Transperineal ultrasound in routine uterine cervix measurement.

PURPOSE: Transvaginal ultrasound (TVUS) is used in routine practice to evaluate cervical length (CL). This technique is nevertheless invasive and often viewed as uncomfortable, which is less the case with transperineal ultrasound (TPUS). This study was conducted in light of recent technological improvements in the ultrasound field to evaluate whether TPUS could be used as an alternative to TVUS in CL assessment. METHODS: This was a prospective single-blind study. Pregnant women requiring CL measurement during their emergency consultation were offered a second assessment by TPUS after an initial TVUS. TPUS was performed by a third-year OBGYN resident, unaware of the CL measurement obtained via TVUS. RESULTS: Seventy-three women were included. The mean ∂ was 0.59 mm. The interclass Pearson correlation coefficient between the two techniques was 0.8987 (95% CI [0.8429; 0.9353]). None of the tested factors were found to be associated with a difference between TPUS and TVUS CL measurements. ROC curve analysis indicated that a transperineal CL cut-off measurement of 24.9 mm was predictive of a transvaginal CL measurement below 25 mm. This threshold enabled a 95% sensitivity [75.1-99.9%] and a 100% specificity [93.3-100%] for the TPUS CL measurement technique. CONCLUSION: TPUS should be acknowledged as a reliable alternative to TVUS for CL assessment in routine every day practice.

Practice and expectations regarding simulation for residents in obstetrics and gynecology.

BACKGROUND: Simulation now has an important role in theoretical and practical aspects of medical education and training. METHODS: We performed an epidemiological, observational, multicenter study based on nationwide data collection. French obstetrics and gynecologic residents were invited to complete an anonymous survey. RESULTS: We received 305 answers. The most frequently offered gynecology sessions were laparoscopy on pelvitrainer (76%) and pelvic ultrasound (60%) while the most frequently offered obstetric sessions were breech delivery (61%), shoulder dystocia (62%) and postpartum hemorrhage (68%) managements. Regarding session frequency, 29.1% of residents thought that one session per month would be ideal. Two hundred and sixty three residents (96%) considered that simulation-training sessions were beneficial. One hundred and thirty-six residents (49%) had an opportunity to repeat sessions and a majority of them (96%) found a daily benefit following a training simulation session. CONCLUSION: Simulation programs were extremely popular among the surveyed residents. To improve OBGYN resident training, simulation should be an integral part of residency programs.

Risk factors for failed chorionic villus sampling: results of a 4-year retrospective study.

OBJECTIVES: Chorionic villus sampling (CVS) allows for earlier results for aneuploidy or genomic abnormalities compared to amniocentesis. Nevertheless, the inability to provide complete results has been described as being more frequent with CVS. This study was conducted in order to identify risk factors for such failures. STUDY DESIGN: A retrospective single-center study was performed from January 2014 to December 2018. Participants were divided into two groups depending on whether complete CVS results were issued ("successful CVS group") or not ("failed CVS group"). Failure affected preliminary short-term cultures, long-term cultures, or both. RESULTS: During the study period, 214 CVS were performed, 73 (34%) of which were classified in the failed CVS group. We observed significant intergroup differences between the successful and failed CVS groups for four variables: BMI (respectively 23.9 [±5.88] and 25.9 [±6.13] kg/m2), term at sampling (12.9 [±1.35] and 12.6 [±1.09] weeks gestation), trophoblastic location (posterior in 49 [40%] and 37 [66%] cases), and sampling approach (transcervical in 54 [43%] and 36 [64%] cases) (p < .05). In a stepwise binary logistic regression analysis, higher BMI, posterior trophoblastic location, and transcervical sampling approach were the only variables negatively influencing CVS success, with respective aOR [95% CI] of 0.947 [0.898; 0.996], 0.322 [0.160; 0.634], and 0.466 [0.238; 0.900]. CONCLUSIONS: In the presence of CVS failure risk factors, a discussion could be initiated regarding a deferred amniocentesis as a first option.

General practitioners and endometriosis: Level of knowledge and the impact of training.

