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1.
BJOG ; 129(4): 656-663, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34541781

RESUMO

OBJECTIVE: To assess the incidence of serious complications and reoperations for recurrence after surgery for pelvic organ prolapse (POP) and compare the three most common types of repair. DESIGN: Prospective cohort study using a registry. SETTING: Nineteen French surgical centres. POPULATION: A total of 2309 women participated between 2017 and 2019. METHODS: A multivariate analysis including an inverse probability of treatment weighting approach was used to obtain three comparable groups. MAIN OUTCOME MEASURES: Serious complications and subsequent reoperations for POP recurrence. RESULTS: The median follow-up time was 17.6 months. Surgeries were native tissue vaginal repairs (n = 504), transvaginal mesh placements (n = 692) and laparoscopic sacropexies with mesh (n = 1113). Serious complications occurred among 52 women (2.3%), and reoperation for POP recurrence was required for 32 women (1.4%). At 1 year the cumulative weighted incidence of serious complications was 1.8% for native tissue vaginal repair, 3.9% for transvaginal mesh and 2.2% for sacropexy, and the rates for reoperation for recurrence of POP were 1.5, 0.7 and 1.1%, respectively. Compared with native tissue vaginal repair, the risk of serious complications was higher in the transvaginal mesh group (weighted hazard ratio, wHR 3.84, 95% CI 2.43-6.08) and the sacropexy group (wHR 2.48, 95% CI 1.45-4.23), whereas the risk of reoperation for prolapse recurrence was lower in both the transvaginal mesh (wHR 0.22, 95% CI 0.13-0.39) and sacropexy (wHR 0.29, 95% CI 0.18-0.47) groups. CONCLUSIONS: Our results suggest that native tissue vaginal repairs have the lowest risk of serious complications but the highest risk of reoperation for recurrence. These results are useful for informing women and for shared decision making. TWEETABLE ABSTRACT: Laparoscopic sacropexy had fewer serious complications than transvaginal mesh and fewer reoperations for recurrence than vaginal repair.


Assuntos
Prolapso de Órgão Pélvico/cirurgia , Complicações Pós-Operatórias/etiologia , Telas Cirúrgicas/efeitos adversos , Vagina/cirurgia , Idoso , Feminino , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Procedimentos Cirúrgicos em Ginecologia/métodos , Humanos , Laparoscopia/efeitos adversos , Pessoa de Meia-Idade , Prolapso de Órgão Pélvico/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Recidiva , Sistema de Registros , Reoperação/estatística & dados numéricos , Fatores de Risco
2.
BJOG ; 129(1): 127-137, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34264001

RESUMO

OBJECTIVE: To compare the effectiveness and safety of laparoscopic sacropexy (LS) and transvaginal mesh (TVM) at 4 years. DESIGN: Extended follow up of a randomised trial. SETTING: Eleven centres. POPULATION: Women with cystocele stage ≥2 (pelvic organ prolapse quantification [POP-Q], aged 45-75 years without previous prolapse surgery. METHODS: Synthetic non-absorbable mesh placed in the vesicovaginal space and sutured to the promontory (LS) or maintained by arms through pelvic ligaments and/or muscles (TVM). MAIN OUTCOME MEASURES: Functional outcomes (pelvic floor distress inventory [PFDI-20] as primary outcome); anatomical assessment (POP-Q), composite outcome of success; re-interventions for complications. RESULTS: A total of 220 out of 262 randomised patients have been followed at 4 years. PFDI-20 significantly improved in both groups and was better (but below the minimal clinically important difference) after LS (mean difference -7.2 points; 95% CI -14.0 to -0.05; P = 0.029). The improvement in quality of life and the success rate (LS 70%, 61-81% versus TVM 71%, 62-81%; hazard ratio 0.92, 95% CI 0.55-1.54; P = 0.75) were similar. POP-Q measurements did not differ, except for point C (LS -57 mm versus TVM -48 mm, P = 0.0093). The grade III or higher complication rate was lower after LS (2%, 0-4.7%) than after TVM (8.7%, 3.4-13.7%; hazard ratio 4.6, 95% CI 1.007-21.0, P = 0.049)). CONCLUSIONS: Both techniques provided improvement and similar success rates. LS had a better benefit-harm balance with fewer re-interventions due to complications. TVM remains an option when LS is not feasible. TWEETABLE ABSTRACT: At 4 years, Laparoscopic Sacropexy (LS) had a better benefit-harm balance with fewer re-interventions due to complications than Trans-Vaginal Mesh (TVM).


