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1.
Gynecol Obstet Fertil Senol ; 48(2): 153-161, 2020 Feb.
Artigo em Francês | MEDLINE | ID: mdl-31953208

RESUMO

OBJECTIVE: The aim of this study is to determine one-day hysterectomy's criteria of acceptability and feasibility. MATERIALS AND METHODS: We realized an observational descriptive survey based on questionnaires which were sent to gynecologic surgeons. Criteria were defined as major when rate of favorable responses was superior to 70%. RESULTS: Main major criteria were: definition of an age limit (80.3% of respondents), of a Body Mass Index limit (70%), no history of coronary artery disease (77.6%), no anticoagulant therapy with curative intent (95.4%) or antiplatelet (71.1%), no history of sleep apnea (77.4%), surgery within two hours (85.1%), definition of intraoperative bleeding limit (87.5%), no laparotomy (97.4%), no intra abdominal drainage (77.6%), presence of an accompanying at home (99.3%), pain evaluation (97.4%), absence of nausea before leaving (75.5%) and spontaneous urination (96.7%). CONCLUSION: Our study determined major criteria to practice one-day hysterectomy. Decision should be based on a personalized benefice-risk balance analysis. Final decision belongs to patient, as her complete engagement is fundamental.

2.
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
3.
J Gynecol Obstet Hum Reprod ; 48(7): 455-460, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30553051

RESUMO

INTRODUCTION: The objective of these clinical practice guidelines was to analyse all of the interventions during pregnancy and childbirth that might prevent obstetric anal sphincter injuries (OASIS) and postnatal pelvic floor symptoms. MATERIAL AND METHODS: These guidelines were developed in accordance with the methods prescribed by the French Health Authority (HAS). RESULTS: A prenatal clinical examination of the perineum is recommended for women with a history of Crohn's disease, OASIS, genital mutilation, or perianal lesions (professional consensus). Just after delivery, a perineal examination is recommended to check for OASIS (Grade B); if there is doubt about the diagnosis, a second opinion should be requested (Grade C). In case of OASIS, the injuries (including their severity) and the technique for their repair should be described in detail (Grade C). Perineal massage during pregnancy must be encouraged among women who want it (Grade B). No intervention conducted before the start of the active phase of the second stage of labour has been shown to be effective in reducing the risk of perineal injury. The crowning of the baby's head should be manually controlled and the posterior perineum manually supported to reduce the risk of OASIS (Grade C). The performance of an episiotomy during normal deliveries is not recommended to reduce the risk of OASIS (Grade A). In instrumental deliveries, episiotomy may be indicated to avoid OASIS (Grade C). When an episiotomy is performed, a mediolateral incision is recommended (Grade B). The indication for episiotomy should be explained to the woman, and she should consent before its performance. Advising women to have a caesarean delivery for primary prevention of postnatal urinary or anal incontinence is not recommended (Grade B). During pregnancy and again in the labour room, obstetrics professionals should focus on the woman's expectations and inform her about the modes of delivery.

