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Objective: To compare the effectiveness and safety of laparoscopic sacropexy (LS) and transvaginal mesh (TVM) at 4 years. Design: Extended follow up of a randomised trial. Setting: Eleven centres. Population: Women with cystocele stage ≥2 (pelvic organ prolapse quantification [POP‐Q], aged 45–75 years without previous prolapse surgery. Methods: Synthetic non‐absorbable mesh placed in the vesicovaginal space and sutured to the promontory (LS) or maintained by arms through pelvic ligaments and/or muscles (TVM). Main outcome measures: Functional outcomes (pelvic floor distress inventory [PFDI‐20] as primary outcome); anatomical assessment (POP‐Q), composite outcome of success; re‐interventions for complications. Results: A total of 220 out of 262 randomised patients have been followed at 4 years. PFDI‐20 significantly improved in both groups and was better (but below the minimal clinically important difference) after LS (mean difference −7.2 points; 95% CI −14.0 to −0.05; P = 0.029). The improvement in quality of life and the success rate (LS 70%, 61–81% versus TVM 71%, 62–81%; hazard ratio 0.92, 95% CI 0.55–1.54; P = 0.75) were similar. POP‐Q measurements did not differ, except for point C (LS −57 mm versus TVM −48 mm, P = 0.0093). The grade III or higher complication rate was lower after LS (2%, 0–4.7%) than after TVM (8.7%, 3.4–13.7%; hazard ratio 4.6, 95% CI 1.007–21.0, P = 0.049)). Conclusions: Both techniques provided improvement and similar success rates. LS had a better benefit–harm balance with fewer re‐interventions due to complications. TVM remains an option when LS is not feasible. At 4 years, Laparoscopic Sacropexy (LS) had a better benefit–harm balance with fewer re‐interventions due to complications than Trans‐Vaginal Mesh (TVM). At 4 years LS had a better benefit–harm balance with fewer re‐interventions due to complications than TVM. [ABSTRACT FROM AUTHOR]

Simulation training is an appealing and useful addition to health facilities. Simulation centers are organized to maximize network resources. Simulation training is used for certification or recertification of health professionals and is now an integral part of the methods used in continuing professional development. Simulation has played a unique role in obstetrics. This article is a narrative review describing the different types of childbirth simulators, whether anatomical, virtual, or instrumented. The article identifies the role of each simulator in the training of obstetricians and the role of these instruments in simulation centers. [ABSTRACT FROM AUTHOR]

Résumé Les troubles de la statique pelvienne sont fréquents et responsables de symptômes pouvant être invalidants pour les patientes. Parmi eux, l’hédrocèle, est une pathologie souvent méconnue, difficile à diagnostiquer cliniquement. Il s’agit d’une hernie du cul-de-sac de Douglas, pouvant contenir de la graisse, de l’intestin grêle ou du sigmoïde, venant provoquer un effet de masse sur la paroi antérieure du rectum. L’imagerie par résonance magnétique pelvienne avec séquences morphologiques et dynamiques en poussée permet de faire une étude globale des troubles de la statique et un diagnostic complet, notamment avant prise en charge chirurgicale. Nous vous proposons quelques exemples afin d’illustrer cette pathologie et de souligner l’importance de son diagnostic, notamment préopératoire. Une meilleure connaissance de ce trouble de la statique pelvienne permettrait d’améliorer la prise en charge des patientes. Pelvic floor disorders are frequent and source of symptoms which can be invalidating for patients. Between them, hedrocele is a pathology often unknown and clinically difficult to diagnose. It is a herniation of fat pad, small bowel or sigmoid colon in the recto-uterine pouch ( cul-de-sac of Douglas) exercising a mass effect on the anterior wall of the rectum. Pelvic magnetic resonance imaging with morphological sequences and dynamic sequences in thrust can be very useful, allowing a comprehensive study of pelvic floor dysfunction and confirming the complete diagnosis, especially before surgery. We suggest you some examples to illustrate this pathology in order to emphasize the importance of its diagnosis, especially preoperative. A better understanding of this pelvic floor dysfunction would improve the care of patients. [ABSTRACT FROM AUTHOR]

Summary: Rib malformation and anatomical variations are not well known and are still often underdiagnosed. Usually, rib malformations are fortuitously discovered. We describe here the case of a girl, 4years and 4months old, who presented at the emergency unit for fever and an anterior tumefaction of the ribcage, without any other symptoms. She was eupneic with a normal pulmonary auscultation and viral tonsillitis with a negative streptococcus test. The thoracic tumefaction was parasternal, painless, and fixed and measured approximately 2.5×2cm. Ultrasound findings consisted of a duplicated and hypoechogenic hypertrophy of the sterno-costal cartilage of the 4th left rib. Magnetic resonance imaging (MRI) confirmed the diagnosis of chondral bifidity of the sterno-costal junction of the 4th left rib. Fever, due to the viral tonsillitis, disappeared after 4days. Rib malformations are rare, often anterior, unilateral, and preferentially located on the 3rd or the 4th rib. The main malformative rib lesions are bifid ribs, rib spurs, and widened ribs. Very rarely, they can be associated with Gorlin-Goltz syndrome or with other malformations such as VATER complex. The main differential diagnoses of these rib malformations are traumatic, tumoral, and infectious etiologies. In case of tumoral diseases, the topography of the lesion focuses the etiologic diagnosis: whereas an anterior and cartilaginous lesion is always benign, a lateral or posterior lesion can be an Ewing sarcoma. Rib malformation investigation consists in meticulous questioning, a complete clinical examination looking for any associated anomaly, completed by basic imaging explorations such as plain thoracic radiography focused on the ribcage and ultrasound. Finally, complementary computerized tomography or preferably MRI, depending on the anatomic location of the lesion, confirms the final diagnosis, as presented in our case report, and removes any uncertainty. [Copyright &y& Elsevier]

