[Partial uterine wall necrosis following Cho hemostatic sutures for the treatment of postpartum hemorrhage]. / Nécrose pariétale utérine partielle après capitonnage hémostatique selon la technique de Cho au cours d'une hémorragie du post-partum.

A 38-year-old woman, gravida 2, para 2, underwent caesarean section at 41 weeks' gestation and suffered postpartum hemorrhage due to uterine atony. Four Cho sutures were used to control hemorrhage. A systematic postpartum hysteroscopy showed a heterogenous whitish area of the fundus and MRI advocated placental retention. However, hysteroscopically guided biopsies confirmed the diagnosis of partial uterine necrosis. We emphasize the need to undergo postoperative follow-up to confirm uterine wall integrity after placement of compression sutures in order to document the complications of this procedure, which remain under evaluated.

[MRI of the post-traumatic penis]. / IRM de la verge: intérêt dans le bilan post-traumatique.

Penile trauma, though rare, requires specialized management. Fibrotic sequelae from lesions of the tunica albuginea and corpora cavernosa must be prevented given their impact of the erectile function. Knowledge of penile anatomy enables acquisition and interpretation of penile MRI, preferably performed in the first few hours following injury. Tear of the tunica albuginea must be identified since it requires surgical management. Other lesions may be present at the acute (hematoma) or chronic (fibrosis, arteriocavernous fistula) phases. MRI, non-invasive and painless, is the imaging modality of choice in the multiplanar evaluation of traumatic injuries of the penis.

[MRI in static and dynamic disfunction of the female floor]. / Troubles de la statique et de la dynamique pelvienne chez la femme en IRM.

MRI is taking a growing place for pelvic prolapse diagnosis. A strict technical protocol with static and dynamic sequences is required with rectal and vaginal ultrasound gel. A good knowledge of physiology and anatomy of pelvic and perineal muscles is mandatory as well as a clinical approach of various pathologic prolapses. MRI fundings are presented and correlated with several clinical situations of prolapse and post operative features.

[Imaging of female infertility]. / Imagerie de l'infertilité féminine.

Medical treatment of a couple's infertility depends upon the cause(s) of infertility. The goals of imaging are to determine these causes (male, female, mixed, unexplained), to evaluate their severity and type on the female side central, ovarian, uterine, tubal, peritoneal, endometriosis, in order to propose an adapted treatment. Imaging modalities are essentially non ionising (US and MRI). Hysterosalpingogram retains its indication to study tubal patency, it can be completed by tubal catheterisation in cases of proximal tubal obstruction.

Preoperative uterine artery embolization (PUAE) before uterine fibroid myomectomy.

PURPOSE: To evaluate the potential of uterine artery embolization to minimize blood loss and facilitate easier removal of fibroids during subsequent myomectomy. METHODS: This retrospective study included 22 patients (median age 37 years), of whom at least 15 wished to preserve their fertility. They presented with at least one fibroid (mean diameter 85.6 mm) and had undergone preoperative uterine artery embolization (PUAE) with resorbable gelatin sponge. RESULTS: No complication or technical failure of embolization was identified. Myomectomies were performed during laparoscopy (12 cases) and laparotomy (9 cases). One hysterectomy was performed. The following were noted: easier dissection of fibroids (mean 5.6 per patient, range 1-30); mean intervention time 113 min (range 25-210 min); almost bloodless surgery, with a mean peroperative blood loss of 90 ml (range 0-806 ml); mean hemoglobin pretherapeutically 12.3 g/dl (range 5.9-15.2 g/dl) and post-therapeutically 10.3 g/dl (range 5.6-13.3 g/dl), with no blood transfusion needed. Patients were discharged on day 4 on average and the mean sick leave was 1 month. CONCLUSION: Preoperative embolization is associated with minimal intraoperative blood loss. It does not increase the complication rate or impair operative dissection, and improves the chances of performing conservative surgery.