Assuntos
Cistocele/cirurgia , Idoso , Feminino , Seguimentos , França , Humanos , Laparoscopia , Pessoa de Meia-Idade , Telas Cirúrgicas , Resultado do Tratamento , Vagina
3.
BJOG ; 127(1): 88-97, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31544327

RESUMO

OBJECTIVE: To assess the short-term incidence of serious complications of surgery for urinary incontinence or pelvic organ prolapse. DESIGN: Prospective longitudinal cohort study using a surgical registry. SETTING: Thirteen public hospitals in France. POPULATION: A cohort of 1873 women undergoing surgery between February 2017 and August 2018. METHODS: Preliminary analysis of serious complications after a mean follow-up of 7 months (0-18 months), according to type of surgery. Surgeons reported procedures and complications, which were verified by the hospitals' information systems. MAIN OUTCOME MEASURES: Serious complication requiring discontinuation of the procedure or subsequent surgical intervention, life-threatening complication requiring resuscitation, or death. RESULTS: Fifty-two women (2.8%, 95% CI 2.1-3.6%) experienced a serious complication either during surgery, requiring the discontinuation of the procedure, or during the first months of follow-up, necessitating a subsequent reoperation. One woman also required resuscitation; no women died. Of 811 midurethral slings (MUSs), 11 were removed in part or totally (1.4%, 0.7-2.3%), as were two of 391 transvaginal meshes (0.5%, 0.1-1.6%), and four of 611 laparoscopically placed mesh implants (0.7%, 0.2-1.5%). The incidence of serious complications 6 months after the surgical procedure was estimated to be around 3.5% (2.0-5.0%) after MUS alone, 7.0% (2.8-11.3%) after MUS with prolapse surgery, 1.7% (0.0-3.8%) after vaginal native tissue repair, 2.8% (0.9-4.6%) after transvaginal mesh, and 1.0% (0.1-1.9%) after laparoscopy with mesh. CONCLUSIONS: Early serious complications are relatively rare. Monitoring must be continued and expanded to assess the long-term risk associated with mesh use and to identify its risk factors. TWEETABLE ABSTRACT: Short-term serious complications are rare after surgery for urinary incontinence or pelvic organ prolapse, even with mesh.


Assuntos
Diafragma da Pelve/cirurgia , Prolapso de Órgão Pélvico/cirurgia , Telas Cirúrgicas/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Colposcopia/efeitos adversos , Colposcopia/mortalidade , Colposcopia/estatística & dados numéricos , Feminino , França/epidemiologia , Humanos , Incidência , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/mortalidade , Pessoa de Meia-Idade , Prolapso de Órgão Pélvico/mortalidade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/mortalidade , Estudos Prospectivos , Sistema de Registros , Slings Suburetrais/efeitos adversos , Slings Suburetrais/estatística & dados numéricos , Telas Cirúrgicas/estatística & dados numéricos , Centros Cirúrgicos/estatística & dados numéricos , Adulto Jovem
4.
J Gynecol Obstet Biol Reprod (Paris) ; 45(9): 1054-1059, 2016 Nov.
Artigo em Francês | MEDLINE | ID: mdl-27114064

RESUMO

INTRODUCTION: Randomized controlled trials (RCT) in surgery are often subject to difficulties inherent in the study design and recruitment of patients. Women's participation rate to RCTs in surgery is relatively low and varies from 30 to 70%. These recruitment problems might induce a weak scientific value and even stop the study. Thus, optimizing recruitment is a challenge for surgical research. In contemporary literature, we lack data on motivations and profile of women who refuse to participate in a RCT in surgery. OBJECTIVE: To explore the potentially influential factors affecting women's decision to decline participation in PROSPERE trial, comparing laparoscopic sacrocolpopexy (LSCP) to vaginal mesh for cystocele repair. PATIENT AND METHOD: Retrospective, observational, qualitative, bicentric study conducted in the department of gynecology of Poissy and Lille hospitals. Patients included were those who refused to participate to PROSPERE trial in both centers. Factors of non-participation in the trial were recorded at the time of the first visit. A control group consisted of women who agreed to participate in the trial was also analyzed. RESULTS: In both centers, 139 were eligible to participate in the trial but 35 of them (25%) refused. Thirty-two women agreed to declare their refusal motivations. Vaginal mesh was finally performed in 18 (56,2%) patients and LSCP in 14 patients (43,8%). The control group consisted of 20 women, including 9 operated by vaginal mesh and 11 by LSCP. Patient's characteristics were similar in the both groups. Most influencing factor in refusal for participation was "previous choice of technique" in 50% cases (16/32), followed by "geographical remoteness and difficulties for additional visits" in 40.6% cases (13/32), and finally by "do not accept the concept of randomization" in 21.8% cases (7/32). The most influencing factor in women's acceptance was interest in helping others by "supporting medical research" in 100% cases (20/20), followed by "potential personal benefits and close follow-up" in 60% (12/20). CONCLUSION: Our study identified the most influential factors relevant to women decision-making whether or not to participate in RCT in surgery. A number of factors leading to refusal of participation are potentially correctable leading to better recruitment rates in future RCTs. Optimization of information on the principle of randomization, limiting the number of additional visits could help researchers improve participation rates.