Objective: To assess the short-term incidence of serious complications of surgery for urinary incontinence or pelvic organ prolapse.Design: Prospective longitudinal cohort study using a surgical registry.Setting: Thirteen public hospitals in France.Population: A cohort of 1873 women undergoing surgery between February 2017 and August 2018.Methods: Preliminary analysis of serious complications after a mean follow-up of 7 months (0-18 months), according to type of surgery. Surgeons reported procedures and complications, which were verified by the hospitals' information systems.Main Outcome Measures: Serious complication requiring discontinuation of the procedure or subsequent surgical intervention, life-threatening complication requiring resuscitation, or death.Results: Fifty-two women (2.8%, 95% CI 2.1-3.6%) experienced a serious complication either during surgery, requiring the discontinuation of the procedure, or during the first months of follow-up, necessitating a subsequent reoperation. One woman also required resuscitation; no women died. Of 811 midurethral slings (MUSs), 11 were removed in part or totally (1.4%, 0.7-2.3%), as were two of 391 transvaginal meshes (0.5%, 0.1-1.6%), and four of 611 laparoscopically placed mesh implants (0.7%, 0.2-1.5%). The incidence of serious complications 6 months after the surgical procedure was estimated to be around 3.5% (2.0-5.0%) after MUS alone, 7.0% (2.8-11.3%) after MUS with prolapse surgery, 1.7% (0.0-3.8%) after vaginal native tissue repair, 2.8% (0.9-4.6%) after transvaginal mesh, and 1.0% (0.1-1.9%) after laparoscopy with mesh.Conclusions: Early serious complications are relatively rare. Monitoring must be continued and expanded to assess the long-term risk associated with mesh use and to identify its risk factors.Tweetable Abstract: Short-term serious complications are rare after surgery for urinary incontinence or pelvic organ prolapse, even with mesh. [ABSTRACT FROM AUTHOR]

To compare pelvic organ prolapse (POP) recurrence and morbidity between first and second line sacrocolpopexies. We conducted a retrospective chart review of all laparoscopic or robotic sacrocolpopexies for POP-Q stage ≥ 2, with or without a history of previous prolapse repair, performed with a similar technique between January 2012 and June 2019 in 3 European Gynecologic Surgery Departments. Patients were separated into two groups: first line sacrocolpopexy (FLS) and second line sacrocolpopexy (SLS). Each patient from the SLS group was age-matched with a patient from the FLS group. The primary outcome measure was reoperation procedures for recurrent POP defined as a symptomatic POP-Q stage ≥ 2 POP in at least one vaginal compartment. Secondary outcomes included operative time, intraoperative organ trauma, intraoperative blood loss, postoperative POP recurrence (operated on or not), global reoperation and mesh-related complications. During this period, 332 patients were included. After age-matching, 170 patients were analyzed: 85 patients in the FLS and SLS groups, respectively. After a mean follow-up of 3 years, there was no statistically significant difference between the two groups in terms of recurrent POP (9.4% versus 10.6%, p = 0.7), recurrent POP reoperation (3.5% versus 5.9% p = 0.7), mesh-related reoperation (0% versus 2.4%, p = 0.5), global reoperation (3.5 versus 8.2%, p = 0.3), operative time (198 ± 67 min versus 193 ± 60 min, p = 0.5), intraoperative complications such as organ injury (4.7% versus 7.1%, p = 0.7) and blood loss > 500 mL (2.4% versus 0%, p = 0.5). Patients who underwent a first or a second line sacrocolpopexy seemed to have similar rates of prolapse recurrence and complications. [ABSTRACT FROM AUTHOR]

Objective: To assess the incidence of serious complications and reoperations for recurrence after surgery for pelvic organ prolapse (POP) and compare the three most common types of repair. Design: Prospective cohort study using a registry. Setting: Nineteen French surgical centres. Population: A total of 2309 women participated between 2017 and 2019. Methods: A multivariate analysis including an inverse probability of treatment weighting approach was used to obtain three comparable groups. Main outcome measures: Serious complications and subsequent reoperations for POP recurrence. Results: The median follow‐up time was 17.6 months. Surgeries were native tissue vaginal repairs (n = 504), transvaginal mesh placements (n = 692) and laparoscopic sacropexies with mesh (n = 1113). Serious complications occurred among 52 women (2.3%), and reoperation for POP recurrence was required for 32 women (1.4%). At 1 year the cumulative weighted incidence of serious complications was 1.8% for native tissue vaginal repair, 3.9% for transvaginal mesh and 2.2% for sacropexy, and the rates for reoperation for recurrence of POP were 1.5, 0.7 and 1.1%, respectively. Compared with native tissue vaginal repair, the risk of serious complications was higher in the transvaginal mesh group (weighted hazard ratio, wHR 3.84, 95% CI 2.43–6.08) and the sacropexy group (wHR 2.48, 95% CI 1.45–4.23), whereas the risk of reoperation for prolapse recurrence was lower in both the transvaginal mesh (wHR 0.22, 95% CI 0.13–0.39) and sacropexy (wHR 0.29, 95% CI 0.18–0.47) groups. Conclusions: Our results suggest that native tissue vaginal repairs have the lowest risk of serious complications but the highest risk of reoperation for recurrence. These results are useful for informing women and for shared decision making. Laparoscopic sacropexy had fewer serious complications than transvaginal mesh and fewer reoperations for recurrence than vaginal repair. Laparoscopic sacropexy had fewer serious complications than transvaginal mesh and fewer reoperations for recurrence than vaginal repair. [ABSTRACT FROM AUTHOR]

