Medium-term outcomes of laparoscopic sacropexy on symptoms and quality of life. Predictive factors for postoperative dissatisfaction.

INTRODUCTION AND HYPOTHESIS: We aimed to evaluate the medium-term results of laparoscopic sacropexy (LSP) with validated self-administered questionnaires of symptoms and quality of life and to identify pre-, intra-, and postoperative predictors of postoperative dissatisfaction. METHODS: The study included 152 women who had LSP for stage 2 or higher pelvic organ prolapse (POP). The study population comprised women who had completed the preoperative symptom questionnaire (including the PFDI-20 and ICIQ-SF). Postoperative questionnaires included those questionnaires as well as the PFIQ-7 and EQ-5D questionnaires, PISQ-12 sexual function questionnaire, and PGI-I questionnaire (to assess patient satisfaction). RESULTS: In all, 92 women (60.5%) responded in the postoperative period; 75 (81.5%) had anterior and posterior mesh and 17 (18.5%) anterior mesh alone. Moreover, 14 women (15.2%) had a concomitant suburethral sling and 18 (19.6%) a concomitant subtotal hysterectomy. The mean follow-up time was 50.5 (± 20.3) months (4.2 years). PFDI-20 scores had improved significantly at 4 years (median: 47.4 before surgery vs. 34.4 afterwards, p = 0.002), and patient satisfaction was quite clear (PGI-I score = 1.8 ± 1.1). Nine women (9.8%) described recurring vaginal bulge symptoms, and 12 patients were reoperated during follow-up. Recurrence [odds ratio (OR) 8.11, 95% confidence interval (95% CI) 2.28-28.9] and postoperative constipation (OR = 3.47, 95% CI 1.02-11.8) were strongly associated with poorer postoperative satisfaction, as was concomitant UI surgery (OR = 12.5, 95% CI 2.32-67.0). CONCLUSIONS: LSP improved women's symptoms and quality of life. Postoperative constipation, sensation of prolapse recurrence, and concomitant UI surgery were strongly associated with postoperative dissatisfaction.

Is a Self-Assessed Questionnaire Useful for the Diagnosis of Ectopic Pregnancy in Hospitalized Patients?

BACKGROUND: Delayed diagnosis of ectopic pregnancy (EP) is responsible for maternal morbidity and mortality. Our objective was to develop and validate decision rules for the diagnosis of EP, in patients in their first trimester of pregnancy with symptoms, based solely on a self-assessment questionnaire. METHODS: From September 2006 to March 2008, 574 patients, who have consulted for acute pelvic pain at the gynecologic emergency department (ED) of five hospitals, completed a Self-Assessment Questionnaire for Gynecological Emergencies (SAQ-GE). We included for our study only women in their first trimester of pregnancy experiencing acute pelvic pain and/or vaginal bleeding who were hospitalized (262 patients). Two-thirds of patients were selected to derive the SAQ-GE EP score which was built on multiple logistic regression. One third of patients were used for internal validation. RESULTS: Five variables were independently and significantly (p<0.05) associated with EP: no frequent need to change sanitary towels (aDOR = 6.1; 95% CI [2.1-17.8]), duration of bleeding > 24 hours (aDOR = 4,3; 95% CI [1,7-11,0]), pain during coughing (aDOR = 3.1; CI 95% [1,4-6,7]), brown discharge (aDOR = 3.0; 95% CI [1.3-7.1]) and unilateral pelvic pain (aDOR = 2.7; 95% CI [1.3-5.9]). The SAQ-GE ectopic pregnancy score was based on these five criteria with values ranging from 0 to 100. The low-risk group of EP (score<25) had a sensitivity of 95.9% 95% CI [89.8-98,9] and an LR- of 0.2 95% CI [0.1-0.5]. The high-risk group (score>70) had a specificity of 97.4 95% CI [90.9-99.7] and a LR+ of 12.3 95% CI [3.0-49.8]. The percentages of EP observed in the validation sample were: 0% in the low-risk group and 88.9% in the high-risk group. DISCUSSION: These prediction rules that classify patients in a low-risk or high-risk group may prove useful for triaging pregnant women in their first trimester with symptoms before complementary exams.

Optimal Combination of Non-Invasive Tools for the Early Detection of Potentially Life-Threatening Emergencies in Gynecology.

OBJECTIVES: Potentially life-threatening gynecological emergencies (G-PLEs) are acute pelvic conditions that may spontaneously evolve into a life-threatening situation, or those for which there is a risk of sequelae or death in the absence of prompt diagnosis and treatment. The objective of this study was to identify the best combination of non-invasive diagnostic tools to ensure an accurate diagnosis and timely response when faced with G-PLEs for patients arriving with acute pelvic pain at the Gynecological Emergency Department (ED). METHODS: The data on non-invasive diagnostic tools were sourced from the records of patients presenting at the ED of two hospitals in the Parisian suburbs (France) with acute pelvic pain between September 2006 and April 2008. The medical history of the patients was obtained through a standardized questionnaire completed for a prospective observational study, and missing information was completed with data sourced from the medical forms. Diagnostic tool categories were predefined as a collection of signs or symptoms. We analyzed the association of each sign/symptom with G-PLEs using Pearson's Chi-Square or Fischer's exact tests. Symptoms and signs associated with G-PLEs (p-value < 0.20) were subjected to logistic regression to evaluate the diagnostic value of each of the predefined diagnostic tools and in various combinations. RESULTS: The data of 365 patients with acute pelvic pain were analyzed, of whom 103 were confirmed to have a PLE. We analyzed five diagnostic tools by logistic regression: Triage Process, History-Taking, Physical Examination, Ultrasonography, and Biological Exams. The combination of History-Taking and Ultrasonography had a C-index of 0.83, the highest for a model combining two tools. CONCLUSIONS: The use of a standardized self-assessment questionnaire for history-taking and focal ultrasound examination were found to be the most successful tool combination for the diagnosis of gynecological emergencies in a Gynecological ED. Additional tools, such as physical examination, do not add substantial diagnostic value.