[Urinary functional complications following radical uterine surgery]. / Complications urinaires fonctionnelles après chirurgie utérine radicale.

BACKGROUND AND STUDY OBJECTIVE: Radical hysterectomy is the surgery of reference for cervical cancer at an early stage. However, it causes functional urinary complications. The purpose of this article is to review the literature recalling the anatomy of the pelvic nerves and their relation to the various viscera, to better understand the etiology of urinary functional disorders associated with pelvic autonomic nerve section, and their prevention techniques. METHODOLOGY AND FINDINGS: A systematic search of the medical literature and PubMed from 1950 to 2013 showed that urinary complications are mainly a decreased sensation of need, urine output and bladder compliance, an increase in residual urine volume, and a urinary incontinence. Causes include a vegetative denervation, anatomical changes causing loss of the support of the urethra and the vesical neck as well as the local trauma. The severity of vesico-ureteral dysfunction is associated with the degree of radical hysterectomy. Radiotherapy can increase associated urinary morbidity of radical hysterectomy. These complications can be avoided with conservative surgery for pelvic nerves initiated by the Japanese Yabuki. In the postoperative course of a radical hysterectomy, it is important to avoid and treat bladder overdistensions, diagnose and treat any urinary tract infections that are often asymptomatic. CONCLUSION: Knowledge of the surgical anatomy of the nerves and their relation to other pelvic structures, allows the improvement of postoperative functional urinary outcomes.

[Laparoscopic treatment of vaginal agenesis: three cases]. / Traitement coelioscopique de l'agénésie vaginale: trois études de cas.

BACKGROUND: Ninety per cent of cases of congenital vaginal agenesis are represented by the Mayer-Rokitansky-Küster-Hauser syndrome, the remaining 10% being represented by the testicular feminization syndrome and vaginal aplasia. Numerous surgical methods for the treatment of vaginal agenesis have been described. Neovagina construction by sigmoid colpoplasty seems to be the best surgical option as regards the anatomical and functional outcome. METHOD: We report the case of three patients operated of neovagina construction with a sigmoid graft by a laparoscopic-perineal approach. RESULTS: The surgical intervention lasted for 330 minutes, 210 minutes and 150 minutes respectively for the three patients. There were no perioperative complications. The duration of hospitalization was respectively 7, 4 and 6 days. The length of the neovagina was 15, 14 and 18 cm without retraction on the follow-up at 2 and 6 months. The vaginal wall maintained its patency allowing normal intercourse. The patients had normal sexual life after the surgery. CONCLUSION: Our results demonstrate the feasibility of laparoscopic-perineal neovagina construction by sigmoid colpoplasty when it is performed by experienced surgeons in gynecology and digestive laparoscopic surgery.

[Skin sparing mastectomy: a revisited technique]. / Mastectomie avec conservation de l'étui cutané. Une technique revisitée.

Skin-sparing mastectomy (SSM) is an appealing treatment option for patients with early-stage breast carcinoma. This article is a review of the literature concerning this innovative technique. Surgery consists in a total mastectomy with preservation of the cutaneous envelope of the breast. This is done by performing the smallest incision possible, e.g., periareolar incision, with ablation of the nipple-areola complex. Mastectomy is followed by immediate reconstruction with a prosthesis and/or flap. Besides complications of reconstruction, the principal postoperative concern is necrosis of the skin flap. SSM seems oncologically safe as studies didn't find any difference in terms of relapse, metastasis and survival when comparing SSM to non-SSM. Nevertheless, the use of this technique remains controversial in advanced stage breast cancer (2B and 3). Finally, SSM is associated with improved aesthetics with a high level of surgeons' and patients' satisfaction.