[Surgical treatment for female stress urinary incontinence by transobturator tape (outside in). Study of 70 cases]. / Cure chirurgicale de l'incontinence urinaire d'effort de la femme par bandelette transobturatrice (de dehors en dedans). Etude de 70 cas.

OBJECTIVES: To evaluate the feasibility, the efficacy and the innocuousness of suburethral transobturator support using multifilament polypropylene transobturator tape (TOT) inside out for stress urinary incontinence in women. MATERIALS AND METHODS: The study concerns 70 patients representing our team's first experience of this technique. The inclusion criterion was persistent SUI despite perineal rehabilitation. There were no exclusion criteria. Among the 70 patients, 22 (31%) presented with associated genital prolapse. Mean parity was 2.6 (extremes ranging from 0 to 6). Thirty-five patients were menopaused (50%), of whom 12 (34%) were under hormone replacement therapy. We retained five judgement criteria to evaluate this surgical act: duration of surgery and hospitalisation, per- and postoperative complications and functional results on SUI (via a telephone questionnaire). RESULTS: The rate of positive results (healing or improvement) was 84% with a mean follow-up of 14.5 months. The rate of peroperative complications was very low: 1.4% (only one case of bladder injury). The mean duration of surgery was 23 minutes. The mean duration of hospitalisation in the case of isolated TOT was 1.25 days. CONCLUSION: The transobturator approach is a feasible, safe and efficient short-term surgical technique. Results inferior to those observed in the literature are probably due to the learning curve in a university hospital unit. None of the preoperative data (age, parity, body mass index, history of SUI treatment or hysterectomy, hormonal status, associated prolapse, mean urethral closure pressure, clinical vesical hyperactivity syndrome) appears to influence results; however, the study strength is poor due to the small study population.

[Laparoscopic management of pelvic mass in pregnancy]. / Prise en charge coelioscopique des masses latéro-utérines pendant la grossesse.

OBJECTIVES: To determine the feasibility, safety and limiting factors of laparoscopic management of pelvic mass in pregnancy. MATERIAL: and methods. During a 10-year period, 21 laparoscopic procedures were performed in patients with pelvic masses in pregnancy after exclusion of appendicitis and ectopic pregnancy. Laparoscopic surgery was done during the first trimester of pregnancy in 8 cases, the second trimester in 12 cases and the third trimester in one case. All the procedures were performed with general anesthesia and the laparoscopic cystectomies were performed with the intraperitoneal technique. RESULTS: The indications were: persistent or sonographically abnormal ovarian cyst (12 cases), torsion of ovarian cyst (5 cases), and symptomatic pelvic mass (4 cases: 2 painful cysts and 2 infarction of fibroma). One borderline tumor were discovered. The laparoscopic procedure could not be performed in two cases due to difficulty of access to the lesion. No patient encountered complications during the intra- and post-operative periods. The mean hospital stay was 4.5 days. The outcome of the pregnancy was normal in all cases. CONCLUSION: Laparoscopic management of pelvic masses in pregnancy by an experienced team, is a safe and effective procedure.