Photodynamic therapy (PDT) is a specific anticancer treatment that received significant interest in several medical and surgical disciplines. The technique is based on (i) the application of the photosensitizer that accumulates in a variable time in the neoplasic lesions and on (ii) excitation (by light whose wavelength coincides with the absorption peak of the photosensitizer) that (iii) finally causes the destruction of the lesion. This technique allows a minimally-invasive, effective and targeted treatment of some gynecological diseases. Experimental and/or clinical studies have been conducted on vulvar intraepithelial neoplasia, cervical intraepithelial neoplasia, ovarian cancer, breast cancer, dysfonctional uterine bleeding, endometriosis and vulvar lichen sclerosus. We aim to present the principles of PDT and to expose the main indications and ways of research of this technique in gynecology today. [Copyright &y& Elsevier]

Abstract: Adhesion barriers are intraperitoneal agents, solid or fluid, developed in order to prevent postoperative adhesions. In this article, we evaluate the efficiency of these new barrier agents for adhesion prevention in gynaecologic surgery, undertaking a review of controlled clinical trials published. Several human clinical trials demonstrated the safety and efficiency of both Interceed® and Seprafilm®. As far as other barrier agents are concerned, data are still insufficient to recommend them for clinical use. There is a need for other randomised controlled trials in order to evaluate functional efficiency of anti adhesion agents. [Copyright &y& Elsevier]

The aims of this work were the evaluation of the reproductive outcome after ectopic pregnancy, and the assessment of the role of infertility risk factors and treatment’s strategy. All patients in the population-based register of the urban area around Lille, Northern France, were followed-up. 345 women treated between April 1994 and March 1997, who were trying to become pregnant were interviewed by telephone every 6 months and then every year. The cumulative pregnancy rates were calculated by the Kaplan-Meier estimation. Associations between infertility risk factors and intrauterine pregnancy were tested by the logrank test, and by a Cox model for multivariate analysis. The mean duration of follow-up was 22 months, and 228 (66%) women had obtained a new pregnancy at the time of the analysis. 23 (10%) of the first pregnancies were recurrences. For women for whom EP occured with an IUCD (17 patients), the 1 year intrauterine pregnancy (IUP) reached 67%. For the others, the 1 year IUP rate was 56%, and reached 67% after 2 years. After adjusting factors associated with fertility with a Cox regression, 3 factors seemed to lower reproductive performances: age > 35 years, previous history of infertility, and anterior tubal damage. More than half the women treated for EP obtained spontaneously a normally progressive pregnancy after 1 year. Reproductive performances are associated with characteristics of the patients, but do not depend on radical or conservative treatment. [Copyright &y& Elsevier]

This paper introduces a method for dynamic 3D registration of female pelvic organs using 2D dynamic magnetic‐resonance images (MRIs). The aim is to provide a better knowledge and understanding of pathologies such as prolapsus or abnormal mobility of tissues. 2D dynamic MRI sequences are commonly used in nowadays clinical routines in order to evaluate the dynamic of organs, but due to the limited view, subjectivity related to human perception cannot be avoided in the diagnoses. A novel method for 2D/3D registration is proposed combining 3D finite element models with a priori knowledge of boundary conditions, in order to provide a 3D extrapolation of the dynamic of the organs observed in a single 2D MRI slice. The method is applied to the four main structures of the female pelvic floor (bladder, vagina, uterus and rectum), providing a full 3D visualisation of the organs' displacements. The methodology is evaluated with two patient‐specific data sets of volunteers presenting no pelvic pathology, and a sensitivity study is performed using synthetic data. The resulting simulations provide an estimation of the dynamic 3D shape of the organs facilitating diagnosis compared with 2D sequences. Moreover, the method follows a protocol compatible with current clinical constraints presenting this way potential short term medical applications. [ABSTRACT FROM AUTHOR]

Background: Our study aimed at understanding the influence of healing time on the mechanical properties of meshes used in pelvic organ prolapse, once implanted in an animal model using the rat.Methods: A standard polypropylene mesh was implanted in 42 rats in order to evaluate the mechanical properties of the implanted mesh. Explantation occurred at 1, 2, 3, 4 and 5 months and mechanical tests were performed. Each sample was mechanically evaluated by a uniaxial tensile test with a machine (BIOTENS). Biological tissues presented a nonlinear relation between stress and strain so it could be modeled by the 2 parameters C0 and C1 of a second-order Mooney-Rivlin law.Results: The rigidity in small deformation might not be affected by healing time or the presence of the synthetic implant. On the contrary, changes seemed to occur on the stiffness in large deformation (C1). The stiffness with the mesh composite changed with healing time. The "two-month implantation" rat group was significantly more rigid than the two control groups (pcontrol/2months = 0,04 and pplacebo/2months = 0,04). The 2- and 3-month healing groups were significantly more rigid than the 1-month healing group (p1/2months = 0,01 and p1/3months = 0,003). After 2 months, the mechanical properties seemed to stabilize (p2/3months = 0,44, p2/5months = 0,16 et p3/5months = 0,3).Conclusion: In order to evaluate the mechanical properties of an implanted mesh, the optimal time for explantation seems to be 2 months. Once this period is over, a more physiological mesh will be developed in order to be similar to native vaginal tissue once implanted and colonized by scar tissue. [ABSTRACT FROM AUTHOR]