OBJECTIVE: To assess general practitioners' (GPs') knowledge of and practice in the diagnosis and management of endometriosis following the publication of updated French national guidelines in 2017. MATERIALS AND METHODS: A descriptive, anonymous, epidemiological survey of 102 GPs in the Picardie region of France. RESULTS: Only 25% of the GPs considered that they knew enough about endometriosis for their routine clinical practice. This proportion was 58.9% amongst GPs with an university diploma in gynaecology and 31.4% amongst those participating in continuing medical education courses on gynaecology. Only 19.6% of the GPs were aware of the updated French national guidelines. With regard to five main suggestive, localizing signs of endometriosis, dyspareunia, dysmenorrhoea and infertility were mentioned as being of diagnostic value by 55.9%, 37.3% and 43.1% of the GPs, respectively; in contrast, functional urinary tract disorders and painful defecation were not mentioned very often. GPs with a qualification in gynaecology and those participating in continuing medical education in gynaecology knew more about treating endometriosis. CONCLUSION: In the Picardie region of France, GPs appear to be only moderately aware of how to manage endometriosis; this probably contributes to the diagnostic delay associated with this condition. GPs with a university diploma in gynaecology and those participating in continuing medical education in gynaecology appeared to have a better grasp of the subject. Continuing medical education on this topic should therefore be promoted and expanded.

Value of large loop excision of the transformation zone (LLETZ) without histological proof of high-grade cervical intraepithelial lesion: Results of a two-year continuous retrospective study.

OBJECTIVE: Large loop excision of the transformation zone (LLETZ) conization has been associated with adverse obstetrical outcomes. In an approach to reduce the number of performed LLETZ procedures, we conducted this study to evaluate whether "diagnostic" LLETZ should still be performed, by analyzing their yield in terms of detection (and treatment) of real high-grade squamous intraepithelial lesion (HSIL). METHODS: During a two-year study period, all patients who underwent a LLETZ procedure in our institution were retrospectively included. Study participants were divided into two groups according to LLETZ indication: a biopsy-proven HSIL group, and a non-biopsy-proven HSIL group. The results of the final histological examination were recorded, as well as excision margin status and specimen dimensions. RESULTS: During the two-year study period, 396 LLETZs were performed, 283 (71%) of which were indicated by biopsy-proven HSIL. In the non-biopsy-proven group, final histology showed 50 cases of HSIL (44%) and 4 cases of carcinoma (3.6%), versus respectively, in the biopsy-proven group, 221 (78%) HSIL and 28 (9.9%) carcinoma (p<0.001). Regarding margin status and specimen dimensions, no intergroup difference was observed between the two groups. CONCLUSION: So called "diagnostic" LLETZ allowed the detection of severe cervical lesions in almost half of cases, without increasing specimen dimensions in comparison with classical conization indications. Moreover, they also allowed an efficient treatment as showed by similar margins status. Our results therefore strengthen the idea that "diagnostic" LLETZ, when specific indications are respected, should not be overlooked as a major part of our therapeutic arsenal.

Can certain factors for recurrence of placenta-mediated pregnancy complications be identified after an initial small-for-gestational-age birth?

Introduction: After a small-for-gestational-age (SGA) birth, recurrence of placenta-mediated pregnancy complications (PMPCs) is a cause for anxiety when contemplating another pregnancy. We sought to identify factors potentially associated with this recurrence.Material and methods: This retrospective single-center observational study was conducted in a tertiary maternity unit between 1 January 2010 and 31 December 2017. We included all women having experienced a non-syndromic SGA birth and who were subsequently monitored for at least one other pregnancy in our institution. PMPCs were defined as recurrent SGA births, three consecutive first-trimester miscarriages, or preeclampsia.Results: Ninety-four women were included over a 7-year study period. Recurrent PMPCs were recorded in 30 (32%) cases, of which 29 featured recurrent SGA births. None of the following characteristics were significantly associated with recurrence: presence of preeclampsia during the initial pregnancy (six [20%] versus 25 [39%] cases in the recurrent PMPCs and non-recurrent PMPCs groups, respectively; p = .11), results of the histopathologic placental examination or thrombophilia screen, or implemented treatment during subsequent pregnancies.Conclusions: PMPCs recur frequently. No risk factor for recurrence was identified in our study. Results of etiologic assessments and treatments implemented after an initial SGA birth should therefore not modify level of clinical and ultrasound monitoring provided during subsequent pregnancies.Rationale: Recurrence of placenta-mediated pregnancy complications is a cause for anxiety when contemplating another pregnancy. We did not identify any risk factor after an initial small-for-gestational-age birth in our study; surveillance should therefore not be modified by the etiologic assessments' results.

