12 months. None patient was lost to follow-up in group 1 (cases) and 2 patients were lost to follow-up in group 2 (controls) at 12 months follow-up. No rehospitalization or postoperative complication was noted in both groups. Immediate suprapubic postoperative pain exceeding 30/100 on VAS occurred in 1/8 (12%) and 3/32 (10%), in group 1 and group 2, respectively (P=1.00). Urinary stress incontinence cure rates were not significantly different between the two groups: 8/8 (100%) vs. 28/32 (87%), in group 1 and group 2, respectively (P=0.56). The level of satisfaction was comparable in both groups: PGI-I score was equal to 1(very satisfied) in 6/8 women (75%) and in 24/32 women (75%), in group 1 and group 2, respectively (P=1.00). De novo urgency was observed in 0/8 (0%) vs. 3/32 (10%), in group 1 and group 2, respectively (P=1.00). CONCLUSION: In the current short retrospective series, immediate removal of catheter drainage following intraoperative bladder injury during retropubic MUS procedure was not associated with an increased prevalence of complications. LEVEL OF EVIDENCE: 4.