Urinary endometriosis: MR imaging appearance with surgical and histological correlations.

OBJECTIVES: The goals of the study were to describe the MR imaging features of endometriosis of the urinary tract and identify those that suggest intrinsic involvement of ureteric wall. MATERIALS AND METHODS: Thirty-five women with proven urinary tract endometriosis and who had preoperative MR imaging between 2001 and 2011 were included retrospectively. MR images were intrepreted by one junior and one senior radiologists. To characterize the intrinsic parietal involvement, the ureteric circumference involved by the lesion of endometriosis was noted. RESULTS: Thirty-eight ureteric and 13 bladder lesions were analyzed. They were found in association in nine women. Ureteric lesions were bilateral in seven women. Of the 38 ureteric lesions, 27 were extrinsic and 11 intrinsic at histopathological analysis. Sixteen women with extrinsic lesions and 10 with intrinsic ones were correctly identified on MR imaging. When the ureter was included less than 360° in the lesion, extrinsic involvement was confirmed in 80% of cases. CONCLUSION: MR imaging appears to be more sensitive (91%vs 82%) but less specific (59% vs 67%) than surgery for the diagnosis of intrinsic form of ureteric location.

[Single-shot ropivacaine wound infiltration during cesarean section for postoperative pain relief]. / Intérêt de l'instillation pariétale unique de ropivacaïne dans la prévention des douleurs après césarienne.

OBJECTIVE: To assess the efficiency of single-shot ropivacaine wound infiltration during cesarean section for postoperative pain relief, using a prospective, randomized, double-blinded study. PATIENTS AND METHODS: One hundred consecutive patients with planned cesarean section were enrolled between September 2007 and May 2008 and randomized into two groups: single-shot wound infiltration of 20mL of ropivacaine 7.5mg/mL (Group R; n=56) or single-shot wound infiltration of 20mL of saline solution (group T; n=44). The primary goal of this study was the double-blinded evaluation of the postoperative pain after coughing and leg raise using the 100-mm visual analog scales (VAS) during the first 48 postoperative hours after cesarean delivery. The secondary goals were the occurrence of nausea and vomiting and the morphine consumption. RESULTS: Numerical pain rating scale for pain evaluation was significantly lower (P<0.05) in the ropivacaine group than in the control group at M0, M20, M40, M60, H2 and H4. But, at H8, H12 and H24, no significant difference for VAS was noted between the two groups. The occurrence of nausea and vomiting and the total morphine consumption were not significantly different between the two groups during the first 48 postoperative hours. DISCUSSION AND CONCLUSION: Single-shot ropivacaine wound infiltration during planned cesarean section is a simple and safe procedure that provides effective reduction of post-partum pain within the first 4hours.

[Postpartum perineal pain: effectiveness of local ropivacaine infiltration]. / Douleur périnéale du post-partum: intérêt de l'infiltration locale de ropivacaïne.

GOAL: To assess efficiency of local ropivacaine infiltration in perineal pain after episiotomy and perineal tear during the first 24 h after vaginal delivery. MATERIALS AND METHODS: Case control survey, including 62 consecutive patients with episiotomy and/or perineal tear during two consecutive periods: the ropivacaine group from February 2, 2008 to March 27, 2008 (n=31) and the control group from December 27, 2007 to January 1, 2008 (n=31). In the ropivacaine group, patients received 10 ml of ropivacaine 7,5mg/ml as a local infiltration along the perineal damage. In the control group no injection was done. A numerical pain rating scale (0-10) at four (H4), eight (H8), 12 (H12) and 24 h (H24) was used to evaluate patients post-partum perineal pain. A numerical rating scale was used to evaluate patients satisfaction (0: no satisfied, 5: very satisfied). RESULTS: Numerical pain rating scale for perineal pain evaluation was significantly lower in the ropivacaine group than in the control group at H4 (1.9+/-0.3 versus 3.6+/-0.5, p=0.006), H8 (3.3+/-0.4 versus 5.2+/-0.4, p=0.003), H12 (2.8+/-0.4 versus 5.2+/-0.4, p=0.0001) and H24 (2.6+/-0.4 versus 4.3+/-0.4, p=0.006). Numerical rating scale for satisfaction evaluation was significantly higher in the ropivacaine group (4.2+/-0.2 versus 3.5+/-0.2, p=0.004). CONCLUSION: Local ropivacaine infiltration in episiotomy and/or perineal tear reduce post-partum perineal pain within the first 24 h.