Risk factors for unsatisfactory colposcopy after large loop excision of the transformation zone: The results of a four-year multicenter prospective study.

OBJECTIVES: Not being able to completely examine the cervical squamocolummar junction (SCJ) in colposcopy after large loop excision of the transformation zone (LLETZ) is an important issue regarding surveillance, as high-grade cervical intra-epithelial neoplasia recurrence risk is high. This study was conducted in order to identify risk factors for post-LLETZ unsatisfactory colposcopy. METHODS: This prospective multicenter observational study was performed in nine French University hospitals, with inclusions running from December 2013 to December 2017. All patients scheduled for LLETZ were included and were divided into two groups after the two to four months post-procedure colposcopic examination: a satisfactory and an unsatisfactory post-LLETZ colposcopy group. RESULTS: In total, 601 cases were analyzed and 71 post-LLETZ colposcopies (12%) were described as unsatisfactory (including 19 cervical stenosis). In a univariate analysis, we only observed a statistically significant increase of the following parameters in the unsatisfactory post-LLETZ group in comparison with the satisfactory post-LLETZ group: parity (2.11 [±1.55] and 1.49 [±1.24] respectively, p < .01), depth of the LLETZ specimen (10.9 mm [±3.37] and 9.76 [±3.79] respectively, p < .01), age (45.9 years [±11.7] and 37.9 [±9.42] respectively, p < .001) and an unsatisfactory pre-LLETZ colposcopy (43 satisfactory pre-LLETZ colposcopies [61%] and 456 [86%] respectively, p < .001). In a stepwise binary logistic regression analysis, only the two latter parameters were found to be independently associated with unsatisfactory post-LLETZ colposcopies. CONCLUSIONS: Surgeons should consider other therapeutic strategies when contemplating iterative diagnosis-LLETZ in older women with initially invisible SCJ, as an appropriate post-LLETZ surveillance is at higher risk of being impossible to achieve.

Management of labor during registrarship: A prospective study during a two-year registrarship program.

AIM: Labor management is often considered to be stressful. Increases in cesarean section (CSD) and assisted vaginal (AVD) deliveries rates have been ascribed to inexperience. To address this issue, we observed the obstetric management activity of four obstetrics and gynecology registrars throughout their 2-year registrarship program. METHODS: We performed a prospective, observational study of urgent and semi-/nonurgent CSD and AVD in a tertiary maternity unit. The registrars' obstetric management was compared with that of a referral group. Changes over time in the registrars' practice were also monitored. RESULTS: A total of 4328 deliveries (including 670 CSD and 736 AVD) were analyzed. The registrars and the experienced obstetricians managed 2930 and 1398 deliveries, respectively, with similar neonatal outcomes. There were no intergroup differences in either total CSD percentage (455 [15.5%] and 215 [15.4%] for registrars and experienced practitioners, respectively, P = 0.90) or AVD percentage (478 [16.3%] and 258 [18.5%], respectively, P = 0.08), or according to degree of urgency. Rates did not change over the course of the registrarship program, regardless of degree of urgency. CONCLUSION: Lower degree of experience was not associated with elevated CSD or AVD rates. Skills required to appropriately manage an obstetric ward seemed to have been acquired at the end of residency.

Factors associated with removal difficulties of etonogestrel-containing contraceptive implants (Nexplanon®).