4.
Gynecol Obstet Fertil Senol ; 46(12): 893-899, 2018 12.
Artigo em Francês | MEDLINE | ID: mdl-30391283

RESUMO

INTRODUCTION: The objective of these clinical practice guidelines was to analyse all of the interventions during pregnancy and childbirth that might prevent obstetric anal sphincter injuries (OASIS) and postnatal pelvic floor symptoms. MATERIAL AND METHODS: These guidelines were developed in accordance with the methods prescribed by the French Health Authority (HAS). RESULTS: A prenatal clinical examination of the perineum is recommended for women with a history of Crohn's disease, OASIS, genital mutilation, or perianal lesions (professional consensus). Just after delivery, a perineal examination is recommended to check for OASIS (Grade B); if there is doubt about the diagnosis, a second opinion should be requested (GradeC). In case of OASIS, the injuries (including their severity) and the technique for their repair should be described in detail (GradeC). Perineal massage during pregnancy must be encouraged among women who want it (Grade B). No intervention conducted before the start of the active phase of the second stage of labour has been shown to be effective in reducing the risk of perineal injury. The crowning of the baby's head should be manually controlled and the posterior perineum manually supported to reduce the risk of OASIS (GradeC). The performance of an episiotomy during normal deliveries is not recommended to reduce the risk of OASIS (Grade A). In instrumental deliveries, episiotomy may be indicated to avoid OASIS (GradeC). When an episiotomy is performed, a mediolateral incision is recommended (Grade B). The indication for episiotomy should be explained to the woman, and she should consent before its performance. Advising women to have a caesarean delivery for primary prevention of postnatal urinary or anal incontinence is not recommended (Grade B). During pregnancy and again in the labour room, obstetrics professionals should focus on the woman's expectations and inform her about the modes of delivery.


Assuntos
Obstetrícia/métodos , Períneo/lesões , Canal Anal/lesões , Cesárea , Parto Obstétrico/efeitos adversos , Parto Obstétrico/métodos , Episiotomia/métodos , Incontinência Fecal/etiologia , Incontinência Fecal/prevenção & controle , Feminino , França , Humanos , Trabalho de Parto , Lacerações/prevenção & controle , Complicações do Trabalho de Parto , Gravidez , Fatores de Risco
6.
Gynecol Obstet Fertil Senol ; 46(7-8): 593-597, 2018.
Artigo em Francês | MEDLINE | ID: mdl-29997048

RESUMO

The evaluation of genital prolapse is essentially clinical; however imaging tests such as dynamic MRI or urodynamic explorations may be useful in complex cases, especially before surgical management. Dynamic MRI allows morphological and dynamic analysis of pelvic floor and levator ani function. It can also detect post-obstetric injuries, although the long-term significance of these injuries remains to be discovered. Quantification of the severity of prolapse is possible with MRI; however, the correlation of these measures with clinical examination seems poor. Its interest lies mainly in the qualitative assessment of the three stages of prolapse and the detection of elytroceles, which can be difficult to clinical examination. Urodynamics provides useful information on vesico-sphincteric function, but none of these parameters seems to be decisive in the management of prolapse.


Assuntos
Imagem por Ressonância Magnética , Prolapso de Órgão Pélvico/fisiopatologia , Prolapso de Órgão Pélvico/cirurgia , Cuidados Pré-Operatórios/métodos , Urodinâmica , Canal Anal/fisiopatologia , Feminino , Humanos , Diafragma da Pelve/patologia , Prolapso de Órgão Pélvico/patologia
7.
Prog Urol ; 28(4): 193-208, 2018 Mar.
Artigo em Francês | MEDLINE | ID: mdl-29307482

RESUMO

INTRODUCTION: Pelvic girdle pain (PGP) is characterized by the presence of pain in the posterior pelvic area, distally and laterally to the fifth lumbar vertebra, and/or at the pubic symphysis. PGP is a very common pain condition in women, especially during pregnancy and postpartum. After delivery, pain prevalence decreases to 7 % in the first three months. The current literature describes an association between pelvic girdle pain and different perineal characteristics and symptoms. OBJECTIVES: A better understanding of perineal structures influence on PGP could assist towards the management of this condition. The aim of this review is to describe the peer-reviewed literature about perineal function in patients with PGP. METHODS: A bibliographic search on PubMed was conducted. The key words used were: pelvic girdle pain, pregnacy-related low back pain, lumbopelvic pain, posterior pelvic pain, peripartum pelvic pain, pelvic girdle relaxation, pelvic joint instability, peripartum pelvic pain, sacroiliac joint pain, sacroiliac joint dysfunction, sacroiliac-joint related pelvic pain and pelvic floor. Two hundred and twenty-one (221) articles were identified. Out of them, a total of nine articles were selected. The level of evidence was determined using Oxford's scale. RESULTS: Patients with PGP showed increased activity of the pelvic floor muscles (P=0.05) (LE3), decreased urogenital hiatus area (PGP 12.4 cm2±2.7, control 13.7 cm2±2.8, P=0.015) (LE3), shorter endurance time (PGP 17.8 s; control 54.0 s, P=0.00) (LE3), significantly later onset time during affected side leg elevation (PGP 25ms, control -129ms, P=0.01) (LE3), levator ani and obturator internus tenderness (PGP 25/26; control 5/25, P<0.001) (LE3) and a higher prevalence of vesico-sphincteric disorders compared to asymptomatic subjects (LE3). CONCLUSION: This review confirms that subjects suffering PGP present particular perineal characteristics regarding morphology and biomechanics. It would be interesting to develop clinical research concerning pelvic floor release effect in PGP.


