Asunto(s)
Fertilidad , Ginecología , Obstetricia , Publicaciones Periódicas como Asunto/tendencias , Francia , LenguajeAsunto(s)
Cesárea/efectos adversos , Cicatriz/cirugía , Infertilidad Femenina/terapia , Útero/patología , Útero/cirugía , Femenino , Humanos , EmbarazoRESUMEN
OBJECTIVE: To study the effect of the surgical repair (isthmorraphy) of the large scar dehiscence after cesarean on symptoms and fertility for women who desire pregnancy. PATIENTS AND METHODS: In this retrospective study, 14 symptomatic patients, who desire a new pregnancy underwent a surgical repair by laparotomy, laparoscopic or vaginal technique. Five women experienced failure of Assistance Reproductive Technique (IVF or ICSI) for idiopathic secondary infertility. The dehiscent scars were evaluated by ultrasound, hysterography, hysteroscopy and magnetic resonance imaging. OUTCOME: Symptoms improvement was found in 92% of case. Ten pregnancy (71%) was obtained after surgical repair, 6 spontaneous and 4 after Assistance Reproductive Technique. Among the 5 women initially followed in the reproductive unit, 4 became pregnant, 3 after IVF or ICSI and 1 spontaneous. No operative complication occurred. The subsequent pregnancy was unremarkable with no uterine rupture. DISCUSSION: Large scar defect after cesarean can take shape of a complete absent of the anterior wall of the uterus. No incident has been proved in this condition. There is a lack of data concerning these isthmocele. The experience of hysteroscopic repair cannot be applied to these real large diverticule of the scar cesarean. The results of this study suggest a link between the isthmocele and reversible symptoms after surgery. The first results concerning the subsequent fertility after surgical repair seem interesting CONCLUSION: When a large scare defect (isthmocele) is found in symptomatic woman (pelvic pain, bleeding uterine, infertility), a surgical repair can be proposed, especially for woman who desire a new pregnancy.
Asunto(s)
Cesárea/efectos adversos , Cicatriz/cirugía , Infertilidad Femenina/terapia , Útero/patología , Útero/cirugía , Adulto , Cicatriz/diagnóstico , Femenino , Humanos , Dolor Pélvico , Embarazo , Estudios Retrospectivos , Hemorragia UterinaRESUMEN
OBJECTIVES: Compare the accuracy of transvaginal ultrasonography (TVUS), rectal endoscopic sonography (RES), and magnetic resonance imaging (MRI) before deeply infiltrating endometriosis surgery. PATIENTS AND METHODS: A retrospective study with 25 deeply endometriosis patients underwent the three imaging examinations before surgery. Calculation of sensitivity, specificity, positive predictive value, negative predictive value and accuracy for the different locations: ovaries, uterosacral ligaments and torus, rectovaginal septum, rectosigmoid junction, bladder. RESULTS: Ovarian and deep pelvic endometriosis was found in surgery and confirmed by histology in all patients. Sensitivity and specificity are respectively: for ovaries: 88.2% and 71% of TVUS; 80% and 81.2% of RES; 87.5% and 71% of MRI. For uterosacral ligaments: 63% and 82,6% of TVUS; 37% and 100% of RES; 69% and 82.6% of MRI. For torus: 57.1% and 100% of TVUS; 76.2% and 100% of RES; 76.2% and 100% of MRI. For rectovaginal septum: 63.2% and 100% for TVUS; 89.5% and 66.7% of EER; 47.4% and 100% of MRI. For rectosigmoid junction: 73.7% and 66.7% of TVUS; 94.7% and 66.7% of RES; 89.5% and 50% of MRI. For bladder: 16.7% and 100% of TVUS; 16.7% and 100% of RES; 33.3% and 89.5% of MRI. DISCUSSION AND CONCLUSION: We found that TVUS is the more performant for endometriomas, it is MRI for torus, uterosacral ligaments and little bladder lesions, RES for rectovaginal septum and rectosigmoid junction. So in the clinical practice, the three imaging examinations are complementary for the preoperative assessment of deeply endometriosis.