OBJECTIVES: Nexplanon®'s new applicator system was designed to limit deep implant placements, known to lead to difficult removals. However, removal difficulties still exist and induce specific and potentially severe complications. Our objective was to identify risk factors associated with difficult removals. STUDY DESIGN: A retrospective single-center study was performed from January 2015 to December 2016. Participants were divided into two groups depending on whether implant was removed during a standard ("standard removal" group) or difficult consultation ("difficult removal" group) after an initial failed removal attempt. RESULTS: The difficult and standard removal groups comprised 63 and 660 women, respectively. In a univariate analysis, significant intergroup differences were found for weight gain (3.7 ±â€¯7.3 kg in the difficult removal group vs. 1.3 ±â€¯5.1 in the standard removal group), proportion of placements performed in private practice (66.7% vs. 19.8%, respectively), and duration of Nexplanon® placement (29.4 ±â€¯11.3 months versus 26 ±â€¯13.6, respectively). We also reported more frequent sub-brachial fascia placements when Nexplanon® was implanted by a private practitioner (7.5% cases versus 0.4% in hospital implantations, p < 0.001). In a stepwise binary logistic regression analysis, placement by a private practitioner, weight gain >1 kg since placement, and duration of implant placement >25 months were confirmed as independent risk factors for removal difficulties (respective risk ratios 7.63 [95% IC 4.35-13.33], 2.10 [1.18-3.70], and 1.91 [1.06-3.44], p < 0.05). CONCLUSIONS: Awareness of these three simple parameters might help physicians to identify "at risk-patients", and suggest a specific consultation before risking a potentially hazardous removal (with its associated, specific morbidity). Our results also emphasize importance of training in implant insertion.

Could Patients Older than 75 Years Benefit from a Systematic Breast Cancer Screening Program?

BACKGROUND/AIM: To assess prognosis of women aged 75 and older according to breast cancer (BC) diagnosis circumstances. PATIENTS AND METHODS: A retrospective cohort study was conducted in the Amiens, France, regional oncologic referral center between 2005 and 2015. Two groups were formed depending on whether the patients followed clinical manifestations (CM) or a prescribed systematic mammography (SM). RESULTS: Three hundred and ninenty-three patients were selected. CM and SM represented 72% and 14.5% of BC diagnosis circumstances, respectively. In the SM group statistically significant differences included: earlier stage cancer diagnosis (tumor stages 0 and 1 accounted for 6.3% and 61.4% of cases, respectively), less lymph node invasions (35.7% and 8.8%) and metastases (19.1% and 0%), more frequent possibility of conservative surgery (25.6% and 74.5%), improved global and disease-free survival rates (by 14.2 and 18.4 months). CONCLUSION: Screening seems to improve prognosis of older BC patients; this constitutes a strong argument for reconsidering age limits of national BC screening programs.

Impact of Age at Conization on Obstetrical Outcome: A Case-Control Study.

OBJECTIVE: The aim of the study was to assess whether an age younger than 25 years at conization affected future pregnancy outcome as an independent factor. MATERIALS AND METHODS: A retrospective study of 115 women who underwent both loop electrosurgical excision procedure (LEEP) and subsequent pregnancy follow-up in a referral center was conducted. Two groups were considered: patients younger than 25 years at the time of LEEP (n = 42) and 25 years or older (n = 73). Analyzed data were occurrence of preterm adverse obstetrical event and, specifically, preterm labor (PL) and preterm rupture of membranes; stratification based on term of occurrence was performed: less than 37 weeks of amenorrhea (WA), less than 34 WA, and less than 26 WA. RESULTS: Patients characteristics were comparable in terms of excised specimen thickness and pathological analysis, as well as for tobacco intoxication during pregnancy. Although there was no difference of term at delivery or total number of preterm adverse obstetrical events, we found a significant increase of events (19% vs 4.1%) and PL (19% vs 0%) before 26 WA in the group of patients younger than 25 years. After adjusting for excised specimen thickness, the same results were found for thickness of 15 mm or less (respectively, 16.7% vs 3.3% and 16.7% vs 0%). For thickness of greater than 15 mm, only ratio of PL before 26 WA was higher in the group of patients younger than 25 years (33.3% vs 0%). CONCLUSIONS: Age younger than 25 years at the time of LEEP seems to be is associated with a more frequent occurrence of extremely early preterm adverse obstetrical events, particularly PL.

Prognostic factors of second primary contralateral breast cancer in early-stage breast cancer.