Assuntos
Comportamento de Escolha , Procedimentos Cirúrgicos em Ginecologia/psicologia , Motivação , Seleção de Pacientes , Ensaios Clínicos Controlados Aleatórios como Assunto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Pesquisa Qualitativa , Estudos Retrospectivos
6.
J Gynecol Obstet Biol Reprod (Paris) ; 45(3): 243-8, 2016 Mar.
Artigo em Francês | MEDLINE | ID: mdl-26096351

RESUMO

OBJECTIVE: Two years after the French guidelines, the objective was to assess the feasibility and efficiency of ultrasound-guided trans-vaginal drainage of tubo-ovarian abscesses (TOA) and to study the responsible germs. MATERIAL AND METHODS: All the patients with a larger abscess than 20mm were included prospectively from May 2011 to July 2014 in the university hospital of Lille. RESULTS: Sixty-nine drainages were performed among 50 patients. Success rate was 94%. No complication occurred. One germ was found in 55% of patients, the TOA was polymicrobian in 20% of cases. CONCLUSION: Ultrasound-guided trans-vaginal drainage of TOA is safe and effective with more than 90% of success rate.


Assuntos
Abscesso/terapia , Drenagem/métodos , Doenças das Tubas Uterinas/terapia , Doenças Ovarianas/terapia , Ultrassonografia de Intervenção/métodos , Abscesso/epidemiologia , Abscesso/microbiologia , Adolescente , Adulto , Antibacterianos/uso terapêutico , Drenagem/efeitos adversos , Doenças das Tubas Uterinas/epidemiologia , Doenças das Tubas Uterinas/microbiologia , Estudos de Viabilidade , Feminino , Humanos , Pessoa de Meia-Idade , Doenças Ovarianas/epidemiologia , Doenças Ovarianas/microbiologia , Complicações Pós-Operatórias/epidemiologia , Resultado do Tratamento , Ultrassonografia de Intervenção/efeitos adversos , Vagina/diagnóstico por imagem , Vagina/microbiologia , Adulto Jovem
7.
Gynecol Obstet Fertil ; 43(6): 459-64, 2015 Jun.
Artigo em Francês | MEDLINE | ID: mdl-26004024

RESUMO

Pelvic floor disorders are frequent and source of symptoms which can be invalidating for patients. Between them, hedrocele is a pathology often unknown and clinically difficult to diagnose. It is a herniation of fat pad, small bowel or sigmoid colon in the recto-uterine pouch (cul-de-sac of Douglas) exercising a mass effect on the anterior wall of the rectum. Pelvic magnetic resonance imaging with morphological sequences and dynamic sequences in thrust can be very useful, allowing a comprehensive study of pelvic floor dysfunction and confirming the complete diagnosis, especially before surgery. We suggest you some examples to illustrate this pathology in order to emphasize the importance of its diagnosis, especially preoperative. A better understanding of this pelvic floor dysfunction would improve the care of patients.


