Colpocystodefecography.

PURPOSE: To assess, in one single procedure, a complete study of the female pelvis, including the Douglas pouch. METHODS: Colpocystodefecography (CCD) combines vaginal opacification, voiding cystography, and defecography. Three hundred examinations are reviewed. RESULTS: Thanks to the simultaneous visualization of the pelvic structures, CCD proved to be more useful than clinical evaluation to diagnose prolapses and particularly Douglas pouch hernias (enteroceles), the clinical diagnosis of which was missed in 93 of 111 cases. Moreover, in addition to morphologic and functional information, CCD brings about a new insight in the study of pelvic organs reciprocal influences, should they be positive (supporting function) or negative (external compression). Finally, significative pelvic surgery and particularly hysterectomy enhances greatly the risk of enteroceles. CONCLUSION: CCD is helpful in the preoperative staging, especially in the selection of the surgical procedure that will least likely predispose to possible late postoperative complications such as vaginal prolapses or enteroceles.

[Defecation disorders. Characteristics of manometric studies and rehabilitation]. / Troubles de la défécation. Quelques particularités des épreuves manométriques et de la rééducation.

The authors review the literature and their personal experience about the systematic exploration of defecation disorders by anorectal manometry and colpocystodefecography. They stress the importance of combining functional and morphological evaluation, in order to avoid inappropriate surgery. Concerning anorectal manometry, the determination of the smallest volume of rectal distention inducing a complete relaxation of the internal anal sphincter was found more useful than the maximal tolerable volume in the exploration of defecation disorders. Finally, the authors report the results of biofeedback conditioning prescribed in 30 patients (27 women, 3 men, mean age: 55 years) with defecation disorders (terminal constipation in 21, fecal incontinence in 9 patients). Several characteristics of anorectal manometry and of defecography were significantly improved after biofeedback conditioning.

[Unstable bladder and kinesitherapy. The concept of deficient unstable bladder]. / Instabilité vésicale et kinésithérapie. Concept de l'instabilité vésicale déficitaire.

The authors present a series of 30 unstable bladders treated only by perineal muscular reeducation by contact. The best results are obtained in the group presenting with pelvic floor hypotonia and USI (efficiency 71.5%), especially when the closure pressure is normal (100%). The urodynamic control and the ominious disappearance of the associated USI confirm a muscular role of the treatment rather than a psychogenic one, the stabilization of the bladder being achieved through the perineo-detrusor inhibitory reflex. Because of this specific and efficient treatment the attention is drawn to the pelvic muscular weakness in the genesis of detrusor instability which is then called "deficitory instability". The interest of a clinical classification of detrusor instability is discussed.

[Bladder instability and kinesitherapy. The concept of deficient bladder instability]. / Instabilité vésicale et kinésithérapie. Concept de l'instabilité vésicale déficitaire.

The authors present a series of 30 unstable bladders treated only by perineal muscular reeducation by contact. The best results are obtained in the group presenting with pelvic floor hypotonia and USI (urinary stress incontinence) (efficiency 71.5%), especially when the closure pressure is normal (100%). The urodynamic control and the ominous disappearance of the associated USI confirm a muscular role of the treatment rather than a psychogenic one, the stabilization of the bladder being achieved through the perineo-detrusor inhibitory reflex. Because of this specific and efficient treatment the attention is drawn to the pelvic muscular weakness in the genesis of detrusor instability which is then called "deficitory instability". The interest of a clinical classification of detrusor instability is discussed.