The aim of the present study was to investigate the therapeutic outcome of early-stage breast cancer (pT1aN0M0) and to identify prognostic factors for secondary primary contralateral breast cancer (CBC). A total of 85 patients with mammary carcinomas were included. All patients had undergone breast surgery and adjuvant treatment between January 2001 and December 2008 at the Central Hospital of Grenoble University (Grenoble, France). The primary end-points were disease-free survival and secondary CBC, and the potential prognostic factors were investigated. During a median follow-up of 60 months, 10 of the 85 patients presented with secondary primary cancer, of which six suffered with CBC. No patient mortalities were reported. The rates of CBC were 2.35, 3.53 and 7.06% at one, two and five years, respectively. The cumulative univariate analysis showed that microinvasion and family history are potential risk factors for newly CBC. The current study also demonstrated that secondary CBC was more likely to occur in patients with microinvasion or a family history of hte dise. In addition, the systematic treatment of secondary CBC should include hormone therapy.

Female urinary incontinence and intravaginal electrical stimulation: an observational prospective study.

OBJECTIVE: To assess the efficacy of intravaginal electrical stimulation in the management of female urinary incontinence. STUDY DESIGN: 359 Women with urinary incontinence (207 with stress incontinence [group A], 33 with urge incontinence [group B] and 119 with mixed urinary incontinence [group C]) were included in this multicenter prospective observational study. Patients were managed by home intravaginal electrical stimulation of the pelvic floor for 20-30 min per day, 5 days a week, for a period of 10 weeks. Identical clinical assessments were performed before and after pelvic floor rehabilitation, comprising a voiding diary and validated symptom and quality of life scores. RESULTS: Objective assessment demonstrated an overall cure rate of 63.5% (228/359): 65.7% (136/207) for group A, 57.6% (19/33) for group B, and 61.3% (73/119) for group C. The overall significant improvement rate was 15.6% (56/359): 14.6% (30/207) for group A, 24.2% (8/33) for group B and 15.1% (18/119) for group C. All domains of quality of life were significantly improved after pelvic floor muscle training (p<0.0001) with a patient satisfaction rate of 83.6%. Treatment was well tolerated with 1.4% (5/359) of patients describing pain at the highest stimulation intensities. No significant difference was observed between the various types of electrodes used (p<0.0001). CONCLUSION: The quantitative and qualitative efficacy in terms of social and psychological consequences and quality of life of home pelvic floor muscle training stimulators probably make this treatment modality one of the first-line treatments for female stress urinary incontinence.

Hemoperitoneum presenting with the use of a topical hemostatic agent in oocyte retrieval: a case report.

INTRODUCTION: Hemoperitoneum may occur from an ovarian puncture point after oocyte retrieval. CASE PRESENTATION: We report a case of massive hemoperitoneum following transvaginal ultrasound-guided oocyte retrieval in a 33-year-old Caucasian woman. The bleeding required emergency laparoscopy because of active bleeding from the ovarian puncture point. Hemostasis was very difficult to achieve, and traditional operative procedures were not efficient. The only way to stop the bleeding was by using an absorbable fibrinogen and thrombin sealant sponge, which was applied around the ovary. During laparoscopy three pints of packed red blood were administered. No specific alteration of screening coagulation tests was found one month later. CONCLUSIONS: Hemostasis can be very difficult to achieve with traditional operative procedures. Topical hemostatic agents can be useful to preserve the ovary wherever possible.

Transvaginal mesh repair of pelvic organ prolapse by the transobturator-infracoccygeal hammock technique: long-term anatomical and functional outcomes.

AIMS: To evaluate long-term anatomical and functional outcomes of the transobturator-infracoccygeal hammock repair for complex genital prolapse with a porcine collagen-coated polypropylene mesh. METHODS: A prospective observational study comparing pre- and postoperative outcomes, using pelvic organ prolapse quantification (POP-Q) measurements, pelvic floor distress inventory (PFDI), and pelvic floor impact questionnaire (PFIQ) scores. RESULTS: One hundred fourteen women with recurrent, advanced, or posthysterectomy genital prolapse were enrolled. During follow-up (median value 57 months), 101 patients were available for assessment. Overall anatomical success rate was 96%, with significant improvement in quality-of-life. Three patients experienced symptomatic recurrent posterior prolapse. Seven had persistent stress urinary incontinence. Mesh exposure occurred in 6.9% of cases, including an infected hematoma that required partial excision of the mesh. No severe adverse event or change in sexual function was observed. CONCLUSIONS: The transobturator-infracoccygeal hammock is well tolerated with effective long-term anatomical and functional results for complex genital prolapse. In our experience and compared to the data of the literature, the use of collagen-coated versus uncoated polypropylene meshes seems to decrease local morbidity.