Résumé Objectif Analyse de la sinistralité en chirurgie gynécologique au sein du centre hospitalier régional et universitaire de Lille. Méthodes Nous avons procédé à un recueil rétrospectif et longitudinal de novembre 1997 à août 2015 de l’ensemble des réclamations au sein du service de chirurgie gynécologique de l’hôpital universitaire de Lille. Les informations médicales et concernant les contentieux ont été recueillies à partir du dossier patient informatisé et auprès de la cellule juridique. Résultats Quarante dossiers ont été collectés sur la période étudiée. Trente-trois dossiers concernaient des accidents médicaux et sept des défauts d’information médicale ou de mauvaise communication. Onze dossiers ont été examinés par la commission de conciliation et d’indemnisation, cinq dossiers ont été portés au tribunal administratif et deux dossiers ont été jugés au tribunal de grande instance. Les motifs de plainte les plus fréquents concernaient les perforations d’organe au décours d’une procédure endoscopique, la survenue d’une infection nosocomiale et l’oubli de corps étrangers. Un seul dossier a fait l’objet d’une condamnation, pour un autre dossier une indemnisation a été versée par l’organisme national d’indemnisation des accidents médicaux. Il n’a pas été observé d’augmentation du nombre des plaintes au cours du temps. La commission de conciliation et d’indemnisation est devenue l’organe de recours majoritaire. Conclusion Cet article a permis d’évaluer spécifiquement la sinistralité en chirurgie gynécologique en exercice public. Ce type d’étude est nécessaire pour l’amélioration de la qualité des soins et la sensibilisation des médecins aux conséquences de leur pratique. Objective Analysis of litigation in gynecological surgery in the French university hospital of Lille. Methods It is a longitudinal and retrospective study. We collected all cases of complaints between November 1997 and August 2015 concerning the department of gynecological surgery, university hospital of Lille. Medical data were obtained using electronic medical record and hospital's legal unit gave data about the complaints. Results Forty cases were identified during the reporting period. Thirty-three records concerned medical injuries and seven cases failing to provide information or lack of communication. Eleven complaints were reviewed by the French “commission de conciliation et d’indemnisation”. Five cases were brought to administrative court. Finally, Lille high court examined two records. Most of complaints concerned perforation during endoscopic procedures, nosocomial infections and forgotten foreign bodies. It was not observed any increasing number of complaints during the whole period. It was noticed a decreasing number of legal action in favor of “commission de conciliation et d’indemnisation”. Conclusion This study evaluated specifically litigation in gynecological surgery. It is necessary to conduct this type of study so as to improve medical care and to provide information for practitioner about consequences of their exercise. [ABSTRACT FROM AUTHOR]

Pelvic mobility is essential for good pelvic organ function. Any modification may be a sign of pathology. The objective of this study was to define a methodology to quantify pelvic mobility. An analysis protocol based on an image registration technique performed on dynamic magnetic resonance imaging sequences is presented. A methodology is proposed for measuring and analysing the whole displacement field based on the contour of the four pelvic organs: the vagina, bladder, rectum and uterus. A targeted analysis of pelvic mobility can be applied in the normal, hypermobility and hypomobility context. The quantification of pelvic mobility in normal conditions allows localising fascia or ligaments involved in the static of pelvic organs. In pathological situations such as prolapse, it helps localise a suspension structure weakness. In a context of hypomobility such as deep pelvic endometriosis, it should help localise pathologic areas to provide more relevant diagnosis and treatment. When combined with conventional radiology, this analysis protocol can be applied to the diagnosis and assessment of complex pelvic pathologies to help define the most suitable surgery. Moreover, these experimental results obtained in normal and pathological cases will help build and validate a better mechanical finite element model of the pelvic system. [ABSTRACT FROM AUTHOR]

In the context of the female pelvic medicine, non-invasive magnetic resonance imaging is widely used for the diagnosis of pelvic floor disorders. Nowadays, in the clinical routine, diagnoses rely largely on human interpretation of medical images, on the experience of physicians, with sometimes subjective interpretations. Hence, image correlation methods would be an alternative way to assist physicians to provide more objective analyses with standard procedures and parametrisation for patient-specific cases. Moreover, the main symptoms of pelvic system pathologies are abnormal mobilities. The finite element model simulation is a powerful tool for understanding such mobilities. Both the patient-specific simulation and the image analysis require accurate and smooth geometries of the pelvic organs. This paper introduces a new method that can be classified as a model-to-image correlation approach. The method performs fast semi-automatic detection of the bladder, vagina and rectum from magnetic resonance images for geometries reconstruction and further study of the mobilities. The approach consists of fitting a B-spline model to the organ shapes in real images via a generated virtual image. We provided efficient, adaptive and consistent segmentation on a dataset of 19 patient images (healthy and pathological). [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: We created a pregnant woman pelvic model to perform a simulation of delivery to understand the pathophysiology of urogenital prolapse by studying the constraints on the pelvic components (muscles, ligaments, pelvic organs) during childbirth. These simulations will also provide valuable tools to understand and teach obstetrical mechanics. Methods: We built a numerical model of the pelvic system from a term pregnant woman, using the finite element method on a mesh built from magnetic resonance images of a nulliparous pregnant woman. Mechanical properties of pelvic tissues already determined by the team were adapted to account for pregnancy. Results: The system allows delivery to be simulated. When a fetal head at the 50th percentile for the term goes through the pelvic system, uterosacral ligaments undergo a deformation of around 30 %. Uterosacral ligaments are the major pelvic sustaining structures, their lesion may be a potential cause of urogenital prolapse. We built a model of childbirth as a function of pregnancy term by varying volumes of fetal head and uterus. The impact on uterosacral ligaments is higher when the fetal head is larger. Conclusions: Our modelling is rather complete considering that it involves many organs including ligaments. It allows us to analyse the effect of childbirth on uterosacral ligaments and to understand how they impact on pelvic statics. First results are promising, but optimisation and future simulations will be needed. We also plan to simulate various delivery scenarios (cephalic, breech presentation, instrumental extraction), which will be useful to study perineal lesions and also to teach obstetrical mechanics. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: The female pelvic floor is a complex network of ligaments and muscles whose mechanical properties have not been completely understood. The goal of this study is to understand the biomechanical properties of the pelvic floor tissues of young women and the impact of aging. Methods: Biomechanical uniaxial tension tests were performed on pelvic floor tissues (ligaments and organs) of six young female cadavers (average 29 years old). Results have been analyzed in order to define the characteristics of the mechanical properties of young pelvic soft tissues. Results have been compared with those in the literature in order to understand the similarities and discrepancies between young and old patients. Results: Damageable, nonlinear elastic biomechanical behavior is observed. The variation in stiffness among the pelvic floor organs could be shown. Ligaments and the vaginal wall are the most rigid organs, whereas the rectum and bladder tend to be less rigid (approximately two times less rigid for small deformations and three times less rigid for large deformations). This study shows that ligaments and the vaginal wall of young women have similar mechanical behavior while those of older women differ. Furthermore, young women's tissues differ slightly from older women's tissues. Conclusions: Results show that aging and possibly diverse 'trauma' have an impact on modifying the mechanical behavior of pelvic floor tissues. Over time pelvic floor ligaments and vaginal tissues will differentiate and acquire different mechanical behavior, as seen within the literature in older cadavers. [ABSTRACT FROM AUTHOR]

