[Endometrial ablation using hydrothermablator: results of a French multicenter study]. / Thermodestruction endométriale par la technique HTA (HydroThermAblator): résultats d'une étude multicentrique française.

OBJECTIVE: To evaluate the reproducibility, the feasibility and the functional results of the HydroThermAblator (HTA) technique. PATIENTS AND METHODS: This is a retrospective multicenter study in which 143 patients were enrolled in six French medical centers. Patients suffering from dysfunctional and heavy uterine bleeding were treated using the HTA technique between June 2003 and June 2005. A preoperational questionnaire describing the symptoms as well as a qualitative assessment of bleeding was filled. We report the surgical conditions as well as the per- and postoperative complications. We analyzed the level of patient's satisfaction with this technique using a postoperative questionnaire. RESULTS: The average patient's age was 48 years (37-67 years). Patients described their bleeding as being very significant in 46% of the cases, significant in 36%, normal but postmenopausal in 11% of the cases and unknown in 7% of the cases. Previous treatment for bleeding was prescribed in 42.4% of cases. Forty-two decimal four percent of the patients had myomas on preoperative ultrasound examinations. Four minor operative complications were encountered. Thirteen patients had postoperative complications, most of which were described as pelvic pain. Mean postoperative follow-up time was nine months. There were 72.7% of the patients who were satisfied with the procedure. Forty-four percent of the patients were amenorrheic, 37% were oligomenorrheic and 13% were eumenorrheic. Seven patients underwent hysterectomy. The indication for hysterectomy in half of these patients was persistent menorrhagias. DISCUSSION AND CONCLUSION: The hydrothermablator is a simple and efficient endometrial ablation technique for patients suffering from menometrorrhagias. This technique can be used in patients with uterine myomas and irregular uterine cavity. Hydrothermablation must be carried out under hysteroscopic control, which allows to assess treatment success at the end of the intervention. Histology is compulsory (with the exception of patients with metrorrhagia only), all the more so as cancer cases can remain undiscovered.

[Levonorgestrel-releasing intrauterine system in the treatment of dysfunctional uterine bleeding: A French multicenter study]. / Efficacité et tolérance du système intra-utérin au lévonorgestrel dans la prise en charge des ménorragies fonctionnelles: étude française multicentrique.

OBJECTIVE: To evaluate the levonorgestrel-releasing intra-uterine system as an alternative to surgical treatment in patients presenting with menorrhagia. PATIENTS AND METHODS: In the set of a prospective multicenter study, 49 patients with menorrhagia resistant to medical treatment and/or referred for hysterectomy or endometrial ablation were included. Medical visits were organized 3, 6, 12, 24 and 36 months after insertion of the levonorgestrel-releasing intra-uterine system. Visual score of menstrual bleeding and satisfaction index were noted on each visit. Transvaginal ultrasound, pap smear, endometrial biopsy, and clinical data were retrieved one month before and 12 months after inclusion for tolerance evaluation. RESULTS: Renouncement rate was 90.0% (95% CI = 80.7-96.6%). After a twelve months follow-up, 86.1% of patients were satisfied or very satisfied with their clinical state. We found a significant increase of hemoglobin rates from baseline (14,0 versus 12,9 g/dl; P < 10(-4)). Similar increases were also found in serum iron and ferritin. DISCUSSION AND CONCLUSION: This study confirms the efficacy of the levonorgestrel-releasing intra-uterine system in the control and reduction of menstrual blood loss in patients with dysfunctional uterine bleeding. The high rate of surgery cancellation is a proof of the potential role of the levonorgestrel-releasing intra-uterine system as an alternative treatment in these patients.

[Modalities and limits of conservative treatment of adenocarcinoma in situ of the uterine cervix: analysis of nine cases and review of the literature]. / Modalités et limites du traitement conservateur des adénocarcinomes in situ du col utérin : analyse de neuf cas et revue de la littérature.

OBJECTIVE: The aim of this study is to assess the results of conservative management of adenocarcinoma in situ (AIS) of the uterine cervix in young patients. PATIENTS AND METHODS: Data of 16 patients treated for AIS were reviewed: 10 were treated initially conservatively (cold knife conization in five patients, loop excision in three patients and cervical amputation in two patients) and six radically. One patient treated initially conservatively with loop excision and positive margins underwent a completion surgery (hysterectomy). RESULTS: None patient had recurrence whatever the type of surgery (radical or conservative) with a mean follow-up of 74 months. Two pregnancies were observed. DISCUSSION AND CONCLUSIONS: Conservative surgery for patients with AIS could be considered in young patients. But [for] reviewing literature several conditions should be respected: careful follow-up after conservative treatment; cold knife conization; length of cone specimen >25 mm and free margins. If those criteria are respected the risk of recurrent disease under the form of invasive carcinoma is low.

[Isolated antenatal pyelic dilatation: postnatal follow-up and care for vesico-ureteral reflux]. / Dilatations pyéliques isolées: diagnostic prénatal, suivi postnatal et prise en charge des reflux vésico-urétéraux.

OBJECTIVE: To assess the risk of aneuploidia in case of isolated antenatal pyelic dilatation and to detail urological care for these children. METHODS: Prenatal and postnatal follow-up was analyzed in 350 cases. RESULTS: The overall rate of chromosome anomalies was 1.3%. Trisomy 21 was found alone in one case (0.3%). The sex ratio was 26% girls and 74% boys. Vesico-ureteral reflux was similar in both sexes (13%). CONCLUSION: The question of proposing karyotyping in case of isolated pyelic dilatation remains unsolved because minimal subjective signs such as slightly excessive amniotic fluid can completely change the assessment of the risk of aneuploidia. The frequency of postnatal vesico-ureteral reflux associated with prenatal pyelic dilatation warrants complete prenatal ultrasound screening.