Assuntos
Prolapso de Órgão Pélvico/diagnóstico , Idoso , Escavação Retouterina/diagnóstico por imagem , Feminino , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Prolapso de Órgão Pélvico/cirurgia , Reto/diagnóstico por imagem , Vagina/diagnóstico por imagem
9.
Gynecol Obstet Fertil ; 43(2): 97-103, 2015 Feb.
Artigo em Francês | MEDLINE | ID: mdl-25618535

RESUMO

OBJECTIVES: Evaluation of pudendal nerve block on the quality of analgesia in perineal or vulvar surgery. PATIENTS AND METHODS: We realised a monocentered, prospective and randomised study of all patients undergoing perineo-vulvar surgery. Two groups of patients were evaluated: general anaesthesia alone (GA group, 41 patients) and both general anaesthesia and bilateral nerve stimulator-guided pudendal nerve block (15 mL of Ropivacaïne 5 mg.mL(-1)+0,5 µg.kg(-1) of Clonidine) (PB group, 42 patients). Evaluation of pain was realised with per- and post-surgical prescription of hypnotics and antalgics was noted. The primary outcome measure was the Visual Analogic Scale (VAS) pain means scores in the first postoperative 24 hours. RESULTS: There was no difference in the VAS pain means scores in the first 24 hours, but it seemed to have a decrease in VAS pain at 2 hours in the PB group. Analgesic consumption during surgery was decreased in the same group. No complication of the pudendal block has been reported. DISCUSSION AND CONCLUSION: The nerve stimulator-guided pudendal nerve block is a simple and useful method which can, when associated with general anesthesia, reduce per-operative antalgics consumption and a decrease in the immediate postoperative pain in perineal or vulvar surgery, without complication or lengthening operating time. Further studies are needed to confirm the effectiveness of this technique and evaluate the costs and potential complications.


Assuntos
Procedimentos Cirúrgicos em Ginecologia , Bloqueio Nervoso/métodos , Dor Pós-Operatória/prevenção & controle , Nervo Pudendo , Amidas/administração & dosagem , Analgésicos/administração & dosagem , Anestesia Geral , Anestésicos Locais/administração & dosagem , Clonidina/administração & dosagem , Feminino , Humanos , Pessoa de Meia-Idade , Períneo/cirurgia , Estudos Prospectivos , Ropivacaina , Escala Visual Analógica , Vulva/cirurgia
10.
Eur J Obstet Gynecol Reprod Biol ; 178: 203-7, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24813082

RESUMO

Surgery of genital prolapse causes haemorrhagic complications in about 1% of cases. The pelvis is highly vascular and accessing the usual landmarks of vaginal surgery, in particular the sciatic spine, is delicate work. Meticulous dissection of closed spaces is often difficult, and exposure and haemostatic procedures will be challenging in the event of any bleeding complication. When fixing prosthesis to the sacrospinous ligament, the inferior gluteal artery and its coccygeal branch are at risk. Fixation to the sacrospinous ligament must be performed more than 25mm away from the sciatic spine and, if possible, must not transfixiate it. Safe insertion of prosthesis requires sufficient experience, and an adequate learning curve. Being aware of vascular anatomy allows one to understand and treat haemorrhagic incidents. Packing or selective embolization seem to be the two methods to adopt, depending on the severity of bleeding and the conditions of exposure on the one hand, and on the technical resources available for embolization, on the other. Hypogastric ligature appears to be ineffective in this context.


Assuntos
Hemorragia/terapia , Complicações Intraoperatórias/terapia , Prolapso Uterino/cirurgia , Feminino , Hemostasia Cirúrgica/métodos , Humanos , Ligamentos/cirurgia , Região Sacrococcígea/irrigação sanguínea , Vagina/cirurgia
11.
Gynecol Obstet Fertil ; 42(2): 97-103, 2014 Feb.
Artigo em Francês | MEDLINE | ID: mdl-24461467

RESUMO

OBJECTIVES: To evaluate fertiloscopy's results and to redefine its place in the management of female infertility. PATIENTS AND METHODS: Retrospective study including 262 cases of fertiloscopy and 260 patients with primary or secondary idiopathic infertility. Analysis of infertility assessment's findings (hysterosalpingography), perioperative data (operating technique, laparoscopic conversion, failures and complications). Comparison of hysterosalpingography's findings and peroperative data; comparison of fertiloscopy and laparoscopy's findings. RESULTS: Access to peritoneal cavity was possible for 248 fertiloscopies (95%), and pelvic exploration was considered as complete for 226 cases (86%). Laparoscopic conversion was necessary in 54 cases (21%) and indicated by surgical pathology in more of one third of the cases (n=20). Our failure rate was only 5,3% (n=14), partially thanks to posterior colpotomie (70% of failures avoided). We deplored 8 complications (3.05%) which were not severe (no bowel injury), among which half were linked with the hysteroscopy (uterus perforation). In the cases of laparoscopic conversion, laparoscopic findings confirmed per-fertiloscopic data, considering adhesions and tubal patency. Hysterosalpingography had poor sensibility and positive predictive value. DISCUSSION AND CONCLUSION: Fertiloscopy is a safe, reproducible and not much invasive procedure. It can be substituted to laparoscopy in infertility assessment when there is no obvious surgical indication. Moreover, it could be considered as a first line way of investigation in female infertility management, instead of hysterosalpingography which has poor sensibility and positive predictive value.