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Endometriosis/patología , Endometriosis/cirugía , Adulto , Endoscopía , Femenino , Humanos , Imagen por Resonancia Magnética , Persona de Mediana Edad , Ovario/patología , Pelvis/patología , Periodo Preoperatorio , Recto/patología , Estudios Retrospectivos , Sensibilidad y Especificidad , Ultrasonografía/métodos , Vagina/patologíaAsunto(s)
Selección de Paciente/ética , Técnicas Reproductivas Asistidas , Femenino , Humanos , Embarazo , PronósticoAsunto(s)
Infertilidad Femenina/diagnóstico , Laparoscopía , Anticuerpos Antibacterianos/sangre , Infecciones por Chlamydia/complicaciones , Infecciones por Chlamydia/diagnóstico , Chlamydia trachomatis/inmunología , Endometriosis/complicaciones , Endometriosis/diagnóstico , Endometriosis/patología , Enfermedades de las Trompas Uterinas/complicaciones , Enfermedades de las Trompas Uterinas/diagnóstico , Enfermedades de las Trompas Uterinas/terapia , Femenino , Humanos , Histerosalpingografía , Infertilidad Femenina/etiología , Infertilidad Femenina/terapia , Inseminación Artificial , Inducción de la Ovulación , Embarazo , UltrasonografíaRESUMEN
Localisation of endometriosis on the sciatic nerve is exceptional. We report the case of a patient presenting an endometriotic nodule of the left ischio-rectal excavation, with an extension contiguous to the sciatic nerve, responsible of invalidating sciatalgia. Two laparoscopies did not allow to localise the lesion. Finally the endometriotic nodule was treated by a direct access of the left ischio-rectal excavation through a pararectal incision. In this article we discuss the means to localise such lesion and the surgical approach to propose.
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Endometriosis/cirugía , Nervio Ciático , Neuropatía Ciática/cirugía , Adulto , Endometriosis/complicaciones , Femenino , Humanos , Recto/cirugía , Neuropatía Ciática/etiologíaRESUMEN
Ovarian low malignant potential tumor account for 10 to 20 percent of ovarian epithelial tumors. They differ from typical ovarian cancers in that they do not grow into the ovarian stroma. Likewise, if they spread outside the ovary, for example, into the abdominal cavity, they do not usually grow into the lining of the abdomen. These cancers tend to affect women at a younger age than the typical ovarian cancers and are less life-threatening than most ovarian cancers. Guidelines for surgical treatment of borderline ovarian tumors are similar to those for ovarian cancer and include hysterectomy with bilateral salpingo-oophorectomy. However, patients with borderline ovarian tumors tend to be younger than women with invasive ovarian cancer. For many of these patients, fertility is an important issue. Previous studies have suggested the safety of conservative surgery with unilateral salpingo-oophorectomy or cystectomy for patients with stage I borderline ovarian tumors. Despite infrequent data, this observation has been expanded to include women with advanced-stage disease. Recurrence is noted more often after this type of treatment, but does not seem to have a negative effect on survival. Management of conservative treatment (complete staging, cystectomy or oophorectomy, oophorectomy or adnexectomy) are still under debate since none avoids the malignant transformation risk. Thus, close follow-up is mandatory and the optimal moment for final oophorectomy remains unclear. When ovarian preservation is impossible, oocyte/ovarian cryopreservation or emergency ovarian induction before the surgical procedure to obtain embryos are promising but still under evaluated options.