Assuntos
Dor da Cintura Pélvica , Períneo/fisiopatologia , Fenômenos Biomecânicos , Feminino , Humanos , Dor da Cintura Pélvica/diagnóstico , Dor da Cintura Pélvica/etiologia , Gravidez , Avaliação de Sintomas
8.
J Gynecol Obstet Biol Reprod (Paris) ; 45(1): 29-35, 2016 Jan.
Artigo em Francês | MEDLINE | ID: mdl-25724600

RESUMO

OBJECTIVES: To evaluate the feasibility of outpatient laparoscopy in gynaecology. MATERIALS AND METHODS: This prospective monocentric study included 50 patients. Postoperative pain was evaluated by the visual analogic scale (VAS). Reasons for hospital stay and emergency consultation rates in the first postoperative month were noted. Patient's satisfaction was recorded at the postoperative visit one month after the intervention. RESULTS: The following procedures were included in the study: cystectomy, oophorectomy±salpingectomy, explorative laparoscopy for chronic pelvic pain and tubal sterilization. Mean operative time never exceeded 90 minutes (mean 60±26.5min). A resident performed 70% of the procedures. No intraoperative complication was reported. Only one patient stayed hospitalised overnight. On the first and second postoperative days, the VAS was 4.89 (±2.25) and 4.14 (±2.20) respectively. Twenty-five patients (50%) were very satisfied of the medical care, 23 patients (46%) were satisfied and one patient (2%) was not much satisfied. CONCLUSION: The outpatient laparoscopy in gynaecology seems feasible with a high level of satisfaction. It can be proposed to patients after good information.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/normas , Procedimentos Cirúrgicos em Ginecologia/normas , Laparoscopia/normas , Adulto , Estudos de Viabilidade , Feminino , Humanos , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Satisfação do Paciente , Estudos Prospectivos
9.
Prog Urol ; 25(9): 530-5, 2015 Jul.
Artigo em Francês | MEDLINE | ID: mdl-26032455

RESUMO

AIMS: To assess the prevalence of anal (AI) and urinary (UI) incontinence at medium term after 3rd and 4th degree anal sphincter tears and their impact on sexuality and women's quality of life. MATERIAL: It is a case-control, single center study. Sixty-eight primiparous women delivered with severe anal sphincter tear (exposed group) were compared to 136 women without (control group). Questionnaires on anal and urinary incontinence, sexual function and quality of life, using validated scores, were sent between two and five years after the first delivery. Maternal and obstetric data were collected retrospectively on the medical files. RESULTS: The answer rate was 22.5% (46/204) of which 30.9% (21/68) in the exposed group and 18.4% (25/136) in the unexposed group. In case of severe anal sphincter tear, 57.1% of women reported an AI vs 48% in the control group (P=0.76). The rate of AI for liquid stool was significantly higher in the exposed group (P=0.05). Patients with severe perineal tears reported a greater impact of symptoms on their quality of life but the difference with the control group was not significant. CONCLUSIONS: The severity of symptoms related to anal sphincter tears is common and underestimated. Preventive measures must be improved in order to maintain women's quality of life. LEVEL OF EVIDENCE: 4.