Assuntos
Histeroscopia/métodos , Infertilidade Feminina/diagnóstico , Infertilidade Feminina/etiologia , Adulto , Feminino , Humanos , Histerossalpingografia , Histeroscopia/efeitos adversos , Laparoscopia/efeitos adversos , Estudos Retrospectivos , Perfuração Uterina/etiologia
12.
Gynecol Obstet Fertil ; 42(2): 84-91, 2014 Feb.
Artigo em Francês | MEDLINE | ID: mdl-22306097

RESUMO

OBJECTIVES: To propose a therapeutic approach and follow-up of patients with atypical polypoid adenomyoma (APA) wishing to remain fertile. PATIENTS AND METHOD: We are presenting a retrospective study of eight APA cases. RESULTS: Two patients immediately received radical treatment, and one patient had an endometrial thermocoagulation. The remaining five patients received a conservative treatment with ultrasound and hysteroscopic monitoring. Among them, two had full-term pregnancies, one is being treated for infertility, in one case, the APA disappeared after three hysteroscopy-curettages and macroprogestative treatment. Lastly, one of our patients died from an aggressive endometrioid ovarian bilateral tumour associated with an endometrial adenocarcinoma. DISCUSSION AND CONCLUSION: Radical treatment is necessary for cases of APA in women no longer wishing to remain fertile. For those wishing to remain fertile, we can offer a conservative treatment once they have been informed regarding the associated risk of relapse, degeneration, and ovarian lesions which necessitate stricter follow-up.


Assuntos
Adenomioma/terapia , Neoplasias do Endométrio/terapia , Adenomioma/patologia , Adenomioma/cirurgia , Adulto , Neoplasias do Endométrio/patologia , Neoplasias do Endométrio/cirurgia , Evolução Fatal , Feminino , Preservação da Fertilidade , Humanos , Histeroscopia , Pessoa de Meia-Idade , Gravidez , Progestinas/uso terapêutico , Estudos Retrospectivos , Fatores de Risco
13.
Clin Radiol ; 68(9): 909-16, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23726654

RESUMO

AIM: To analyse the value of double contrast-enhanced (DCE) magnetic resonance imaging (MRI) in addition to conventional MRI to characterize ovarian teratomas subtypes with histological correlation. MATERIALS AND METHODS: From January 2005 to December 2008, 38 women undergoing MRI and subsequent resection of ovarian teratomas were identified [40 mature cystic teratomas (MCT), two struma ovarii, three immature teratomas]. MRI images were analysed blindly by two radiologists according to morphological and vascular abnormalities. An experienced histopathologist reviewed all slides to determine the presence and histological composition of Rokitansky protuberances. RESULTS: Thirty-one MCT (77%) had at least one small, regular Rokitansky protuberance presenting at an acute angle with the cyst wall. Ten out of 31 MCT did not display any enhancement on contrast-enhanced MRI related to sebaceous glands, adipose lobules, keratin, and pilosebaceous adnexa at histology. Three different time-intensity curve (TIC), types 1, 2, and 3, were related to presence of smooth muscular cells and fibrous, neuroglial, or thyroid tissue, respectively, found at histology of MCT. Type 3 TIC was also present in one struma ovarii and two immature teratomas. CONCLUSION: TIC types are related to the specific content of the solid tissue of ovarian teratomas but cannot be used to differentiate benign and malignant ovarian teratomas.