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Fertilidad/fisiología , Neoplasias Ováricas/patología , Femenino , Fertilización In Vitro/métodos , Humanos , Histerectomía , Metástasis de la Neoplasia/patología , Recurrencia Local de Neoplasia/patología , Estadificación de Neoplasias , Neoplasias Ováricas/cirugía , Ovariectomía , Inducción de la Ovulación/métodos , Embarazo , PronósticoRESUMEN
AIM: The object of this study was to evaluate access to preventative care, screening and treatment of women in vulnerable socio-economic groups presenting with cervical cancer and the progression of their disease. METHOD: This is a retrospective study of 123 patients with cervical cancer treated at the hôpital Bichat (Paris) or the hôpital Verdier (Bondy) between 1st January 1996 and 31 December 2005. RESULTS: "CMU" or "AME" is the entitlement for fully state funded medical care and was used in this study to indicate social deprivation. Social deprivation is associated with homelessness (43.9 vs 1.23%; P = 0.0001) and unemployment (90 vs 30%; P = 0.0001). Women from deprived groups seldom enter screening programs (25 vs 56.1%; P = 0.008). Once symptomatic they delay seeking medical attention (1.8 months later than for non-deprived groups; P = 0.027), present more often to accident and emergency departments (51.22 vs 17.07%; P = 0.0003), and do not see any primary care practitioner (41.46 vs 8.64%; P < 0.0001). There was no significant difference with regard to treatment instituted in the two groups. The non-deprived patients residing in Bondy had similar access to care as the deprived patients treated in Paris. The average follow-up period was 30.43 months (+/- 26.64). CONCLUSION: Cervical screening is not taken up adequately throughout the general population. Access to health care is poorly tailored to the needs of the socially deprived. Social deprivation did not demonstrate an association with levels of pelvic recurrence, metastasis or death. The low doctor to patient ratio in certain geographical areas reduces access to medical care.
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Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Áreas de Pobreza , Neoplasias del Cuello Uterino , Frotis Vaginal/estadística & datos numéricos , Análisis de Varianza , Instituciones Oncológicas , Estudios de Casos y Controles , Progresión de la Enfermedad , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Seguro de Salud/estadística & datos numéricos , Paris , Características de la Residencia , Estudios Retrospectivos , Factores Socioeconómicos , Factores de Tiempo , Neoplasias del Cuello Uterino/diagnóstico , Neoplasias del Cuello Uterino/patología , Neoplasias del Cuello Uterino/prevención & control , Neoplasias del Cuello Uterino/terapiaRESUMEN
OBJECTIVE: To appreciate the evolution of the current surgical practice for female for stress urinary incontinence (SUI) in the gynaecologic surgery departments of Parisian public hospitals in three different periods of 12 months (2002-2003, 2003-2004, and 2006). PATIENTS AND METHODS: The 16 departments were surveyed by postal questionnaire about their surgical practice for the treatment of female SUI. The number, the type of operation, the type of suburethral tapes and their surgical routes were detailed. RESULTS: The participation rate in the survey was 87.5% (14/16) for the first two studied periods and 75% (12/16) for the last one. The number of SUI procedure decreases between the three periods (586, 505, and 263 procedures, respectively; p<0.001). Suburethral slings represent the technique of choice for SUI (86.2% in 2002-2003; 92.7% in 2003-2004, and 98.1% in 2006). Other practices are exceptional. The transobturator approach has widely progressed and became the preferred one in 2006 (31.1%; 64.5%; 95.4% in 2006; p<0.001). No transobturator route was privileged. TVT procedures have decreased between the three studied periods (48.3%, 36.5%, and 4.6% in 2006; p<0.001). TVT-O is the preferred sling in 2006 (120/258, 46.5% of suburethral tapes). DISCUSSION AND CONCLUSION: Suburethral tape placement is nowadays the main surgical treatment for female SUI amongst members in gynaecology departments in Parisian public hospitals. The transobturator approach is preferred.