Assuntos
Canal Anal/lesões , Parto Obstétrico/efeitos adversos , Incontinência Fecal/etiologia , Períneo/lesões , Qualidade de Vida , Incontinência Urinária/etiologia , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Gravidez , Sexualidade
10.
Gynecol Obstet Fertil ; 42(12): 822-6, 2014 Dec.
Artigo em Francês | MEDLINE | ID: mdl-25456490

RESUMO

AIM: To study the impact of the use of glue instead of some laparoscopic sutures, on the operative time, the morbidity, and the short-term anatomical and functional results in the laparoscopic sacrocolpopexy (LSCP). PATIENTS AND METHODS: Thirty-two patients underwent a LSCP at Poissy-St-Germain-en-Laye University Hospital. The fixation of prostheses was made either exclusively by sutures (Group S), or by associating sutures (on traction sites) and biological glue (GroupC). Comparison was made after pairing on the number of prostheses associated surgery. Patients' satisfaction was assessed thanks to the validated PGI-I questionnaire. RESULTS: The mean operative time (178.7 [Group S] vs 173.1 minutes [Group C]) and the mean hospital stay (3.94 [Group S] vs 3.31 days [Group C]) were not significantly different. Anatomical results (POP-Q) and the mean satisfaction rate in the short-term were similar in both groups (1.67 [Group S] vs 1.30 [Group C]. Morbidity was also similar in both groups; no serious complications have been experienced. DISCUSSION AND CONCLUSION: The use of the glue in the LSCP did not significantly reduce the operative time. However, the use of glue for the adhesion of prostheses in addition to sutures has shown its safety and efficacy compared to the conventional technique (sutures exclusively) since the morbidity, the anatomical results and satisfaction rate are identical in the short-term. A study involving a larger number of patients with a longer follow-up seems necessary.


Assuntos
Adesivos , Laparoscopia/métodos , Prolapso de Órgão Pélvico/cirurgia , Idoso , Colo do Útero , Feminino , Humanos , Pessoa de Meia-Idade , Duração da Cirurgia , Satisfação do Paciente , Região Sacrococcígea , Telas Cirúrgicas , Suturas , Resultado do Tratamento
11.
Prog Urol ; 24(10): 646-50, 2014 Sep.
Artigo em Francês | MEDLINE | ID: mdl-25214294

RESUMO

AIMS: To assess the prevalence of urinary incontinence (UI) in a population of young nulliparous women and the effectiveness of self-perineal exercises in symptomatic women. MATERIAL: Three hundred and fifteen nulliparous students from French secondary establishments answered through a secure website, created for the study, an anonymous questionnaire about UI. The questionnaire included validated symptom scores (International Consultation on Incontinence Questionnaire-Short Form, ICIQ-UI SF) and quality of life (Contilife). Women who reported UI were asked to perform a self-perineal rehabilitation program for 8 weeks. A second questionnaire was completed after reeducation to assess the evolution of their UI. RESULTS: Among the 315 respondents, 92 women (29.2%) reported UI. The mean age was 23.0 (± 4.4) years in the continent group and 22.9 (± 3.6) years in the incontinent group. Only 24 of the 92 women with UI (26.1%) completed the reeducation program with a significant improvement in UI and quality of life (QoL). CONCLUSION: UI is a common disorder in young nulliparous women. Perineal self-exercises without the intervention of a professional could help to improve the disorders. LEVEL OF EVIDENCE: 5.


