[Small intestinal submucosa (SIS): prospects in urogenital surgery]. / Small intestinal submucosa (SIS): perspectives en chirurgie urogénitale.

SIS (Small Intestinal Submucosa) is an extracellular matrix isolated from pig intestine. Since its discovery in 1987, many studies have defined its structure and have demonstrated its useful biointegration and tissue regeneration properties. It also appears to be a resistant substrate associated with a low risk of infection. The role of this matrix is still under investigation in many fields of surgery, but its value has been clearly established in urological and gynaecological surgery. Several experimental and clinical studies have reported interesting results in cystoplasties, repair of stress urinary incontinence by suburethral support, urethroplasties or even chordee of the penis. Applications of this material are still to be evaluated in pelvic floor disorders, particularly in prolapse surgery.

Conservative treatment of ectopic pregnancy in a cesarean scar.

BACKGROUND: Pregnancy developing in a cesarean scar is a very rare but possibly life-threatening condition because of the risk of rupture and excessive hemorrhage. CASE: A 34-year-old woman presented with lower abdominal pain at 6 weeks of gestation. A cesarean delivery had been performed 3 years earlier. Transvaginal ultrasound examination revealed a viable pregnancy developing in the anterior wall of the uterus. The patient was treated successfully with systemic methotrexate and curettage. CONCLUSION: Conservative management with methotrexate and curettage can be considered in the treatment of ectopic cesarean scar pregnancy.

[Laparoscopic sacral colpopexy: comparison of nonresorbable prosthetic tape (Mersuture) and a SIS collagen matrix (Surgisis ES)]. / Promontofixation coelioscopique: comparaison d'une bandelette prothétique non résorbable (Mersuture) et d'une matrice collagène SIS (Surgisis ES).

OBJECTIVE: Surgical repair of pelvic prolapse by sacral colpopexy classically uses nonresorbable prosthetic tape. Infectious or erosive complications can sometimes occur and are often difficult to treat. The authors propose the use of a xenogeneic biomaterial composed of an extracellular collagen matrix: SIS (Small Intestinal Submucosa). MATERIAL AND METHODS: Fifty seven laparoscopic sacral colpopexies were performed between November 2001 and December 2003: 14 using SIS tape (anterior + posterior in 13 cases, anterior only in 1 case) and 43 using Mersuture PETP nonresorbable tape (anterior + posterior in 31 cases, anterior only in 10 cases and posterior only in 2 cases). Suburethral support was associated with sacral colpopexy in 40 patients with stress urinary incontinence. RESULTS: With a mean follow-up of 15.3 months (range: 3-24 months), one case of recurrent prolapse was observed after 7 months in the SIS group. For the PETP group (mean follow-up: 14.6 months, range: 5-25 months) 3 cases of recurrent prolapse were observed at the third postoperative month. Two cases of refractory constipation were observed in the PETP group versus one in the SIS group. The mean operating time was 100 (1 tape) and 120 minutes (2 tapes) with difference according to the type of material. The mean hospital stay was 4.8 days. No infectious complication was observed in either group. CONCLUSION: These encouraging results suggest that SIS can constitute an alternative to nonresorbable tape in sacral colpopexy. It appears to be well tolerated in the medium-term. The functional characteristics of SIS, replaced within 6 months by newly formed connective tissue, suggest a lower long-term risk of infection and erosion.