Résumé Objectifs Rapporter la mise en place d’un programme de simulation pour l’apprentissage des examens mammaire et pelvien gynécologiques aux étudiants de deuxième année de médecine (DFGSM2) et évaluer la satisfaction des étudiants et des enseignants suite à cet enseignement. Patients et méthodes Mise en place de la séance d’apprentissage aux gestes par groupes de cinq étudiants avec une évaluation prospective du programme d’apprentissage grâce à un questionnaire de satisfaction rempli par les étudiants et les enseignants à la fin de la séance d’enseignement. Résultats Le programme d’apprentissage comprenait une préparation en ligne à la séance, trois ateliers sur mannequins simples (examen mammaire, examen pelvien avec mise en place d’un spéculum et frottis cervico-vaginal) et la projection d’un film. Au total, 419 (80,6 %) sur 520 étudiants en MED2 et 15 (50 %) sur 30 enseignants (13 chefs de clinique et 17 sages-femmes) ont répondu au questionnaire. L’appréciation globale de l’enseignement était excellente pour 56,6 % des étudiants et bonne pour 43,2 % d’entre eux. Pour les enseignants, ces pourcentages étaient respectivement de 13,4 % et 86,6 %. En moyenne, 89,7 % des étudiants souhaitaient plus d’enseignements de ce type et tous les enseignants jugeaient ces formations utiles ou très utiles pour les étudiants. Discussion et conclusion La mise en place de séances d’apprentissage par simulation des examens pelvien et mammaire destinés à des étudiants en médecine de deuxième année avec l’utilisation de mannequins simples et de vidéos est associée à un haut degré de satisfaction chez les étudiants et chez les enseignants. Objectives To report the setting-up of a new educational program in the teaching of female pelvic and breast examinations and to investigate and compare the views and experience of undergraduate medical students and teachers on the program. Patients and methods Prospective evaluation of the teaching program through completion of a satisfaction questionnaire including items related to the educational value of the session by the students and the teachers. Results The educational program included an online preparation for the session, 3 workshops on training models (breast examination, pelvic examination, cervical snear procedure) and a video clip. In total, 419 (80.6%) of 520 second study year students (and 15 [50%] of 30 teachers [13 doctors and 17 midwifes] responded to the questionnaire). The students and the teachers were either very satisfied (56.6% and 13.4%, respectively) or satisfied (43.2% and 86.6%, respectively). On average, 89.7% of students wanted more lessons of this type and all teachers felt these useful or very useful training for students. Discussion and conclusion Teaching sessions for pelvic and breast examination, which make combined use of videos and training models, are associated with a high degree of satisfaction from teachers and students in their second student's year. [ABSTRACT FROM AUTHOR]

Abstract: Surgery of genital prolapse causes haemorrhagic complications in about 1% of cases. The pelvis is highly vascular and accessing the usual landmarks of vaginal surgery, in particular the sciatic spine, is delicate work. Meticulous dissection of closed spaces is often difficult, and exposure and haemostatic procedures will be challenging in the event of any bleeding complication. When fixing prosthesis to the sacrospinous ligament, the inferior gluteal artery and its coccygeal branch are at risk. Fixation to the sacrospinous ligament must be performed more than 25mm away from the sciatic spine and, if possible, must not transfixiate it. Safe insertion of prosthesis requires sufficient experience, and an adequate learning curve. Being aware of vascular anatomy allows one to understand and treat haemorrhagic incidents. Packing or selective embolization seem to be the two methods to adopt, depending on the severity of bleeding and the conditions of exposure on the one hand, and on the technical resources available for embolization, on the other. Hypogastric ligature appears to be ineffective in this context. [Copyright &y& Elsevier]

