[Epidemiology, etiology and psychosocial impact of urogenital fistulas in a cohort of 170 consecutive patients managed in three treatment centers in Burkina Faso from 2010 to 2012]. / Aspects épidémiologiques, étiologiques et impact psychosocial des fistules urogénitales dans une cohorte de 170 patientes consécutives, prises en charge dans trois centres du Burkina Faso de 2010 à 2012.

OBJECTIVE: To describe the socio-demographical aspects, etiologies and psychosocial consequences of urogenital fistula patients (UGF) in Burkina Faso (BF). PATIENTS AND METHODS: Descriptive study of a cohort of consecutive patients during a period of 18 months (December 1st 2010 to August 31st 2012) in three centers of treatment in BF. Each patient has had a standardized complete medical observation focused on sociodemographics, clinical finding, past medical history and etiologies of UGF. Some patients had an interview with a psychologist. RESULTS: One hundred and seventy patients with mean age 35 years (minimum: 16, maximum: 70) were enrolled during the study period. The majority of patients were housewives (90.5%, n=152) and illiterates (92.9%, n=158). Among the patients, 62.4% (n=106) lived in rural zones. Obstetrical fistula was the most common cause of UGF (87.6%, n=149) in our study and prolonged labor occurred in 93.3% (n=139) of cases with 17.5% (n=26) who delivered at home. The majority of our cases were vesico-vaginal fistula (70.6%, n=120). Fifty-five patients (32.4%) were divorced after the fistula. The sensation of humiliation and sadness were noted at all the patients who had a psychological evaluation and 87.5% (n=14) of them have had suicidal ideas. CONCLUSION: The UGF are frequent in Burkina Faso and obstetrical etiology is dominant. The physical and psychosocial repercussions are important for the women victims of this pathology. LEVEL OF EVIDENCE: 4.

Comparison between trans-obturator trans-vaginal mesh and traditional anterior colporrhaphy in the treatment of anterior vaginal wall prolapse: results of a French RCT.

INTRODUCTION AND HYPOTHESIS: To compare the efficacy of a collagen-coated polypropylene mesh and anterior colporrhaphy in the treatment of stage 2 or more anterior vaginal wall prolapse. METHODS: Prospective, randomized, multicenter study conducted between April 2005 and December 2009. The principal endpoint was the recurrence rate of stage 2 or more anterior vaginal wall prolapse 12 months after surgery. Secondary endpoints consisted of functional results and mesh-related morbidity. RESULTS: One hundred and forty-seven patients were included, randomized and analyzed: 72 in the anterior colporrhaphy group and 75 in the mesh group. The anatomical success rate was significantly higher in the mesh group (89%) than in the colporrhaphy group (64%) (p = 0.0006). Anatomical and functional recurrence was also less frequent in the mesh group (31.3% vs 52.2%, p = 0.007). Two patients (2.8%) were reoperated on in the colporrhaphy group for anterior vaginal wall prolapse recurrence. No significant difference was noted regarding minor complications. An erosion rate of 9.5% was noted. De novo dyspareunia occurred in 1/14 patients in the colporrhaphy group and in 3/13 patients in the mesh group. An analysis of the quality of life questionnaires showed an overall improvement in both groups, with no statistical difference between them. Satisfaction rates were high in both groups (92% in the colporrhaphy group and 96% in the mesh group). CONCLUSION: Trans-obturator Ugytex mesh used to treat anterior vaginal wall prolapse gives better 1-year anatomical results than traditional anterior colporrhaphy, but with small a increase in morbidity in the mesh group.

[Bowel injuries after port insertion in laparoscopy. Gynerisq's database analysis]. / Plaies digestives à l'insertion des trocarts en cœlioscopie. Analyse de la base de données de retour d'expérience de Gynerisq.

INTRODUCTION: Port insertion is a high-risk period during laparoscopy. The French Gynecologist and Obstetricians College (CNGOF) published recommendations in 2010 to minimize those risks. The aim of our analysis was to establish the accidents' circumstances and consequences and to determine if those incidents could have been depending on whether recommendations had been respected or not. MATERIAL AND METHODS: Gynerisq is an approved organism by the Haute Autorité de santé (HAS). Its mission is to evaluate and improve practices by a risk management centered approach. We analysed incidents reported by Gynerisq's adherents in an experience report database. RESULTS: Above 114 incidents analysed in the Gynerisq's database, we reported 31 bowel injuries. Those injuries occurred for 77.4% (24/31) during planned interventions. For 32.3% of the cases (10/31), interventions were judged complex by the surgeons. A total of 54.8% (17/31) of the patients had a history of laparotomy. Above 27 injuries occurred during Veress needle or open laparoscopy, 17 could have been avoided regarding to the surgeon. The causes reported were in 10 cases that the recommendations had not been respected, in 2 cases another cause and in 5 cases no causes were given to explain the incident. CONCLUSION: Our analysis shows that bowel injuries after port insertion, in open laparoscopy or Veress needle use, do not seem to occur only in an emergency context or during complicated interventions. However, most of the incidents occurred for patients with risk factors.

[A case of disseminated Encephalitozoon intestinalis microsporidiosis in an AIDS patient in Nîmes]. / Un cas de microsporidiose disséminée à Encephalitozoon intestinalis au cours d'un SIDA à Nîmes.

The pathogene's role importance of the microsporidia in nature is considerable. The human being, easily in contact, presents clinical manifestations only with some of them and in a very occasional manner. The increased frequency of the immunodepression has permitted to describe recently a new protozoon, Encephalitozoon intestinalis (alias Septata intestinalis) of the family of the Glugeidae and the human illness of which it is the agent. This parasitose is interesting to be presented because of its rarity and its circulation to organs far from one another. The diagnostic has been done thanks to the only optic microscope and confirmed from its visible efficacity of one cure of albendazole. The pyrimethamine could present a relative efficiency on a relapse of the sinusitis.

[Is human Dirofilaria (Nochtiella) repens parasitosis mor frequent than it appears on the Mediterranean coast?]. / La parasitose humaine par Dirofilaria (Nochtiella) repens est-elle plus fréquente qu'il ne paraît sur les rivages méditerranéens?

Some observations of human parasitism by Dirofilaria (Nochtiella) repens are frequently enough reported but they are also individually reported by different authors. Nïmes's geographical situation makes of it a privileged observatory for this helminthiasis. The worm's maturity varies depending on the subjects: the sensitivity of those and the clinical reactions are of a large variety. The ones that seem to be constant are the parasit's migrations in the different territories during a lot of months. It is the case in the observation reported here; in another article, we have shown the possibility of an intraperitoneal migration which discovery can be only of an extreme fate. Next to some noisy manifestations, other cases stayed quiet advise the adaptation of some autochtones submissed to iteratif infestations.

[Transobturator subvesical mesh. Tolerance and short-term results of a 103 case continuous series]. / La prothèse sous-vésicale transobturatrice. Tolérance et résultats à court terme d'une série continue de 103 cas.

OBJECTIVE: Native tissue plasty for surgical repair of anterior prolapse segment is associated with high level of recurrent defects. MATERIAL AND METHODS: We used a transvaginal polypropylen tension-free mesh fixed through the obturator hole with Emmet needle. We report the results of a total of 103 consecutive transobturator mesh fixations between January 1, 2000 and June 30, 2002. RESULTS: Vaginal erosion ratio is 5% and recurrence ratio is 3% at 18 months post operative follow-up. CONCLUSION: Transobturator mesh is a safe and efficient method for anterior segment prolapse repair.