Assuntos
Neoplasias Ovarianas/patologia , Teratoma/patologia , Adolescente , Adulto , Criança , Meios de Contraste , Diagnóstico Diferencial , Detecção Precoce de Câncer , Feminino , Humanos , Imageamento por Ressonância Magnética/métodos , Pessoa de Meia-Idade , Neoplasias Ovarianas/cirurgia , Teratoma/cirurgia , Adulto Jovem
14.
J Gynecol Obstet Biol Reprod (Paris) ; 42(4): 334-41, 2013 Jun.
Artigo em Francês | MEDLINE | ID: mdl-23618743

RESUMO

BACKGROUND: Cystocele is a frequent and invalidating type of genital prolapse in woman. Sacropexy using synthetic mesh is considered the surgical gold standard, and the laparoscopic approach has supplanted the open abdominal route because it offers the same anatomical results with a lower morbidity. The use of mesh through the vaginal route may have many advantages: easiness to perform, shorter operative time and recovery, but may increase morbidity. In France, both laparoscopic sacropexy and vaginal mesh are commonly used to treat cystoceles. The French Haute Autorité de santé (HAS) has highlighted the lack of evaluation of safety assessment for vaginal meshes. METHOD/DESIGN: The main objective of the study is to compare the morbidity of laparoscopic sacropexy with vaginal mesh for cystocele repair. The primary endpoint will be the rate of surgical complications greater or equal to grade 2 of the Clavien-Dindo classification at 1-year follow-up. The secondary aims are to compare the functional results in the medium term (sexuality, urinary and bowel symptoms, pain), the impact on quality of life as well as anatomical results. PROSPERE is a randomized controlled trial conducted in 12 participating French hospitals. 262 patients, aged 45 to 75years old, with cystocele greater or equal to stage 2 of the POP-Q classification (isolated or not) will be included. Exclusion criterias are a previous surgical POP repair, and inability or contra-indication to one or the other technique. We have designed this study to answer the question of the choice between laparoscopic sacropexy and vaginal mesh for the treatment of cystocele. The PROSPERE trial aims to help better determine the indications for one or the other of these techniques, which are currently based on subjective choices or school attitudes. This is the reason why competent authorities have asked for such studies.


Assuntos
Cistocele/cirurgia , Procedimentos Cirúrgicos em Ginecologia/métodos , Laparoscopia , Telas Cirúrgicas , Prolapso Uterino/cirurgia , Idoso , Cistocele/complicações , Feminino , Procedimentos Cirúrgicos em Ginecologia/instrumentação , Humanos , Histerectomia/métodos , Laparoscopia/métodos , Pessoa de Meia-Idade , Próteses e Implantes , Procedimentos de Cirurgia Plástica/instrumentação , Procedimentos de Cirurgia Plástica/métodos , Incontinência Urinária/etiologia , Incontinência Urinária/cirurgia , Prolapso Uterino/etiologia , Vagina/cirurgia
15.
J Gynecol Obstet Biol Reprod (Paris) ; 42(2): 184-90, 2013 Apr.
Artigo em Francês | MEDLINE | ID: mdl-23395463

RESUMO

OBJECTIVES: To evaluate the educational interest of a workshop on diagnosis and repair of obstetric anal sphincter injuries (OASIS). To evaluate the theoretical and anatomical knowledge of OASIS repair by French residents in obstetrics and gynecology. MATERIALS AND METHODS: The workshop was composed of slides, video of repair and training using cadaveric sow's anal sphincters. All subjects were tested with a questionnaire before and after the course. RESULTS: Thirty residents participated. Classification of OASIS was known by 13.3% of the residents before the training versus 93.3% after the workshop (P<0.001). Initially, only 6.7% correctly classified operative procedures of OASIS versus 86.7% after the workshop (P<0.001). Per pre-test, 90% of residents did not know how to identify the internal anal sphincter (IAS) versus 3% at post-test (P<0.001). Seventy percent of trainees correctly identified the external anal sphincter (EAS) at the beginning of training. Before the course, no resident knew the repair of the IAS and only one third knew the technical repair of the EAS. After the workshop, the theoretical knowledge of EAS and IAS repair were acquired by all (P<0.001). CONCLUSION: Structured hands-on training improves significantly the knowledge of OASIS diagnosis and repair.