Introduction and hypothesis: Genital prolapse remains a complex pathological condition. Physiopathology remains poorly understood, aetiology is multi-factorial, surgery is not always satisfying, as the rate of relapse cannot be overlooked. More over a good anatomical result will not always guarantee functional satisfaction. The aim of our study is to have a better understanding of the involvement of uterine ligaments in pelvic statics via 3D simulation. Methods: Simulation of pelvic mobility is performed with a validated numerical model in a normal situation (standing up to lying down) or induced pathological ones where parts of the constitutive elements of the model are virtually “cut” independently. Displacements are then discussed. Results: Numerical results have been compared with dynamic MRI for two volunteers. Dynamic sequences had 90 images, and 180 simulations have been validated. Results are coherent with clinical data and the literature, thus validating our mechanical approach. Uterine ligaments are involved in pelvic statics, but their lesions are not sufficient to generate a genital prolapse. Round ligaments play a part in uterine orientation; the utero-sacral ligaments support the uterus when standing up. Conclusions: Pelvic normal and pathological mobility study via modelling and 3D simulation is a new strategy in understanding the complex multifactorial physiopathology of genital prolapse. This approach must be validated in a larger series of patients. Nevertheless, pelvic ligaments seem to play an important role in statics, especially, in agreement with a literature survey, utero-sacral ligaments in a standing position. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: To evaluate clinical effectiveness and complication rates at 5 years following the total Trans Vaginal Mesh (TVM) technique to treat pelvic organ prolapse. Methods: Prospective, observational, multi-centre study in patients with prolapse of stage II or higher. Results: Of the 90 women enrolled in the study, 82 (91 %) were available for the 5-year follow-up period. At the 5-year endpoint, success, defined as no surgical prolapse reintervention and leading edge <−1 (International Continence Society [ICS] criteria) or above the level of the hymen, was 79 % and 87 % respectively. A composite criterion of success defined as: leading edge above the hymen (<0) and no bulge symptoms and no reintervention for prolapse was met by 90 %, 88 % and 84 % at the 1-, 3-, and 5-year endpoints respectively. Quality of life improvement was sustained over the 5 years. Over the 5-year follow-up period, a total of only 4 patients (5 %) required re-intervention for prolapse, while a total of 14 patients (16 %) experienced mesh exposure for which 8 resections needed to be performed. Seven exposures were still ongoing at the 5-year endpoint, all asymptomatic. Only 33 out of 61 (54 %) sexually active patients at baseline remained so at 5 years. De novo dyspareunia was reported by 10 %, but no new cases at the 5-year endpoint. One patient reported de novo unprovoked mild pelvic pain at 5 years, 5 reported pains during pelvic examination only. Conclusions: Five-year results indicated that TVM provided a stable anatomical repair. Improvements in QOL and associated improvements in prolapse-specific symptoms were sustained. Minimal new morbidity emerged between the 1- and 5-year follow-up. [ABSTRACT FROM AUTHOR]

Abstract: The use of mesh for pelvic organ prolapse repair through the vaginal route has increased within the last decade. The main objective is to improve anatomical results (based on the superiority of sacropexy with meshes when compared to vaginal traditional surgery), with the advantages of the vaginal route. An increasing number of cohort series and randomized control trials have been published. There is level-1 evidence that the use of mesh for the treatment of cystocele through the vaginal route improves anatomical results when compared to traditional surgery. The rates of complications between these two techniques seem equivalent, even for de novo dyspareunia. [Copyright &y& Elsevier]

Objective: Fluorescence diagnosis is still undeveloped in gynaecology. In order to diagnose and localize squamous intraepithelial lesion (SIL) of the cervix, a new method improving the low specificity of colposcopy would be useful. The goal of this study was to assess the feasability and safety of colposcopic fluorescence diagnosis of SIL after topicaly application of methyl aminolevulinate (MAL). Patients and methods: Patients with histologic proved cervical intraepithelial neoplasia (CIN) and planned for loop electrosurgical excision procedure (LEEP) under general anesthesia were included in a prospective study. Before general anesthesia, a thick layer of MAL (Metvix®-160mg/mL cream) was applied on the cervix for 35-150min. Fluorescent colposcopic inspection of the cervix was performed using a rigid 10-mm laparoscope inserted in the vaginal cavity and connected to D-light AF system (Karl Storz Endoskope, Tuttlingen Germany). In order to confirm neoplasic status, fluorescent foci underwent directed punch biopsy(ies). Results: Fourteen patients were included in the study. Colposcopic fluorescence imaging revealed red fluorescent foci in 71.4% of cases (10/14) (neoplasic status of fluorescent foci was confirmed in 80%). Concerning MAL, the mean of application time was 73min (35-150). Two cases presented a false-positive fluorescence and four cases of false-negative fluorescence. For all cases of false-negative fluorescence, application time of MAL was less than 60min. We observed no systemic or local toxicity of MAL application in any group. Discussion and conclusion: Using topical application of MAL to the cervix, we demonstrated that fluorescence diagnosis of SIL is feasible. This study justifies the further development of fluorescence imaging that combines classical white light colposcopy with the use of a photosensitizer. [Copyright &y& Elsevier]

Even if genital prolapse does particularly affect the elder woman, we often have to face a surgical demand with conservation of the uterus from a patient less than 50 years. Before making the decision of treating a non life-threatening symptom by a specific surgical technique, it is important to ask who should be operated and when. Then, the route of the surgery has to be chosen considering that the woman wants to preserve her fertility. In the past decade, some surgical acts, like the sacrohysteropexy, were known as having poorer results if the women got pregnant. Thus, if there was a persistent childbearing desire, more interventions allowing pregnancy (like the Manchester’s or the Richardson’s procedures) were preferred. Nowadays, the sacrohysteropexy is considered as the gold standard technique, but one question is coming out: could we substitute this traditional surgery by a vaginal repair with meshes? Despite the big diversity of the so-called “sacrohysteropexy”, we think that it remains the first choice technique to cure a young woman. Vaginal meshes have too high a rate of morbidity (especially on sexual activity) to be considered as the best surgical treatment. But this question could probably find another answer in the future, when all the studies about the component of the meshes will be finished. [Copyright &y& Elsevier]

