ABSTRACT
Resection of endometriosis nodules infiltrating the bladder is routinely performed by laparoscopy. However, laparoscopic resection may lead to inadvertent loss of healthy bladder tissue. Conversely, when bladder nodules are treated by cystoscopy alone, resection may be incomplete. A combined laparoscopic-cystoscopic approach allows safe and controlled resection. The video reports the procedure performed in a 33 year-old primipara who presented with a 40mm bladder nodule. The laparoscopic step is carried out by the gynecologist, who separates the bladder from the uterus and opens the vesico-vaginal space. Concomitantly, the urologist identifies and circumscribes the nodule's limits by cystoscopy. Then, the gynecologist identifies the circular incision previously performed, and completes the resection. The bladder defect is sutured. Early and mid-term postoperative outcomes were uneventful. In patients with large nodules of the bladder, combined laparoscopic-cystoscopic approach allows complete resection of endometriosis lesion, preserves healthy bladder tissue and avoids inadvertent injury of ureters.
Subject(s)
Cystoscopy/methods , Endometriosis/surgery , Gynecologic Surgical Procedures/methods , Laparoscopy/methods , Peritoneal Diseases/surgery , Urinary Bladder Diseases/surgery , Adult , Combined Modality Therapy/methods , Endometriosis/pathology , Female , Humans , Peritoneal Diseases/pathology , Rectal Diseases/pathology , Rectal Diseases/surgery , Urinary Bladder/pathology , Urinary Bladder/surgery , Urinary Bladder Diseases/pathologyABSTRACT
OBJECTIVES: Although the benefit of magnesium sulfate to prevent cerebral palsy in antenatal on very preterm infants has been shown, there is still reluctance to use it. The aim of this study was to conduct an assessment of our practice using magnesium sulfate to prevent cerebral palsy at Rouen University Hospital to report its feasibility and safety in order to spread its use. METHODS: Unicentric and retrospective study, at the University Hospital of Rouen, between January and June 2014. All patients who delivered before 33 weeks or considered at risk of imminent delivery before 33 weeks were included (n=86). RESULTS: Among the patients who delivered before 33 weeks (n=82), a magnesium sulfate loading dose was administrated in 91.5% of cases. Treatment was mainly established and monitored by midwives (98.6%), usually in the delivery room (82.4%), and with an average duration of administration of 8.9±17.5hours. The treatment had to be stopped in a patient who presented bradypnea associated with impaired consciousness. CONCLUSION: Our study shows that magnesium sulfate can easily be prescribed in clinical practice.
