[Lower urinary trauma complicating gyneacologic and obstetrical surgery]. / Les lésions urologiques provoquées par des interventions chirurgicales gynécologiques et obstétricales.

INTRODUCTION: The trauma of the lower urinary tract in gynecologic and obstetrics surgery is rare. AIM: Discover the circonstances of their happening, their symptoms, and their methods of diagnostic and their treatment. METHODS: Authors report 24 cases observed over a 12 years period. RESULTS: These lesions consisted on 20 bladder lesions and 4 ureteric lesions. The frequency of these urological complications was 0.21% among the 12000 surgical operations performed between 1992 and 2003. The most causal operation was caesarean and abdominal hysterectomy. Urinary trauma was more frequent in patients with history of abdominal surgery. Post operative course was uneventful in most cases. CONCLUSION: Trauma of the lower urinary tract in gynecologic and obstetrics surgery is rare but their ignorance may seriously affect the functional urinary prognostics.

[Cesarean deliveries in the maternity of military hospital of Tunis. Indication and prognosis: about 5008 cases]. / Les césariennes à la maternité de l'hôpital militaire de Tunis indication et pronostic: à propos de 5008 cas.

BACKGROUND: The rates of cesareans increased in many countries, these last years. AIM: we propose to evaluate the indications, and the maternal and foetal prognosis. METHODS: it's a retrospective study of 5008 cesareans during 10 years period, collected in the maternity of the military hospital of Tunis. RESULTS: Cesarean section rate is 21.59%. The cicatricial uterus constitutes the dominant indication (34%). In the event of noncicatricial uterus, the fetal suffering (24.7%), the failure of the trial of labour (14.2%), and the breech presentation (12.7%) are the principal indications. The hemorrhage constitutes the major complication into peroperational (2%). The post-operative complications are noted in 15.5%. Maternal mortality is 0.13%; perinatal mortality is 1.06%; perinatal morbidity is 9.68%. CONCLUSION: The increase of cesarean rate improves fetal and neonatal prognosis however it was associated to an increase of maternal.

[The approach diagnoses of ovarian tumors by echography]. / L'approche diagnostique des masses ovariennes par l'echographie.

In more of positive diagnosis, echography makes it possible to approach the histological nature of ovarian tumors. From a series of 106 cases of ovarian tumours, we propose to evaluate this approach by analysing the various echographic signs according to histological types'. The serous cysts are anechogen in 77,7% of the cases. The mucinous cysts are anechogen in 71,4% and finely echogen in 28,5% of the cases. The dermoid cysts are echogen in 47,3% and heterogeneous in 26,3%. The endometriosic cysts can be finely echogen (45%), heterogeneous (25%) or echogen (20%). The malignant tumors are of mixed aspect in 54,55% of the cases. The sensitivity of echography for the malignant tumors is 81,82% whereas specificity is 75,79%. The negative predictive value is 97,3%, and the positive predictive value is 28,13%. The size of the tumor, the vegetations and the partitions are also studied: a size lower than 5 cm and the absence of partition and vegetation are synonymous with benignity in all the cases.

[Potter's reno-facial syndrome]. / Syndrome de Potter. Etude analytique a propos de 4 cas.

Potter's reno-facial syndrome is a rare innate abnormality. We bring 4 observations repertoried at the maternity of military hospital of Tunis over a period of 6 years (1997 - 2002). The purpose of our work is to determine after a review of the literature the echographic and foetopathologic characteristics, and the forecast of this syndrome. The frequency of the bilateral renale agenesis is of 0.27 per thousand. Positive diagnosis bases essentially on the ultrasound of the 2th, or the 3-th trimester. The signs of appeal are essentially the oligoamnios associated to an hypotrophy. The caryotype is systematic to eliminate an associeted chromosomic abnormality. Foetopathologic exam is usefull for the diagnosis. Main abnormality except the urinary pathology is the lung hypoplasia. Therapeutic interruption of the pregnancy in this situation not compatible with the extra-uterine life., only type IV authorize the development of the pregnancy according to echographic data and of foetal urinaire biochemistry. We insist on the early practice of the morphological ultrasound between 20 - 22 weeks for the diagnosis of foetal abnormalities and the place of the genetic advice in association with the geneticist in the coverage of the couple.

[Surgical laparoscopy in the management of women infertility]. / Apport de la coelioscopie operatoire dans la sterilite feminine.

The authors report their experience about surgical laparoscopy in the management of women infertility. Based on a series of 87 patients (median age: 31 years), 61% have primary infertility. The surgical procedures were distal tuboplasty in 26 cases, endometriosis cure in 19 cases, ovarian driling for polycystic ovarian syndrome in 18 cases and adhesiolysis in 24 cases. The rate of intra uterine pregnancy of the 81 followed patients is 40.7% with 23 newborn (28.39%), 5 abortions (6.17%) and 5 current pregnancies (6.17%). The rate of ectopic pregnancies is 3.7%.

[Umbilical endometriosis: apropos of 3 cases]. / Endométriose ombilicale: à propos de trois cas.

Umbilical endometriosis is a rare localisation of the disease. The authors report three cases of umbilical endometriosis. The symptomatology is not usually typic. The only effective treatment remains the surgical exercise thus allowing the confirmation histological.

[Management of urogenital prolapse in the maternity service of the Tunis military hospital. 82 cases]. / Prise en charge des prolapsus urogenitaux à la maternité de l'hôpital militaire de Tunis. A propos de 82 cas.

This survey has for goal to specify the epidemiological and of the prolapse of our patient, as well as our therapeutic attitude. It is about a retrospective survey that concerned 82 cases of prolapse, structural on a period of 5 years. The average of age of our patient is of 59 years. 73.17% of women are multiparous. 78% of women gave birth less once at home. The main motive of consultation is the vaginal ball sensation, in agreement with the total character of the prolapse that is the third degree in 46.34% of cases. The urinary incontinence is associated to the prolapse in 50% of cases. We achieved a vaginal surgery in 82.93 of cases. The hysterectomy has been achieved at 86.76% of operated then by vaginal surgery whereas for operated them by abdominal surgery, the uterus is preserved in the half of cases.

[Role of uterine curettage in endometrial pathology. Report of 200 cases]. / Intérêt du curetage biopsique dans l'exploration de l'endomètre. A propos de 200 cas.

UNLABELLED: The aim of this study is to evaluate the reliability of the uterine curettage in endometrial pathology. It is a retrospective analysis of 200 uterine curettages carried out in the military hospital of Tunis over 4 years (1994-1998). The reasons of consultation were genital hemorrhage, sterility and amenorrhea. Histological lesions were classified as follows: 40.8% hyperplasia, 8.4% atrophy, 1.34% endometrite, and 1.34% adenocarcinoma. CONCLUSION: Uterine curettage associated to hysteroscopy is far the best technique for the diagnosis of intrauterine lesions.