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Ginecología , Hospitales Públicos/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Incontinencia Urinaria de Esfuerzo/cirugía , Procedimientos Quirúrgicos Urológicos , Femenino , Hospitales Públicos/tendencias , Humanos , Paris , Pautas de la Práctica en Medicina/tendencias , Prótesis e Implantes , Cabestrillo Suburetral , Encuestas y Cuestionarios , Procedimientos Quirúrgicos Urológicos/métodos , Procedimientos Quirúrgicos Urológicos/estadística & datos numéricos , Procedimientos Quirúrgicos Urológicos/tendenciasRESUMEN
Several surgical treatment modalities have been described in cases of isolated or multiple ovarian endometriotic cysts. The aim of this preliminary study was to investigate and test the efficacy of ethanol sclerotherapy (EST) for recurrent endometriotic cysts, before ovarian stimulation in infertile patients with an adequate ovarian status. In the setting of a prospective comparative study, EST was proposed to 31 infertile patients with recurrence of ovarian endometriomas before inclusion in assisted reproduction cycles. Reproductive outcome was compared with that of patients who had previous laparoscopic cystectomy for recurrent endometriomas. The mean size of endometriomas treated with sclerotherapy was 38.6 +/- 11.2 mm in diameter. Ovarian cysts recurred in 12.9% of cases; at a mean time of 10 months after EST. Ovarian reserve and ovarian response to stimulation were better in the EST group than in the control group. Consequently, clinical and cumulative pregnancy rates of the study group were higher than those of the control group (48.3% versus 19.2%, P = 0.04; and 55.2% versus 26.9%, P = 0.03, respectively). Ethanol sclerotherapy may be a good alternative to surgical management of recurrent endometriotic cysts before assisted reproductive treatment. It could be advised for selected infertile patients.
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Endometriosis/tratamiento farmacológico , Etanol/administración & dosificación , Infertilidad Femenina/tratamiento farmacológico , Enfermedades del Ovario/tratamiento farmacológico , Inducción de la Ovulación , Escleroterapia/métodos , Adulto , Femenino , Humanos , Embarazo , Técnicas Reproductivas AsistidasRESUMEN
Cystadenofibroma of the ovary is a relatively rare benign tumor. Such tumors are characterised by their malignant macroscopical appearance which may lead to an inappropriate aggressive surgical approach. We present two cases of cystadenofibromas of the ovary. The first has been treated by extensive surgery, including pelvic and para-aortic lymphadenectomy. The second has been treated in a more appropriate way, by conservative surgery.
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Adenofibroma/cirugía , Cistoadenoma/cirugía , Neoplasias Ováricas/cirugía , Adenofibroma/diagnóstico , Anciano , Cistoadenoma/diagnóstico , Femenino , Humanos , Persona de Mediana Edad , Neoplasias Ováricas/diagnóstico , Resultado del TratamientoRESUMEN
OBJECTIVE: This study aims to show the treatment outcome in women affected by bladder endometriosis. PATIENTS AND METHODS: Retrospective review of records of 24 women with deep vesical endometriosis treated between 1998 and 2007. RESULTS: All cases had cyclic symptoms even though they were not specific. A percentage of 66% of women had concomitantly deep nodules of the rectovaginal septum and/or uterosacral ligaments. Five patients (20.8%) had previously undergone a transurethral resection (TUR) of the bladder lesion, but this therapy has failed in all cases. Partial cystectomy was carried out in 14 patients (60.8%) and an extramucosal dissection of the endometriotic lesion in nine patients (39.2%). Laparoscopy was used in 19 cases (82.6%). Recurrence of bladder endometriotic lesions was documented in two patients. This was mainly due to an incomplete initial treatment. Success rate, defined by total improvement of symptoms after the initial treatment, was estimated at 86.7% in this series. The only complication encountered was a pelvic hematoma with bladder compression that required a ureteral cannulation (JJ). Seven patients out of 11 became pregnant; four of them were infertile before the surgical treatment. DISCUSSION AND CONCLUSION: Diagnosis of bladder endometriosis is often difficult to make because of its non-specific symptoms. The management is mainly surgical and resection should be complete. TUR is not an optimal treatment for bladder endometriosis.