ABSTRACT
The follow-up of premature rupture of membranes requires an hospitalization. The aim of this work was to evaluate the interest of the Prom-Test in the action to be taken in the case of a suspicion of premature rupture of membranes, a negative result allowing to not hospitalize the patient. 105 tests have been carried out producing 73 negative results, 23 positive and 9 doubtful. The childbirth, started or not, occurred much more quickly when the test is positive. Only 13 of the 73 negative tests resulted in a hospitalization including 11 for beginning of delivery. A correct use of the test can prevent unnecessary days of hospitalization.
Subject(s)
Fetal Membranes, Premature Rupture/diagnosis , Adult , Female , Follow-Up Studies , Humans , Pregnancy , Prospective StudiesABSTRACT
UNLABELLED: Burch colpo-suspension, which is the present gold standard for treatment of stress urinary incontinence, may be performed laparoscopically. STUDY AIM: The aim of this retrospective study was to report the results of laparoscopic Burch colpo-suspension with a 30-month follow-up and to assess the reason for the unsuccessful results. PATIENTS AND METHOD: From 1990 to 1999, 118 patients (mean age: 46 years) were operated on for stress urinary incontinence with laparoscopic colpo-suspension. Urinary incontinence was classified grade 1 (6%), 2 (67%) and 3 (27%). The Burch colpo-suspension was performed through extraperitoneal approach in 51% and transperitoneal in 49%. A genital prolapse was associated in 31% of the patients and treated with sacropexy. A subtotal hysterectomy was performed in 25% of the patients and a vaginal hysterectomy in 46%. RESULTS: Global morbidity rate was 19%, including four cases of bladder injury. With a 30-month follow-up, 76/118 (64.4%) had no more urinary incontinence. Parity, age, previous pelvic surgery, detrusor instability and low urethral closure pressure were not predictive of recurrent stress urinary incontinence after treatment. Associated sacropexy was only correlated with a high risk of failure (P = 0.04). Patients with hysterectomy had significantly better results (72% vs 41.9%) (P = 0.05). Trans- and extraperitoneal techniques had similar results (P = 0.7). CONCLUSION: With a 30-month follow-up, 64.4% of the patients had satisfactory results with strictly no more stress urinary incontinence. There was no significant difference between the trans- and the extraperitoneal approach. Sacropexy was only associated with a higher rate of failure.
Subject(s)
Colposcopy/methods , Urinary Incontinence, Stress/surgery , Adult , Age Factors , Aged , Colposcopy/adverse effects , Female , Humans , Hysterectomy/statistics & numerical data , Middle Aged , Morbidity , Parity , Predictive Value of Tests , Recurrence , Retrospective Studies , Risk Factors , Severity of Illness Index , Treatment Outcome , Urinary Incontinence, Stress/classification , Urinary Incontinence, Stress/etiology , UrodynamicsABSTRACT
New methods of staging (MRI, laparoscopic surgery) and therapy (concomitant radio-chemotherapy, debulking of diseased nodes), with a trend towards the reduction of the aggressivity of surgical procedures (minimal access surgery, ovarian preservation, reduction of the extent of radical hysterectomy, uterine conservation) may and should by integrated in new therapeutic protocols. As a consequence, the management of invasive cervical cancer becomes even more multidisciplinary and specialized.