Mid-term outcome of laparoscopic sacrocolpopexy with anterior and posterior polyester mesh for treatment of genito-urinary prolapse.

OBJECTIVES: To evaluate the anatomical and functional outcomes of laparoscopic sacrocolpopexy using an anterior and a posterior polyester mesh, for the cure of genital prolapse at one year or longer. STUDY DESIGN: This is a consecutive 5 year prospective observational study in which 119 patients presented with at least a Stage 2 apical prolapse, with an anterior or a posterior vaginal wall prolapse, who underwent a double sacrocolpopexy. Two large pore size (≥ 1mm) heavyweight (115 g/m(2)) multifilaments of polyester prostheses (Parietex Prosup PAC/GK 06, Sofradim-Covidien) were exclusively used for this technique. The prostheses were fixed on the levator ani muscles, the vagina and the sacrum with permanent extracorporeal laparoscopic sutures. Pre- and post-operative data referring to international pelvic organ prolapse quantitation classification (POP-Q), scores of quality of life and sexuality (French equivalent of the Pelvic Floor Distress Inventory (PFDI), Pelvic Floor Impact Questionnaire (PFIQ) and Pelvic organ prolapse-urinary Incontinence-Sexual Questionnaire (PISQ-12)) were compared. RESULTS: With a mean follow-up of 34 months, 116 patients were accessible for evaluation. For these patients, the anatomical success rates (Stage 0 or 1) on the apical, anterior or posterior compartments were respectively, 97%, 89% and 98%. On the functional level, all the scores of quality of life and sexuality were improved. CONCLUSIONS: This study confirms the effectiveness of laparoscopic sacrocolpopexy for the repair of the apical compartment prolapse. It also shows its effectiveness for the anterior compartment repair when the cystocele is moderate and limited to a median defect. In our experience, laparoscopic sacrocolpopexy with heavyweight polyester prosthesis is an effective treatment of the posterior defect.

Biomechanical analysis of polypropylene prosthetic implants for hernia repair: an experimental study.

BACKGROUND: Although polypropylene (PP) is the most common biomaterial used for ventral and inguinal hernia repairs, its mechanical properties remain obscure. METHODS: Retraction, solidity, and elasticity of 3 large pore-size monofilament PP prostheses, 1 heavy-weight PP (HWPP), a second low-weight PP, and a third coated with atelocollagen were evaluated in a rabbit incisional hernia model. A small pore-size multifilament PP implant (MPP) also was tested. RESULTS: Unlike pore size, the weight of the prosthesis was not an influencing factor for retraction. Atelocollagen coating reduced retraction (P < .05). HWPP and MPP were less likely to rupture (P < .05). HWPP had comparatively better elasticity (P < .05), whereas MPP supported the greatest elastic force (P < .05). Nevertheless, the amount of shrinkage of MPP (30% of the original size) made this prosthesis unusable. CONCLUSIONS: In this study, HWPP presented the most advantageous biomechanical compromise for hernia surgery.

Perioperative course and medium-term outcome of the transobturator and infracoccygeal hammock for posthysterectomy vaginal vault prolapse.

OBJECTIVE: To describe the perioperative course and medium-term anatomic and functional outcomes of the transobturator-infracoccygeal hammock for posthysterectomy vaginal vault prolapse repair. METHODS: A prospective consecutive series of 52 women with a stage 2 vaginal vault prolapse or higher that occurred after total hysterectomy who underwent surgery between 2003 and 2007. Principal outcome measures were anatomic cure (stage 1 or lower) and impact on quality of life measured using the pelvic floor distress inventory (PFDI) and pelvic floor impact self-reported questionnaire (PFIQ). Anatomical results were analyzed using chi(2) and Fisher exact tests, and PFDI and PFIQ scores were analyzed using the Wilcoxon test. RESULTS: With a median follow-up of 36months, the anatomic cure rate was 96%. Significant improvements were noted in POPQ-S scores after surgery (P<0.05). Stress urinary incontinence was cured in 73% of patients and improved in 15% of patients. The PFDI and PFIQ scores were improved (P<0.05). One mesh extrusion was observed. The rates of mesh contraction and new cases of dyspareunia were 31% and 13%, respectively. CONCLUSION: The transvaginal mesh hammock represents a useful treatment for recurrent and major vaginal vault prolapse, and has few complications.

