[Surgical treatment of female urinary stress incontinence]. / Traitement chirurgical de l'incontinence urinaire d'effort féminine.

Since the description of the sub urethral technique for genuine stress incontinence all the others have been abandoned. The surgical indications have not changed and are related to the poor quality of life of the patient induced by stress incontinence. A careful clinical examination and a pre operative urodynamique investigation should prevent from the failures due to a wrong indication. All the techniques are the same when it comes to the result except the mini slings which still have to be evaluated. There are two types of complications: the ones which are specific to the using of a hexogen material by vaginal way and the ones linked to the technique itself. The results are excellent, more than 80% success and last for a long period.

[Vaginal vault fixation and reinforcement of the rectovaginal septum technique for the treatment of vault prolapse associated or not with rectocele]. / Técnica de fijación de la cúpula vaginal y refuerzo del tabique recto-vaginal para el tratamiento del prolapso de cúpula asociado o no a rectocele.

The most important current concept in therapeutic management of female genital prolapse is the use of non absorbable prosthesis through a vaginal approach. The application of these surgical techniques to repair prolapse aims to restore the anatomic position of the pelvis, while preserving urinary, bowel and sexual functions. Since 2005, we use the Apogee® prosthesis for the treatment of both the vault prolapse and associated posterior colpocele. The purpose of this paper is the detailed description of the technique of placement of Apogee® prosthetic system, so that it can be useful to clarify the key points of this surgical reconstructive surgical technique and different gestures associated with the placement of this type of prosthesis.

Circumstances of leakage related to low urethral closure pressure.

PURPOSE: We determined whether urinary leakage in some circumstances is associated with intrinsic sphincter deficiency, defined by a low maximum urethral closure pressure of 30 cm H(2)O or less, in women presenting for urinary incontinence. MATERIALS AND METHODS: We retrospective analyzed the records of 100 consecutive women who underwent complete urodynamic evaluations for complaints of urinary leakage. RESULTS: Logistic regression adjusted for age showed that leakage while running or during physical exertion, leakage while walking and leakage with no obvious reason were associated with intrinsic sphincter deficiency, while leakage upon coughing or sneezing was not. CONCLUSIONS: These results suggest that different mechanisms may govern incontinence during prolonged vs brief stress. Low maximum urethral closure pressure may be a sign of abnormal sphincter fatigability.

Abdominal sacrohysteropexy in young women with uterovaginal prolapse: long-term follow-up.

OBJECTIVE: The purpose of this study was to evaluate the long-term efficiency after abdominal sacrohysteropexy in women with uterovaginal prolapse. STUDY DESIGN: We conducted a retrospective chart review at our tertiary referral urogynecology unit. Thirty women of childbearing age with uterovaginal prolapse who wanted uterine preservation underwent abdominal sacrohysteropexy between 1987 and 1999. RESULTS: The mean age of the women was 35.7 years (range, 29-43 years). All women were parous. Thirteen women had grade 2 uterovaginal prolapse, and 17 women had grade 3 prolapse. In all women, the Burch procedure and posterior colporrhaphy were performed at the same time. Intraoperative and postoperative complications occurred in 2 patients (6.6%) and 4 patients (13.3%), respectively. The mean objective and subjective follow-up periods were 44.5 months (range, 2-156 months) and 94.6 months (range, 8-160 months), respectively. At the time of the last physical examination, there were two cases of recurrent uterovaginal prolapse (6.6%), which was symptomatic in 1 patient and required repeat surgical treatment. At the time of the last questionnaire, apart from the patient who underwent repeat surgery, no patients had any uterovaginal prolapse symptoms. Three women had pregnancies that were conceived spontaneously, which led to three early legal abortions. CONCLUSION: The abdominal sacrohysteropexy is effective and safe in the treatment of uterovaginal prolapse in women of childbearing age. This procedure has a high success rate in correcting prolapse without a time-dependent decrease in efficiency.

Long-term survival with consolidation intraperitoneal chemotherapy for patients with advanced ovarian cancer with pathological complete remission.

OBJECTIVES: The goal of this study was to evaluate the long-term outcome after consolidation intraperitoneal (IP) chemotherapy in patients with a negative second-look laparotomy (SLL) following first-line intravenous chemotherapy for advanced ovarian cancer. METHODS: This study included patients with FIGO stage III-IV ovarian cancer who entered into four prospective trials (1984-1995) including intravenous chemotherapy based on cisplatin (six cycles) and anthracycline, early debulking surgery after three cycles of chemotherapy in the case of initial residual disease >2 cm, SLL, and IP consolidation chemotherapy. Among 218 patients, 68 with biopsy-negative SLL received every 4 weeks three consolidation cycles of IP chemotherapy (mitoxantrone, cisplatin, etoposide) via a totally implantable port. Long-term outcome of these patients is reported. RESULTS: Mean age was 56 years (33-72 years). Overall, 51% of the patients had at least a grade 3 or 4 toxic effect. Main toxic effects were leukopenia, abdominal pain related to the catheter, and nausea and vomiting. Only 13 patients (19%) did not receive the full three cycles. The median progression-free survival (PFS) for the whole population is 34 months, 34% of the patients being estimated to be free of disease at 5 years. The median overall survival is 73 months, and the 5-year survival is 58%. CONCLUSIONS: In this selected population treated with IP consolidation chemotherapy, prolonged survival was observed. However, the occurrence of late relapses in this most favorable patient category underlines the need to improve the consolidation therapy options in ovarian cancer.

Predictive value of urethral mobility before suburethral tape procedure for urinary stress incontinence in women.

PURPOSE: We determined whether preoperative urethral mobility predicts the outcome of the suburethral tape procedure outcome in women with urinary stress incontinence. MATERIALS AND METHODS: This retrospective study included 78 women who underwent preoperative cystourethrography while standing. Proximal urethral support was assessed by lateral cystourethrograms at rest and during straining. The 2 images were anatomically superimposed and the angle formed by the 2 proximal urethra axes determined urethral mobility. Surgical outcome was assessed by stress and pad tests. RESULTS: Median followup was 9 months (range 1 to 37) and the objective success rate was 85% (66 of 78 cases). Median rotation of the proximal urethra was 67 degrees in cases without previous surgery for incontinence, 33 degrees in those with 1 and 28 degrees in those with 2 or more procedures (p <0.0001). The success rate was 97% (29 of 30 cases) when urethral mobility exceeded 60 degrees versus 86% (18 of 21) for mobility between 30 and 60 degrees, and 70% (19 of 27) when it was less than 30 degrees (p = 0.023). The success rate was 96% (26 of 27 cases) without previous surgery for incontinence versus 84% (31 of 37) when 1 unsuccessful procedure had been performed and 64% (9 of 14) with 2 or more surgical failures (p = 0.026). Patient age at surgery, menopausal status, mixed incontinence, body mass index, parity, overactive bladder and low maximal urethral closure pressure had no significant prognostic value. CONCLUSIONS: The suburethral sling procedure takes advantage of urethral mobility to avoid leakage. The more the proximal part of the urethra moves while under stress, the better the continence achieved. Risk factors for failure are poor proximal urethral mobility and previous surgery for incontinence.