Assuntos
Terapia por Exercício , Incontinência Urinária/epidemiologia , Incontinência Urinária/terapia , Feminino , Humanos , Paridade , Períneo , Prevalência , Inquéritos e Questionários , Adulto Jovem
12.
Gynecol Obstet Fertil ; 42(2): 67-70, 2014 Feb.
Artigo em Francês | MEDLINE | ID: mdl-24468702

RESUMO

OBJECTIVE: Outpatient surgery is nowadays a major evolution axis of the surgery in France. Outpatient vaginal hysterectomy is possible with the use of electrosurgical bipolar vessel sealing allowing the reduction of operative time and postoperative pain. Our aim was to study the feasibility and morbidity of outpatient vaginal hysterectomy by assessment of postoperative pain and satisfaction. PATIENTS AND METHODS: Thirty patients were enrolled in this observational study. All patients underwent an outpatient vaginal hysterectomy with a standardized operative technic. Pain was evaluated by administering a 10 cm visual analogic scale (VAS) at the first and second postoperative days. The total duration of analgesic treatment was noticed. Patient's satisfaction was recorded at the postoperative visit one month after the intervention and by a telephonic interview. RESULTS: The mean operative time was 59.3 (25-110) minutes and the mean uterine weight was 170.2 (60-710) grams. No intraoperative complications were reported. Among the thirty patients, 3 (10%) were not discharged the same day. At the first and second postoperative days, the VAS was 4.40 and 4.35 respectively. The mean total duration of analgesic's use was 5 days (3-8 days). Patients were very satisfied of medical care in 36.7% of cases (11/30), satisfied in 53.3% (16/30) and not much satisfied in 10% (3/30). In total, 83.3% (25/30) have agreed to repeat the procedure in the ambulatory sector. DISCUSSION AND CONCLUSION: Outpatient vaginal hysterectomy seems to be a possible and a safe technique with a high patient's satisfaction in France at the present time.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , Histerectomia Vaginal/métodos , Adulto , Analgesia , Estudos de Viabilidade , Feminino , França , Humanos , Histerectomia Vaginal/efeitos adversos , Pessoa de Meia-Idade , Duração da Cirurgia , Medição da Dor , Dor Pós-Operatória/epidemiologia , Satisfação do Paciente
13.
Gynecol Obstet Fertil ; 41(7-8): 467-70, 2013.
Artigo em Francês | MEDLINE | ID: mdl-23867760

RESUMO

Pelvic organ prolapse is a common pelvic floor disorder in postmenopausal women. The literature is quite poor concerning the management of prolapse during pregnancy in young women. We report the case of a 39-year-old multiparous woman referred for the treatment of an exteriorized uterine prolapse at 13 weeks of gestation. The management of cervical prolapse depends on its stage, its evolution and on gestational age. It combines local antiseptics, rest and manual reintegration or reduction of the prolapsus using a pessary to prevent ulceration of the cervix. In case of stage IV (POP-Q) uterine prolapse, vaginal delivery may be compromised. No recommendation is actually available about route of delivery in case of exteriorized uterine prolapse. It should be clearly discussed regarding the potential risk of cesarean section for dystocia. Surgical repair of the prolapse will be discussed after childbirth according to functional impairment and women's desire for pregnancy.


Assuntos
Complicações na Gravidez/terapia , Prolapso Uterino/terapia , Adulto , Cesárea , Parto Obstétrico , Distocia , Feminino , Idade Gestacional , Humanos , Assistência Perinatal , Pessários , Gravidez , Prolapso Uterino/cirurgia
14.
J Gynecol Obstet Biol Reprod (Paris) ; 41(6): 587-90, 2012 Oct.
Artigo em Francês | MEDLINE | ID: mdl-22921158

RESUMO

Cervical pregnancy is a rare form of ectopic pregnancy defined by the implantation of the blastocyst in the cervical canal. Most of the cervical pregnancies have been reported in patients with a history of vacuum curettage or caesarean section. The authors report a case of cervical pregnancy occurred after a failure of medical abortion. A literature review discusses the possibility of a cervical secondary implantation and describes the management of such pregnancies.


