[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.

[Delivery by forceps: indications and materno-fetal morbidity]. / L'accouchement par forceps: indications et morbidité materno-foetale.

A retrospective study concerning patients having had a delivery by means pair of forceps over a period going from 1st Jun 1999 to 31st December 2000. The frequency of the use of forceps for delivery is 4.95%. The defect of eviction was an indication of the pair of forceps. Fetal suffering was the main indication. Maternal morbidity was represented essentially by a more or less injury of the genital tract with a rate of 11.1%. The rate of neonatal mortality is 1.28%. The maternal improvement of the maternal and fetal prognosis depends on an accurate indication of the use of forceps. In certain circumstances, mainly in fetal suffering, it is often difficult to choose between the high way and the low way.