Abstract: Objective: The objective was to develop an animal model using bacterial inoculation to evaluate tissue integration and tolerance to meshes used in genital prolapse surgery. Study design: We placed three different meshes under the abdominal skin of 120 Wistar rats: a polypropylene monofilament non-coated mesh (Parietene®), a polypropylene monofilament collagen-coated mesh (Ugytex®) and a polyethylene terephthalate mesh (Mersuture®). We performed bacterial inoculation just after implantation with 1ml of 107 colonies forming unit (CFU) of Staphylococcus epidermidis or Escherichia coli. Rats were sacrificed 7, 14, 60, and 90 days after intervention. We used polarised light microscopy to analyse the collagen deposition and organisation. We quantified the inflammation cells. Bacterial analysis and quantification of the explanted meshes were performed. The exact Fisher''s test and Kruskal–Wallis test were used for statistics. Results: We did not find any significant difference between inoculated or non-inoculated meshes in terms of collagen deposition. The scarring process seemed stable at day 90. Tissue integration was best with the polypropylene meshes, which allowed the development of a well-organised, mature connective tissue. Inflammatory reaction was higher in inoculated meshes, but only at day 7. At day 90, we found a high number of macrophages and multinuclear cells around all the meshes. There was no significant difference between prostheses that had been inoculated and those that had not with regard to positive bacterial culture. Quantification of bacterial colonies decreased with time. Conclusion: In this animal model, we did not find any clinically related difference in infection and tissue integration between the meshes used in genital prolapse. Such experimental studies must be carried out whenever new prostheses become available before their use is validated in common practice. [Copyright &y& Elsevier]

Abstract: Ibuprofen is the non-steroidal anti-inflammatory drug most prescribed for the treatment of fever and moderate pain in childhood. Its analgesic and antipyretic efficacy is now well documented: at equal doses ibuprofen appears slightly more effective than acetaminophen in the treatment of fever and is equivalent for analgesia. However, adverse effects should be taken into account in the choice between ibuprofen and acetaminophen. Lot of studies (case reports, cohort studies, case-control studies and one multicenter double-blind randomized control trial) have reported ibuprofen adverse effects at therapeutics doses. These data suggest there is an increased risk of invasive group A streptococcal infection after chickenpox and of acute renal failure in case of hypovolemia after a treatment by ibuprofen. Gastroduodenal and hemorrhagic adverse events could also happen, but the causality with ibuprofen is not demonstrated. Therefore, ibuprofen is not recommended for the treatment of fever or moderate pain during chickenpox or during a disease with a risk of dehydration, until other pharmacoepidemiology studies more accurately quantify the risk of adverse events of ibuprofen in children. [Copyright &y& Elsevier]

Abstract: Objectives: The purpose is to quantify objective tissue resistances before healing of prostheses used in pelvic floor surgery. Patients and methods: We measured tissue resistances offered to five types of meshes by four classical surgical routes. We also tested the incidence of the modification of the width of meshes on tissue resistance. This study was realized on frozen cadavers, by pull on prostheses just after implantation. Tests are realized with a dynamometer and results obtained in Newton. Results: In the Retzius space, TVT® offers a better resistance than IVS® or LIFT® meshes. We did not bring to the fore a significant difference between four routes for 1 cm wide prosthesis. The increase of width of Prolene® meshes improves their resistance in tissues and thus quality of their fixation. We underscore a better resistance of the trans sacrospinous route with regard to the trans muscular one. Discussion and conclusion: The increase of resistance is bound to the increase of the contact area between the prosthesis and the tissues. This increase of resistance should be taken into account in prolapse surgery: constraints are stronger than for stress incontinence. The posterior arms of meshes have to measure more than 1 cm wide and be set up through the sacrospinous ligament rather than through the elevator muscles. The type of knitting of prostheses is important and influences the resistance in tissues in the immediate postoperative time. Manufacturers should be interested in conceiving specific meshes for the tension-free fixation, with special and adapted mechanical properties. [Copyright &y& Elsevier]

Abstract: Objective: To bring to the fore the differences in terms of anatomical restoration between the abdominal and vaginal approach of pelvic floor repair. We compared the short-term anatomical results of the sacropexy and the sacrospinous fixation and paravaginal repair. Patients and methods: Magnetic Resonance Imagery (MRI) allowed us to obtain a reproducible and objective comparison of location of the various pelvic organs. Forty-three patients benefited from a MRI a pre- and postoperative evaluation according to the position of organs with regard to the pubo-coccygeal line. We noted cystocele, hysterocele or enterocele when the bladder, the uterine cervix, or the Douglas'' cul-de-sac came under this line during efforts of push. We measured length modifications and lateral and anteroposterior vaginal axis. Results: After the surgery, we noted that all pelvic organs were found above the reference line. On the other hand, bladders are significantly situated less high after vaginal pelvic floor repair. There is no postoperative difference as regards of the vaginal wall location. The lengths and vaginal axis are comparable in pre- and postoperative evaluation. Discussion and conclusion: In our study, the anatomical results of pelvic floor repair performed by vaginal or abdominal route are short-term comparable and the vaginal approach is not responsible for decrease of length or vaginal reorientation. Standardized and longer term evaluated, the MRI can represent an objective and reproducible help to the staging of pelvic floor dysfunction. [Copyright &y& Elsevier]

Abstract: Objectives: To evaluate the efficacy and safety of a surgical treatment for stress urinary incontinence by implantation of a silicone-coated polyester tape (Lift®). Materials and methods: This retrospective study included 72 female patients having had a suburethral silicone-coated polyester tape inserted as treatment for stress urinary incontinence, combined or not with pelvic surgery. We recorded the patient''s characteristics, the surgical procedure, the short and long-term results and complications. Results: Seventy-two patients were operated, 60 of whom were fully evaluated. The average follow-up was 17 months. On 48 patients (80%) the treatment was successful, 3 (5%) were improved, and 9 (15%) were regarded as a failure. Dysuria occurred in six (10%) patients, five were de novo, and one was persistent. Ten patients (16.6%) presented de novo urge incontinence. The main complication was a higher rate of severe infections, accompanied by defective healing (4, i.e. 6.7%). Conclusion: The procedure using a silicone-coated polyester tape seems to be efficient, but insufficiently secure. This higher rejection rate leads us to prefer other synthetic materials proved to be better tolerated. [Copyright &y& Elsevier]