Assuntos
Aborto Induzido/efeitos adversos , Aborto Retido/diagnóstico , Gravidez Ectópica/induzido quimicamente , Abortivos/efeitos adversos , Aborto Retido/etiologia , Aborto Retido/cirurgia , Adulto , Colo do Útero , Implantação do Embrião/fisiologia , Feminino , Humanos , Histerectomia , Gravidez , Gravidez Ectópica/diagnóstico , Gravidez Ectópica/etiologia , Gravidez Ectópica/cirurgia
15.
Gynecol Obstet Fertil ; 39(1): 42-8, 2011 Jan.
Artigo em Francês | MEDLINE | ID: mdl-21185762

RESUMO

Transvaginal ultrasound is the first line imaging investigation in gynaecology. It was thus introduced for the exploration of female stress urinary incontinence at the beginning of the 1980s. Various techniques and parameters of ultrasound examination have been used for the assessment of bladder neck mobility. The aim of this literature review was to suggest the adequate ultrasound technique to study bladder neck mobility. We reviewed articles indexed in MEDLINE dealing with urogenital ultrasound and published between 1998 and 2008. The bladder-symphysis distance measured by transperineal ultrasound is a reliable and reproductive tool to study female stress urinary incontinence. Despite a lack of standardization of Valsalva manoeuvre, normal bladder neck mobility is estimated between 15 and 20 mm. Furthermore, in case of complications from stress urinary incontinence surgery, ultrasound is considered as the first line imaging test. Perineal ultrasound is an interesting investigation for preoperative assessment of stress urinary incontinence or in case of surgery failure or complications. This suggests the need for wider diffusion of this technique in urogynecology teams.


Assuntos
Ureter/diagnóstico por imagem , Ureter/fisiopatologia , Bexiga Urinária/diagnóstico por imagem , Bexiga Urinária/fisiopatologia , Incontinência Urinária por Estresse/diagnóstico por imagem , Incontinência Urinária por Estresse/fisiopatologia , Feminino , Humanos , Ultrassonografia/métodos
16.
J Gynecol Obstet Biol Reprod (Paris) ; 38(8 Suppl): S166-73, 2009 Dec.
Artigo em Francês | MEDLINE | ID: mdl-20141915

RESUMO

BACKGROUND: Female urinary incontinence raises various physiopathological mechanisms which can be investigated by urodynamics. The aim of this work is to specify the validity and the relevance of the various urodynamic parameters used in clinical practice. METHODS: A bibliographical research was realized on the basis of Medline data from original articles dealing with the incontinence in the absence of genital prolapse. CONCLUSIONS: Urodynamic examination has to contain uroflowmetry, post void residual, filling cystometry with detrusor pressure measurements during micturition, urethral pressure profile with maximal urethral closure pressure (MUCP) and Valsalva leak point pressure (VLPP). A urodynamic examination is not necessary before conservative treatment of urinary incontinence in the female. A complete urodynamic examination is recommended before any decision of surgical correction of urinary incontinence and in case of surgical failure.


Assuntos
Incontinência Urinária/diagnóstico , Incontinência Urinária/fisiopatologia , Urodinâmica , Feminino , Humanos , Guias de Prática Clínica como Assunto
17.
Prog Urol ; 18(7): 483-5, 2008 Jul.
Artigo em Francês | MEDLINE | ID: mdl-18602612

RESUMO

Complete necrosis of the penis and scrotum due to strangulation of the external genitalia is unusually encountered in urologic emergencies. Urological conservative management is recommended. Delayed presentation is a major source of complications. We report the case of a psychotic patient, who was transferred from the emergency department in a context of complete necrosis of the external genitalia. This patient's history included chronic psychotic disorder and positive HIV serology, but he refused to take either neuroleptic or antiretroviral therapy. Complete amputation of the penis and bilateral orchidectomy were performed. We report the first six months of medical management.


Assuntos
Orquiectomia , Pênis/patologia , Pênis/cirurgia , Transtornos Psicóticos , Testículo/patologia , Adulto , Amputação , Emergências , Seguimentos , Soropositividade para HIV , Humanos , Masculino , Necrose , Fatores de Tempo , Resultado do Tratamento
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