[Impact of hysterectomy on urinary incontinence: A systematic review]. / Impact de l'hystérectomie sur l'incontinence urinaire : revue de la littérature.

INTRODUCTION: The impact of a hysterectomy on urinary incontinence is a controversial subject in the literature. OBJECTIVE: To evaluate the prevalence and incidence of urinary incontinence after a hysterectomy as well as associated risk factors such as the type of hysterectomy, the surgical approach, urodynamic criteria and uterine disease. STUDY DESIGN: We conducted a systematic review in Pubmed database with the following keywords and MeSH term: hysterectomy, urinary incontinence. RESULTS: A total of 1340 articles were retrieved, 42 articles were selected for the final text analysis. The results of the different studies were heterogeneous. Hysterectomy seemed to increase the rate of sphincter deficiency (VLPP<60mmH2O for 20% of cases versus 1,7% without hysterectomy, P=0.003). The vaginal route could increase the incidence of UI with OR of 2.3 (95%CI 1.0-5.2). Subtotal hysterectomy appears to increase UI with a 0,74 RR for total hysterectomy (95%CI 0.58-0.94). A radical hysterectomy with nerve conservation would preserve urinary functions, unlike pelvic radiotherapy, which is responsible for irreversible nerve damage by demyelination and bladder fibrosis.

[Magnetic Resonance Imaging for local preoperative staging in endometrial cancer: Nantes local experience]. / Performances de l'IRM dans le bilan d'extension locale préopératoire des cancers de l'endomètre : l'expérience nantaise.

OBJECTIVES: To determine the diagnostic accuracy of magnetic resonance imaging (MRI) for local preoperative staging in endometrial cancer in our center (Centre Hospitalier Universitaire de Nantes: CHU), since the French National Cancer Institute's surgery recommendations publication in 2010, especially for the prediction of myometrial and cervical stromal invasion. METHODS: Retrospective monocentric study of consecutive women operated of endometrial cancer in gynecology department of CHU de Nantes, who underwent preoperative pelvic MRI in our Radiology department from November 2010 to November 2016. MRI data collected from initial report and compared to surgical histological findings as gold standard. RESULTS: Sixty-four patients were included. Deep myometrial invasion was present in 35 patients in MRI versus 34 patients on postoperative histology (5 false positives, 4 false negatives). Cervical stromal invasion was present in 9 patients in MRI versus 19 patients on postoperative histology (2 false positives, 12 false negatives). The sensitivity and the specificity were respectively 88.23% (95% confidence intervals (CI) [0.71-0.96]) and 83.33% (CI [0.64-0.93]) for the deep myometrial invasion; 36.84% (CI [0.17-0.61]) and 95.55% (CI [0.83-0.99]) for the cervical stromal invasion. CONCLUSION: Our results were comparable to the literature data, with a low sensitivity for the cervical stromal invasion detection, driving us to change our MRI protocol with optional high-resolution T2 sequences perpendicular to the cervical canal if necessary.

[Uterine preservation or not during prolapse surgery: Review of the literature]. / Préserver ou non l'utérus en cas de chirurgie du prolapsus : revue de la littérature.

OBJECTIVE: To evaluate the impact of hysterectomy in case of genital prolapse on the anatomical and functional results, and on per and post operative complications compared with uterine preservation. MATERIAL AND METHODS: We conducted a review of the Pubmed, Medline, Embase and Cochrane literature using the following terms and MeSH (Medical Subject Headings of the National Library of Medicine): uterine prolapse; genital prolapse; prolapse surgery; vaginal prolapse surgery; abdominal prolapse surgery; hysterectomy; hysteropexy; sacrocolpopexy; surgical meshes; complications; sexuality; neoplasia; urinary; incontinence; cancer. RESULTS: Among the 168 abstracts studied, 63 publications were retained. Whatever performance of hysterectomy or not, anatomical and functional results were similar in abdominal surgery (sacrocolpopexy) (OR=2.21 [95% CI: 0.33-14.67]) or vaginal surgery (OR=1.07 [95% CI: 0.38-2.99]). There was no difference in terms of urinary symptoms or sexuality after surgery. Hysterectomy was associated to a higher morbidity (bleeding, prolonged operating time, longer hospital stay), to an increased risk of mesh exposure particularly in case of total hysterectomy (8.6%; 95% CI: 6.3-11). CONCLUSION: In the absence of evidence of superiority in terms of anatomical and functional outcomes, with an increased rate of complications, concomitant hysterectomy with prolapse surgery should probably not be performed routinely.

[Study of the sexuality of women after a total hysterectomy versus subtotal hysterectomy by laparoscopy in Nantes CHU]. / Étude de la sexualité des femmes après hystérectomie totale versus subtotale par voie cœlioscopique au CHU de Nantes.

OBJECTIVE: To research the differences in the sexuality and sexual satisfaction for 2 groups of women after a hysterectomy only by laparoscopy for benign pathologies, with or without conservation of the cervix. METHODS: Retrospective monocentric study, in Nantes CHU, of 46 women divided into two groups. Three validated questionnaires were used (PISQ-12, DSFI, ultra-short Questionnaire of depression). RESULTS: There is no difference in the scores between the 2 tests in sexuality post-surgically between the 2 groups. But there exists a significant improvement in the postoperative sexuality according to the questionnaire PISQ-12 in the hysterectomy subtotal group, which is not found in the hysterectomy total group. The score of the questions about the orgasm also seems to improve in the hysterectomy subtotal group with some features statistically significant. CONCLUSION: This study confirms the improvement of the sexual function after hysterectomy. In spite of the absence of proof of interest in the conservation of the cervix in the literature, our study seems to show an improvement on certain criteria in the evaluation of sexuality in the hysterectomy subtotal group, in particular on the orgasm. A proposal for a future study with a more detailed questionnaire on the orgasm would allow to better specify the role of the cervix.

[Evolution of waiting time and length of stay between 2005 and 2012 in an obstetric and gynaecologic emergency unit in a French teaching hospital]. / Analyse de l'évolution des temps d'attente et durées de passage aux urgences gynécologiques et obstétricales du CHU de Nantes entre 2005 et 2012.

OBJECTIVES: To compare and analyze waiting time and length of stay between 2005 and 2012 in the obstetric and gynaecologic emergency unit of Nantes teaching hospital, new unit opened in 2004. METHODS: Descriptive study from the registers over 2months' periods in 2005 and 2012. RESULTS: Despite an increase of the daily average number of visits from 28 to 39 (P<0.0001), the waiting time increased in obstetrics from 15minutes to 18 in 2012, P<0.03. In gynaecology, waiting time decreased in 2012 on daytime weekdays (37minutes versus 44) and increased on weekend (41minutes versus 28) and at night (37minutes versus 23) P<0.01. The length of stay was similar in obstetrics (108minutes versus 104) but reduced on daytime weekdays (124minutes in 2005, 109 in 2012, P<0.05). In gynaecology duration was similar (108minutes versus 105), but decreased on daytime weekdays (110minutes in 2005, 101 in 2012) and increased on overnight weekend (94minutes in 2005, 121 in 2012) (P<0.05). CONCLUSION: Our organization enabled to improve some lengths of time despite an increased activity. Those lengths of time should be monitored as they reflect our organizations and are indicators of efficiency.