Assuntos
Canal Anal/lesões , Canal Anal/cirurgia , Avaliação Educacional , Internato e Residência , Complicações do Trabalho de Parto/cirurgia , Procedimentos Cirúrgicos Obstétricos/educação , Canal Anal/patologia , Competência Clínica , Feminino , Ginecologia/educação , Humanos , Procedimentos Cirúrgicos Obstétricos/métodos , Obstetrícia/educação , Gravidez , Inquéritos e Questionários , Resultado do Tratamento
16.
Gynecol Obstet Fertil ; 41(1): 67-72, 2013 Jan.
Artigo em Francês | MEDLINE | ID: mdl-23305931

RESUMO

OBJECTIVE: The aim of our study was to evaluate the practice of Lille in the management of ovarian cyst during pregnancy and to compare our results with data from the literature. PATIENTS AND METHODS: The study was a retrospective cohort of Lille University Hospital between 1st January 2007 and 31st December 2010. The inclusion was based on the ultrasound diagnosis of an ovarian cyst greater or equal to 30mm during pregnancy. Obstetrical and neonatal data, surgical techniques and indications were analyzed. RESULTS: Seventy-one patients had a diagnosis of ovarian cyst during pregnancy, i.e., 0.35% of pregnancies followed at the University Hospital of Lille during the study period. The diagnosis took place in the first quarter in the majority of cases, at 12.30±6.99 weeks of amenorrhea (WA). Most often, the ovarian cyst is monitored during pregnancy, which has been strictly the case in 63.38% of cysts (45 patients). Fourteen patients had to be operated during pregnancy (19.72%). There were 7 emergency interventions and 7 programmed intrapartum interventions. Five intrapartum laparoscopies were performed at a mean term of 14.75±2.63 WA, and 9 laparotomies were performed at a mean term of 18.88±4.57 WA. Twelve ovarian mass surgeries were performed per caesarean section. Operated cysts are most often organic cysts (74.39%). No malignancies were observed, and 3 cases of borderline tumors were diagnosed. There were no obstetrical or neonatal complications. DISCUSSION AND CONCLUSION: A simple monitoring is possible if the cyst is benign, less than 6cm and does not change. Surgery is required in an emergency or in case of suspicious signs of complications or malignancy. Laparoscopy can be widely used until the 2nd quarter. Lille's attitude respects the recommendations is consistent with the literature.


Assuntos
Cistos Ovarianos/complicações , Cistos Ovarianos/cirurgia , Complicações na Gravidez/cirurgia , Cesárea , Estudos de Coortes , Feminino , França , Idade Gestacional , Hospitais Universitários , Humanos , Laparoscopia , Cistos Ovarianos/diagnóstico por imagem , Gravidez , Estudos Retrospectivos , Ultrassonografia
17.
Gynecol Obstet Fertil ; 41(5): 314-21, 2013 May.
Artigo em Francês | MEDLINE | ID: mdl-22818520

RESUMO

OBJECTIVE: Intrauterine device insertion is common. It is however not harmless and uterine perforation can be serious. PATIENTS AND METHODS: Eleven cases of uterine perforation after intrauterine device insertion were listed at Tourcoing hospital between 2005 and 2009. They were analyzed to identify risk factors of uterine perforation and specify management. RESULTS: The main symptom was pelvic pain (4 cases), pregnancy occurrence (3 cases) or inability to remove the IUD (2 cases). The intrauterine device was set during the first 9 months of post-partum in 7 cases, 2 patients were still breastfeeding. Seven patients underwent laparoscopy, 2 needed switch for laparotomy, one was treated by laparotomy only and one was lost of follow-up. DISCUSSION AND CONCLUSION: Incidence of uterine perforation after IUD insertion ranges from 0,1 to 3/1000. Pelvic pain is the most revealing symptom. Fifteen percent of perforations complicate with adjacent organ lesion. Perforation incidence seems greater if the intrauterine device is set during the 6 first weeks of post-partum and breastfeeding, but non influenced by operator practical experience. Ultrasound follow-up of patients carrying intrauterine device is controversial. Facing a suspicion of ectopic intrauterine device, pelvic ultrasound examination is the first step imaging modality and using 3D could be useful. If it fails to localize the intrauterine device, an abdominal X-ray must be performed. Ectopic intrauterine device removal is recommended.


