[Abdominal approach of rectocele and colpocele]. / Approache abdominale des rectocèles et des élytrocèles.

The authors report a series of 62 female patients operated for rectocele and/or elytrocele via an abdominal approach. The technique was based on insertion of a retrovaginal prosthesis attached to the sacrum. Other surgical procedures can be performed at the same operation: hysterectomy, insertion of a prevaginal prosthesis, retropubic colpopexy. The anatomical and functional results were excellent in these patients previously operated for urinary incontinence or prolapse (99%). The indication for total hysterectomy during the same operation must be limited as this procedure increases the morbidity and impairs the functional results. Dyschexia is improved, but may be followed by postoperative constipation. Abdominal treatment of rectoceles and/or elytroceles by interposition of an interrectovaginal prosthesis attached to the sacrum is particularly indicated after hysterectomy in the case of associated or recurrent genitourinary prolapse.

[A new treatment procedure for stress urinary incontinence: sub-urethral support using a Prolene sling under local anesthesia]. / Un nouveau procécé de traitement de l'incontinence urinaire d'effort (IUE): soutènement sous-urétral par une bandelette de Prolene sous anesthésie locale.

An original technique for the treatment of USI under local anaesthesia is described. It consists of insertion of a Prolene sling under the middle part of the urethra. This sling is not placed under tension, but simply supports the suburethral region. In a series of 22 patients without prolapse requiring surgical correction and presenting USI confirmed by clinical examination, 20 were totally cured by this technique and the postoperative voiding flow rate was not decreased. This technique therefore appears to be simple, non-dysuric and effective.

[A new treatment procedure in stress urinary incontinence (SUI): suburethral prolene sling under local anesthesia]. / Un nouveau procédé de traitement de l'incontinence urinaire d'effort (IUE) : soutènement sous-urétral par une bandelette de Prolène sous anesthésie locale.

An original technique for the treatment of USI under local anaesthesia is described. It consists of insertion of a Prolene sling under the middle part of the urethra. This sling is not placed under tension, but simply supports the suburethral region. In a series of 22 patients without prolapse requiring surgical correction and presenting USI confirmed by clinical examination, 20 were totally cured by this technique and the postoperative voiding flow rate was not decreased. This technique therefore appears to be simple, non-dysuric and effective.

[Exploration of urinary incontinence in women]. / Exploration des incontinences urinaires de la femme.

The diagnosis of urinary incontinence is based on history and physical examination. For the patient, the incontinence is related with a wet vulva, but history differentiate stress from urge incontinence and note the associated urinary symptoms and alterations in bowel habit or sexual function. Physical examination confirms urinary incontinence and assess pelvic prolapses, perineal, muscle tone and skin condition. Specialized tests include imaging and urodynamic tests. Imaging tests are dynamics and identify the position and the aspect of the bladder neck during resting and straining view. Urodynamic tests are designed to determine the functional status of the bladder. They assess the detrusor function, the urethral pressure, the transmission of the pressure from the bladder to the urethra. After clinical evaluation and specialized tests, the urinary incontinence could be identified and evaluated so that an adapted treatment can be proposed.

[Surgical treatment of genito-urinary prolapse by abdominal approach with promotofixation and setting of an anterior subvesical prosthesis combined with retropubic colpopexia: anatomical and functional results in 104 patients]. / Traitement chirurgcal des prolapsus génito-urinaires par voie abdominale avec promontofixation et mise en place d'une prothèse antérieure sous-vésicale associées à une colpopexie rétropubienne: résultats anatomiques et fonctionnels chez 104 patientes.

A homogeneous series of 104 patients with genito-urinary prolapse or urinary incontinence is reported. Surgical treatment combined promotofixation with (n = 45) or without (n = 59) subtotal hysterectomy, retropubic colpopexia and in certain cases posterior colpoperineorraphia with myorraphia of the levator ani (n = 28). Anatomic results were excellent for bladder and uterine ptosis. Moderate results were obtained for rectoceles and procedures involving the posterior perineum. A rectovaginal prosthesis or complete repair of the rectovaginal wall appeared to be required to improve results for rectoceles. Urine function was good for urinary incontinence: 91% success. Results depended on the pressure of the uretral closure. A complete urodynamic work-up is required prior to surgery in case of sphincter failure. Poor results were also related to excessive posterior traction which can open the cervico-uretral angle. Treatment of genito-urinary prolapse with promotofixation in combination with retropubic colpopexia is a reliable reproducible technique which gives excellent long-term results if excessive promontory traction is avoided and if, in certain cases, the rectovaginal wall is repaired or a prosthesis implanted when maximum uretral closure pressure is weak.