[Plication of suburethral slings as treatment of persisting or recurring stress urinary incontinence]. / Plicature de la bandelette sous-urétrale comme traitement de l'incontinence urinaire d'effort persistante ou récidivante.

OBJECTIVE OF THE STUDY: Feasibility and efficiency study of mesh readjustment in suburethral slings by overcoat plication in case of persisting of recurring stress urinary incontinence in patients with suburethral slings. METHODS: Retrospective and monocentric study including patients that present with a failure or recurring incontinency after suburethral slings surgery. The eligibility was evaluated after a complete clinical and paraclinical statement, proving the recurrence of the incontinence and its mechanism. Surgery consisted in a plication in an overcoat. RESULTS: Nineteen patients were included. The medium delay between initial surgery and the plication was 23.4months (ds=25.5). Results were evaluated subjectively by the MHU questionnaire and objectively by the urodynamic appraisal. The medium survey was 27.2months (ds=37.3). The procedure lasts about 30minutes. According to MHU, 73.7% of patients were cured and for 10.3% the symptoms were lessened. The difference in the MHU score of stress urinary incontinence before and after mesh readjustment was significant (P=0.0005) and get down from 2.31 (ds=0.75) to 0.56 (ds=0.92) as an average. There was no complication during surgery. There were two cases of postoperative acute urinary retention which were reoperated by simply cutting a thread allowing the sling to relax without losing the benefit of the plicature. There was no significant increase in urge incontinence or dysuria. CONCLUSION: The results of this study confirmed the feasibility, the efficiency and the low morbidity of mesh readjustment for the suburethral sling.

Accuracy of blood transfusion in postpartum hemorrhage to assess maternal morbidity.

OBJECTIVE: To measure the accuracy of blood transfusion (timing and number of blood units) in postpartum hemorrhage (PPH) in a perinatal network. STUDY DESIGN: (1) The ANONYMAT software system was used for anonymization and linkage of two large stand-alone databases, the Burgundy Perinatal Network (BPN) and the National Blood Centre (EFS) databases, which contain, respectively, clinical data from hospital discharges and information concerning any blood transfusion in France (considered as the gold standard database for identifying any transfusion). (2) Identification of prescriptions of at least one red blood cell (RBC) unit at the day of delivery (≥22 weeks) and up to 42 days, with manual reviewing of medical records in case of discordant recording. (3) Assessing the sensitivity and positive predictive value of data from the BPN database. RESULTS: Among the 9736 women receiving at least one blood product dispensed between 01/01/2006 and 12/31/2007 and the 35,779 women who delivered, 233 women (0.65% of deliveries) received at least one RBC unit for post partum hemorrhage. In the BPN database according to the type of hospital stay in our perinatal network (delivery stay only, delivery and post-delivery stays), sensitivity and positive predictive value for RBC transfusion ranged from 61.4% (55.1-67.6) to 67.8% (61.8-73.8) and 82.2% (76.5-87.9) to 83.2% (77.8-88.5), respectively. Linkage of both BPN and EFS databases allowed accurate recording of all but one RBC transfusion. CONCLUSION: Our approach allowed 100% electronic recording of PPH requiring blood transfusion, making it an important sentinel event of maternal morbidity to assess the perinatal network.

[Pelvic organ prolapse-surgical technique (POP-ST): a classification of techniques of mesh augmented repairs for pelvic organ prolapse by vaginal route]. / Proposition d'une classification des techniques chirurgicales de cure de prolapsus (pelvic organ prolapse-surgical technique [POP-ST]) avec mise en place d'une prothèse par voie transvaginale.

OBJECTIVE: The aim of this study was to propose a classification of surgical techniques for treatment of prolapse by vaginal route using prosthetic reinforcements and to relate the evaluation of surgeons involved in the care of surgical patients. METHODS: A literature review was conducted searching for all articles relating novel technique of surgical management of patients with use of prosthetic reinforcements vaginally. The classification was made from descriptions found and then assessed by questionnaires filled out by surgeons. RESULTS: The classification takes account of all the techniques available today and can integrate new. Among the surgeons, 56.5% (13/23) found that the POP-ST is adapted to reflect the reality and variety of techniques and 60.8% (14/23) will be ready for daily use. CONCLUSION: A classification covering all the techniques put them at risk of a final tool too complex for routine use. The simplification would make it more usable but limited the comprehensiveness and evolutionary. Only 23 surgeons returned the questionnaire. A larger sample would be desirable. The POP-ST is the first classification of this type. We believe that it would assess the new techniques to better understand the complications.