Assuntos
Dispositivos Intrauterinos/efeitos adversos , Perfuração Uterina/diagnóstico , Perfuração Uterina/cirurgia , Adulto , Aleitamento Materno , Feminino , França , Humanos , Laparoscopia , Laparotomia , Dor Pélvica , Período Pós-Parto , Gravidez , Radiografia Abdominal , Fatores de Risco , Fatores de Tempo , Ultrassonografia , Perfuração Uterina/etiologia
18.
Diagn Interv Imaging ; 94(1): 3-25, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23246186

RESUMO

Adenomyosis is a common benign uterine pathology that is defined by the presence of islands of ectopic endometrial tissue within the myometrium. It is asymptomatic in one third of cases, but when there are clinical signs they remain non-specific. It can often be misdiagnosed on sonography as it may be taken to be multiple uterine leiomyomata or endometrial thickening, both of which have a different prognosis and treatment. Adenomyosis is often associated with hormone-dependent pelvic lesions (myoma, endometriosis, or endometrial hyperplasia). It is less commonly connected to infertility or obstetrical complications and indeed any direct relationship remains controversial. The purpose of imaging is to make the diagnosis, to determine the extent of spread (focal or diffuse, superficial or deep adenomyosis, adenomyoma), and to check whether there is any associated disease, in particular endometriosis. The aim of this article is to provide assistance in recognising adenomyosis on imaging and to identify the pathologies that are commonly associated with it in order to guide the therapeutic management of symptomatic patients. Pelvic ultrasonography is the first line investigation. Sonohysterography can assist with diagnosis in some cases (pseudothickening of the endometrium seen on sonography). MRI may be used in addition to sonography to back up the diagnosis and to look for any associated disease.


Assuntos
Adenomiose/diagnóstico , Adenomiose/diagnóstico por imagem , Adenomiose/terapia , Feminino , Humanos , Imageamento por Ressonância Magnética , Ultrassonografia
19.
J Gynecol Obstet Biol Reprod (Paris) ; 41(4): 387-92, 2012 Jun.
Artigo em Francês | MEDLINE | ID: mdl-22607987

RESUMO

We report two cases of endo-uterine incarceration occurred after vacuum aspiration. In the first case, it is a sigmoid fringe incarceration in a patient asymptomatic. In the second case, it is a fallopian incarceration whose diagnosis was made during an infertility evaluation. The hysterography, ultrasound and magnetic resonance imaging have confirmed these diagnoses. The treatment of these incarcerations was surgical and realized in two steps by hysteroscopy combined with laparoscopy. Monitoring by hysterography and hysteroscopy after three months has been proposed to assess the impact on future fertility.


Assuntos
Doenças das Tubas Uterinas/diagnóstico , Doenças das Tubas Uterinas/etiologia , Doenças das Tubas Uterinas/terapia , Útero/patologia , Curetagem a Vácuo/efeitos adversos , Adulto , Doenças das Tubas Uterinas/patologia , Feminino , Humanos , Histeroscopia/efeitos adversos , Histeroscopia/métodos , Infertilidade Feminina/diagnóstico , Infertilidade Feminina/etiologia , Gravidez , Ultrassonografia , Útero/diagnóstico por imagem , Vácuo
20.
J Gynecol Obstet Biol Reprod (Paris) ; 40(8): 902-17, 2011 Dec.
Artigo em Francês | MEDLINE | ID: mdl-22056189

RESUMO

More and more perimenopausal and menopausal women seek an alternative to hysterectomy because they desire future pregnancy or wish to retain their uteri even if they have completed childbearing. Myomectomy may be an option. We can't know the evolution of leiomyomas. Hysteroscopic myomectomy is the treatment of submucous fibromas. Recurrence and subsequent surgery occurs in 16 to 21 % of cases. Intramural and subserousal myomas can be treated by myomectomy. Myomectomy should be performed laparoscopically because of shorter hospital stay, faster recovery and reduced postoperative pain. Second surgery is needed in 4-16 % of patients. If hysterectomy is performed, it should be by vaginal or laparoscopic route. There is no difference in perioperative morbidity between hysterectomy and myomectomy. Intra- and postoperative complications are similar between myomectomy and hysterectomy. Hysterectomy may be prefered if there is risk factor of malignancy or if the fibroma is discovered or has a rapid growth after menopause.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/estatística & dados numéricos , Leiomioma/cirurgia , Perimenopausa , Pós-Menopausa , Neoplasias Uterinas/cirurgia , Progressão da Doença , Feminino , Fertilidade/fisiologia , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Procedimentos Cirúrgicos em Ginecologia/métodos , Humanos , Leiomioma/epidemiologia , Leiomioma/patologia , Perimenopausa/fisiologia , Pós-Menopausa/fisiologia , Complicações Pós-Operatórias/epidemiologia , Gravidez , Neoplasias Uterinas/epidemiologia , Neoplasias Uterinas/patologia , Conduta Expectante/estatística & dados numéricos
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