Treatment of concomitant prolapse and stress urinary incontinence via a transobturator subvesical mesh without independent suburethral tape.

OBJECTIVE: Evaluate the efficacy of a transobturator subvesical mesh for cystocele in concomitant stress urinary incontinence (SUI). DESIGN: Longitudinal observational study. SETTING: Tertiary referral urogynecology center. POPULATION: One hundred and five women with at least an anterior vaginal wall prolapse and concomitant SUI who underwent surgery. METHODS: After reduction of prolapse elements, the intervention consisted of a non-absorbable monoprosthesis placement with two transobturator expansions and, if necessary, associated hysterectomy or infraccocygeal sacropexy. No specific procedure was performed for SUI. MAIN OUTCOME MEASURES: All patients had a physical examination and a subjective symptoms assessment via questionnaire in the preoperative period and at one-year or more after surgery. The pelvic organ prolapse quantification system was used for anatomical results. For SUI, Ingelman-Sundberg classification and cough test were used. Loss of urine was measured by a one-hour pad test. Functional results were evaluated by visual analog scale, quality-of-life questionnaires, including the pelvic floor distress inventory and the pelvic floor impact questionnaire. RESULTS: Median follow-up was 45 months (range: 12-72). A total of 102 women (97%) were cured of their prolapse, of whom 72 (69%) were cured of their SUI and 13 (12%) showed improvement. Pad test, visual analogic scale and quality-of-life questionnaires were all improved (p < 0.05). Complications consisted of one rectal injury, one transitory urinary retention, and two hematomas. Of the erosions 6% was observed for monofilament polypropylene prostheses. CONCLUSION: Transvaginal monoprosthesis for the simultaneous correction of prolapse and SUI represents an effective treatment for bulky or recurrent prolapse as well as posthysterectomy vaginal vault prolapse.

Ineffectiveness of associating a suburethral tape to a transobturator mesh for cystocele correction on concomitant stress urinary incontinence.

OBJECTIVES: To evaluate the effect of a transobturator subvesical mesh for cystocele on concomitant stress urinary incontinence (SUI). Genital and urinary prolapse surgery presents difficulties, particularly regarding cure of SUI. Advances in vaginal prosthetic surgery could correct these difficulties. METHODS: Between July 2003 and October 2007, a total of 74 patients with a minimum stage 2 anterior prolapse with concomitant SUI were operated on, using a porcine collagen-coated large-pore-size monofilament polypropylene mesh with 2 transobturator expansions, but without an additional procedure for SUI. All patients had a physical examination and a subjective symptoms assessment using a questionnaire in the preoperative period and again 6 weeks, 6 months, and then each year after surgery. The pelvic organ prolapse quantification system was used for anatomic results. For SUI, Ingelman-Sundberg classification and cough test were used. Loss of urine was measured by a 1-hour pad test. Functional results were evaluated by visual analog scale, pelvic floor distress inventory, and pelvic floor impact questionnaire. RESULTS: Median follow-up was 36 months (range 12-51). Seventy-two women (97%) were cured of their prolapse. A total of 53 women (72%) were cured of their SUI and 11 (15%) were improved. Pad test, visual analog scale, pelvic floor distress inventory, and pelvic floor impact questionnaire all showed improvement (P <.05). Prolonged bladder catheterization was not required. Complications consisted of 1 hematoma requiring blood transfusion and 5 vaginal extrusions (6%). CONCLUSIONS: Transvaginal mono prosthesis for the simultaneous correction of prolapse and SUI represents an effective treatment without the risk of prolonged urinary retention.