[Functional symptoms and associations of women with genital prolapse]. / Prévalence des troubles fonctionnels et associations anatomo-fonctionnelles chez les femmes présentant un prolapsus génital.

OBJECTIVE: To assess functional symptoms related to genital prolapse and to test anatomo-functional associations. PATIENTS AND METHODS: Observational study, performed between January 2005 and June 2012, on all patients operated for prolapse in a French tertiary referral centre. Data were collected from standardized patients' notes, including baseline characteristics, complete interview on urinary and colo-rectal functional symptoms, MHU score, and POP-Q (Pelvic Organ Prolapse Quantification) clinical evaluation. RESULTS: Three hundred and seventy-four patients, with a mean age of 65.1 years old, mean parity of 2.5, and mean BMI of 25.4, were included. These patients were post-menopausal in 92.5% of cases. Urinary symptoms were: SUI in 30.5%, urgencies in 44.4%, and voiding difficulties in 38.8%. Colo-rectal symptoms, such as defecatory dysfunction and anal incontinence, occurred in 25.1% and 18.5%, respectively. On clinical examination, anterior vaginal wall prolapses were the most common (74.1%). Patients with stage 3-4 cystocele suffered significantly more frequently of nocturia (P=0.04), voiding difficulties (P=0.04), and occult stress urinary incontinence (P<0.001). Patients with stage 3-4 rectocele suffered significantly more frequently of defecatory dysfunction (P=0.005) and performed more often maneuver for defecation (P<0.001). CONCLUSION: Urinary and colo-rectal symptoms are commonly associated with genital prolapse. Anatomo-functional associations were shown regarding different prolapse types and stages. LEVEL OF PROOF: 4.

[Should we perform intra-operative endometrial biopsy during pelvic reconstructive surgery with uterine preservation?]. / Doit-on faire une biopsie d'endomètre peropératoire dans les cures de prolapsus avec conservation utérine?

OBJECTIVE: To evaluate the interest of systematic endometrial biopsy at the time of vaginal reconstructive surgery with uterine preservation. METHODS: We performed a retrospective monocentric study on all women who had vaginal reconstructive surgery with uterine preservation from 2005 to 2012. All following parameters have been studied: baseline characteristics (age, parity, BMI, hormonal status, medical history), prolapse stage using the POP-Q, preoperative pelvic ultrasound (endometrial thickness), and type of surgery. Women with previous hysterectomy were excluded. RESULTS: Four hundred and fourteen patients were operated during this period, and 268 have uterine preservation (64.7%). Baseline characteristics were mean age 64.7±10.7 (39 to 92), mean parity 2.6±1.5, mean BMI 25.5±4.2, menopause 238 (88.8%), HRT 32 (12%), previous breast cancer 16 (6%), diabetes mellitus 31 (11.6%), and hypertension 87 (32.5%). Prolapse were at stage II in 127 (47.3%), stage III in 99 (36.9%) and stage IV in 17 (6.3%). Preoperative pelvic ultrasound has been done in 255 patients (95.2%), and mean endometrial thickness was 5.1mm (range 1.6-16). Overall, 152 intra-operative endometrial biopsies were assessable (56.7%). In 24 cases (15.8%), samples were too small to be interpretable. Finally, the 128 interpretable biopsies (82.2%) have shown one carcinoma (0.8%), four hyperplasia (3.2%), two endometrial polyps (1.6%), and 121 normal endometria (94.5%). The only cancer was discovered on a 77 year old patient, with a history of previous breast cancer, and with a preoperative endometrial thickness of 7 mm. No patient with normal preoperative ultrasound endometrial screening had abnormal endometrial biopsy. CONCLUSION: Vaginal reconstructive surgery with uterine preservation implicates a preoperative endometrial evaluation by ultrasound. Intra-operative endometrial biopsy does not seem to be justified.

Can the PFDI (Pelvic Floor Distress Inventory) or PFIQ (Pelvic Floor Impact Questionnaires) be used to predict outcome in pelvic reconstructive surgery?

OBJECTIVE: To determine a syndrome score threshold on PFDI or PFIQ predictive of a significant improvement in post-operative functional results. DESIGN: A retrospective case review (Canadian Task Force Classification II-2). SETTING: University and research hospital. POPULATION: Women diagnosed with pelvic organ prolapse and repaired with synthetic vaginal mesh. METHODS: Quality of life was arbitrarily considered to have improved significantly if the score decreases by more than 50% between pre-operatively and 36 months post-operatively. We investigated the pre-operative cut-off score predictive of no quality of life improvement at M36 from a prospective trial for surgical pelvic organ prolapse treatment. RESULTS: The most accurate pre-operative cut-off score predicting a failure to improve quality of life at 36 months post-operatively was 62/300 (PFDI Score). This cut-off value had a positive predictive value of 83.6% and specificity of 62.1%. No significant threshold was obtained from the PFIQ score. CONCLUSION: The intensity of symptoms before surgery may interfere as a predictive factor for outcome.

[Appendicitis and pregnancy: 21 cases]. / Appendicite aiguë et grossesse. A propos de 21 cas.

OBJECTIVE: Describe the epidemiological, diagnostic and therapeutic features of acute appendicitis in pregnant women. MATERIAL AND METHODS: Retrospective analysis of a series of 21 cases of appendicitis in pregnant women who underwent surgery between January 1997 and June 2001. RESULTS: The association of acute appendicitis with pregnancy was noted in 0.2% of the pregnant women. Ten patients were in the first trimester of pregnancy, ten in the second and one in the third. Abdominal pain was noted in all patients. The localization varied with gestational age. Abdominal ultrasound contributed to the diagnosis in twenty patients who underwent the examination. Diagnoses retained were: acute uncomplicated appendicitis (n=18), acute appendicitis with focal induration (n=1) and acute diffuse peritonitis (n=2). Appendectomy was performed in all cases. Intensive care, peritoneal cleaning and drainage were associated in cases with appendicitis. In cases with focal induration, medical treatment was followed by appendectomy performed after delivery. Tocolysis was instituted in all cases. Twelve pregnancies continued to delivery: one fetal death, one premature delivery and ten term deliveries of live infants. CONCLUSION: Pregnancy makes it difficult to confirm the diagnosis of appendicitis. Appendectomy should be performed in patients presenting a highly suggestive clinical and ultrasonographic picture, preferably by laparoscopy in order to avoid more severe complications which could be life-threatening for the mother or infant.