[Patient satisfaction and symptom changes in women using a pessary for pelvic organ prolapse]. / Satisfaction des patientes et efficacité du pessaire en cas de prolapsus des organes pelviens.

INTRODUCTION: Pessary is one of the commonly used conservative treatments of pelvic organ prolapse (POP). However, its use seems to be limited to elderly patients or in case refusal or contraindication to surgery. AIM: Our main objective was to evaluate and identify factors associated with satisfaction in women using a pessary. Secondary objectives were to assess improvement in symptom and quality of live scores and to identify factors associated with unsucessfull pessary use. METHODS: This was a prospective cohort study performed in a French teaching hospital in women with symptomatic POP. The primary endpoint was the PGI-I (Patient Global Impression of Improvement). Symptom improvement was assessed using the symptom scores (PFDI-20, ICIQ-SF, PISQ-12 and USP) and the PFIQ-7 quality of life score. RESULTS: Eighty five patients were included. The satisfaction rate was 78,1% at 1 month and 87,5% at 6months. The effectiveness of pessary was the main benefit reported by patients at both 1month (60%) and 6 months (59,4%). The only factors associated witch patient satisfaction were the greater improvement in symptoms (PFDI20 et PFIQ7; p<0.05). In case of failure, patients were significantly younger and overweight (p=0.001). CONCLUSION: The pessary is a true first-line treatments alternative of POP without major complications. Patient acceptance and satisfaction are important.

Sustainable conversion of agriculture wastes into activated carbons: energy balance and arsenic removal from water.

The aims of this study are to investigate the production of activated carbons (AC) from Senegal agricultural wastes such as cashew shells, millet stalks and rice husks and to implement them in adsorption processes devoted to arsenic (V) removal. AC were produced by a direct physical activation with water steam without other chemicals. This production of AC has also led to co-products (gas and bio-oil) which have been characterized in terms of physical, chemical and thermodynamical properties for energy recovery. Considering the arsenic adsorption results and the energy balance for the three studied biomasses, the first results have shown that the millet stalks seem to be more interesting for arsenate removal from natural water and an energy recovery with a GEEelec of 18.9%. Cashew shells, which have shown the best energy recovery (34.3%), are not suitable for arsenate removal. This global approach is original and contributes to a recycling of biowastes with a joint recovery of energy and material.

[Management of third and fourth degree perineal tears: A systematic review]. / Prise en charge des périnées complets (déchirure périnéale stade 3 et 4) : revue de la littérature.

This was a comprehensive literature review using Pubmed, Medline, Embase and Cochrane, whose aim was to analyse the prevalence of anal sphincter injuries, their risk factors, their management and their functional prognosis. The prevalence of 3rd and 4th degree perineal tears varies between studies from 2.95% regardless the parity to 25% in nulliparous women. Twenty-eight percent to 48% of these lacerations were clinically occult. Perineal tears were associated with (multivariate analysis) forceps (6.021 [IC 95% 1.23-19.45]), nulliparity (OR 9.8 [IC 95% 3.6-26.2]), gestational age over 42 SA (OR 2.5 [IC 95% 1-6.2]), fundal pressure (OR 4.6 [IC 95% 2.3-7.9]), midline episiotomy (OR 5.5 [IC 95% 1.4-18.7]) or fetal weight in interval of 250g (OR 1.3 [IC 95% 1.1-1.6]). There was no difference between the sphincter repair techniques. Post-partum laxative use showed less painful bowel motion and earlier postnatal discharge. Data concerning rehabilitation were contradictory. The rate of anal incontinence 6 months after vaginal delivery were 3.6% following third degree of perineal tear and 30.8% in case of fourth degree of perineal tear. Thirty years after anal sphincter disruption, the prevalence of fecal incontinence reached 6.9%.

[Management of postpartum anal incontinence: A systematic review]. / Prise en charge de l'incontinence anale du post-partum: revue de la littérature.

AIM: To analyse the prevalence of postpartum anal incontinence, its risk factors, and its management. MATERIALS AND METHODS: A comprehensive systematic review of the literature on PubMed, Medline, Embase and Cochrane using: postpartum anal incontinence, postpartum fecal incontinence, perineal rehabilitation, anal surgery. RESULTS: The prevalence of postpartum anal incontinence varied from 4% (primipare) to 39% (multipare) at 6 weeks postpartum, whereas fecal incontinence can reach respectively 8 to 12% 6 years after delivery. Identified risk factors were: vaginal delivery (OR: 1.32 [95%CI: 1.04-1.68]) compared to cesarean section, instrumental extractions (OR: 1.47 [95%CI: 1.22-1.78]) compared to spontaneous vaginal delivery but it was only with forceps (OR: 1.50 [95%CI: 1.19-1.89]) and not with vaccum (OR: 1.31 [95%CI: 0.97-1.77]). Maternal age over 35 years (OR: 6 [95%CI: 1.85-19.45]), number of births (3 births: OR: 2.91 [95%CI: 1.32-6.41]) and the occurrence of anal-sphincter injury (OR: 2.3 [95%CI: 1.1-5]) were associated with an increased risk of anal incontinence regardless of the type of delivery compared to a group of women without anal incontinence. Perineal rehabilitation should be interpreted with caution because of the lack of randomized controlled trials. A reassessment at 6 months postpartum in order to propose a surgical treatment by sphincteroplasty could be considered if symptoms persist. The results of the sphincteroplasty were satisfactory but with a success rate fading in time (60 to 90% at 6 months against 50 to 40% at 5 and 10 years). CONCLUSION: Postpartum anal incontinence requires special care. Recommendations for the management of postpartum anal incontinence would be useful.

[Is vaginal delivery possible for patients with myomectomy? Results of a monocentric study]. / Après myomectomie, les patientes ont-elles le droit d'accoucher par voie basse ? Résultats d'une étude monocentrique.

OBJECTIVE: To compare delivery outcomes according to the scar: myomectomy versus low-segment transverse cesarean. METHODS: A retrospective cohort study was performed in a university type 3 service between 1st January 2006 and 1st January 2012. We compared 18 women who gave birth after myomectomy (exposed group) to 72 women who gave birth after cesarean section (non-exposed group). Women younger than 43 years who underwent laparotomy or laparoscopic myomectomy were included. The primary endpoint was the rate of vaginal delivery. The route of delivery, the rate of uterine rupture, complications of delivery and neonatal outcome were studied. RESULTS: The acceptance rate of vaginal delivery was 55.6% after myomectomies versus 84.7% after cesarean section (P=0.005). The success of vaginal birth was 88.9% after myomectomy versus 73.9% after cesarean (NS). No uterine rupture has occurred after myomectomy against three sub-peritoneal rupture after cesarean. The occurrence of post-partum hemorrhage was not significantly different between the 2 groups (11.1% among exposed group versus 6.9% in the non-exposed group). The cesarean section rate was even higher than the number of hysterotomy was great (P=0.0047). CONCLUSION: This study seems to show that vaginal birth after myomectomy is possible with a success rate similar to vaginal birth after cesarean section.