Abstract: Endometriosis of the urinary tract (bladder and/or ureter) is rare and concerns 1–2% of cases of endometriosis. Surgical management is usually mandatory. Rate of peri operative morbidity is low. There is a risk of functional (dysuria, chronic hypogastric pains, imperiosity) and anatomical recurrences (0–15 and 0–10% respectively). Surgical treatment of bladder and/or ureteral endometriosis requires informed consent of patients and multidisciplinary management. [Copyright &y& Elsevier]

Abstract: Objectives. – Prosthetic reinforcement in the surgical repair of pelvic prolapse by the vaginal approach is currently on the increase. However, this technique is not without tolerance-related problems. The most frequently described complication is prosthesis exposure, including erosion and delayed healing. It is independent of a granuloma and a major infection as pelvic cellulitis. Its mechanism is associated with defective vaginal healing. The purpose of our study is to define the risk factors for exposure of the prosthetic material. Patients and methods. – Two hundred and seventy-seven medical records relating to patients undergoing surgery due to pelvic prolapse were included in our study. The treatment of genital prolapse was managed via the vaginal approach with polypropylene mesh. This is a continuous, retrospective study conducted over a period of 24 months. Results. – Thirty-four cases of prosthesis exposure were observed in the 2 months following surgery, which represents an incidence of 12.27%. The risk factors are concomitant hysterectomy [odds ratio 5.17 (P =0.001)] and inverted T colpotomy [odds ratio 6.06 (P =0.01)]. The protective factors are preservation of the uterus and the performance of a minor colpotomy in patients who had already undergone a hysterectomy or in those whose uterus had been preserved [odds ratio 5.16 (P =0.0001)]. Discussion and conclusion. – In our study, we have only found risk factors of operative protocol. In fact, other information as age, menopause status or medical history of the patient is not significant. The uterus must be preserved and the number and extent of colpotomies needed to insert the prosthesis must be limited. [Copyright &y& Elsevier]

Objectif. – Mesures des résistances maximales à la rupture des ligaments pelviens utilisés dans les cures de prolapsus et d''incontinence urinaire.Patientes et méthodes. – Nos mesures sont effectuées à partir de ligaments pelviens de cadavres. Nous avons disséqué 29 bassins de cadavres féminins dont les modes de conservation différaient. Dix cadavres étaient frais congelés, dix frais et neuf formolés. Sur chacun, nous avons disséqué le ligament pré-vertébral au niveau du promontoire, les ligaments pectinés, sacro-épineux et les arcs tendineux du fascia pelvien. Une évaluation subjective clinique de la qualité ligamentaire par l''examen et la palpation digitale nous a permis d''effectuer une classification en trois groupes de qualité : A, B et C. Ces mêmes ligaments étaient ensuite aiguillés par un fil, prenant l''ensemble de leur épaisseur, et les ligaments étaient soumis à une traction dans l''axe du vagin jusqu''à obtenir leur rupture. L''appareil de mesure est un dynamomètre de type Samson, adapté à notre étude. La résistance à la rupture des ligaments est rapportée en newtons. Résultats. – Il existe une grande variabilité dans les mesures de résistance maximale à la rupture des ligaments. Les valeurs minimales obtenues sont de l''ordre de 22 newtons, et proches de 200 newtons pour les valeurs maximales. Les résultats montrent une grande disparité. Le ligament pré-vertébral est en moyenne plus résistant. Lorsqu''on compare la résistance en fonction des trois modes de conservation, il n''existe une différence significative de résistance que pour les ligaments pré-vertébraux aux dépens des sujets formolés. Pour tous les autres ligaments il n''existe pas de différence significative en fonction du mode de conservation. On ne retrouve pas de différence significative entre les mesures droite et gauche pour les ligaments bilatéraux. Le ligament pectiné est significativement plus résistant que le ligament sacro-épineux et que les arcs tendineux du fascia pelvien. Il existe un lien significatif entre l''appréciation subjective de la qualité ligamentaire et les mesures objectives de résistance.Discussion et conclusion. – La littérature ne donne pas de référence concernant la résistance à la rupture des ligaments pelviens. Ces ligaments sont pourtant utilisés couramment dans presque toutes les interventions de cures de prolapsus ou d''incontinence urinaire. Les résultats rapportés permettent de constater que ces ligaments sont de résistance très variable d''une patiente à l''autre, d''un ligament à l''autre, voire chez une même patiente et pour un même ligament d''un côté à l''autre. Ces observations pourraient permettre d''expliquer certains échecs des techniques chirurgicales et soulignent l''intérêt de rechercher des techniques d''évaluation de ces résistances en pré-opératoire. Ceci nous permettrait de modifier les indications chirurgicales en fonction de la qualité des ligaments. L''évaluation subjective per-opératoire de la résistance est globalement corrélée aux mesures objectives et devrait donc être un élément déterminant dans le choix per-opératoire des ligaments de suspension pour les montages chirurgicaux. [Copyright &y& Elsevier]

Objective. – We describe the intra and postoperative frequency of complications in vaginal hysterectomies for benign disorders in patients with a history of caesarean section.Patients and methods. – Since 1996, 963 hysterectomies have been performed in our institution. 76.94% were performed exclusively by vaginal route (n = 741), 10.1% (n = 98) were by laparoscopic-assisted vaginal route and 12.9%, by pure abdominal route. We compared two groups of patients who underwent vaginal hysterectomy, with or without history of caesarean section. In each group we recorded the characteristics of the population and compared the intra and postoperative data, such as bladder or digestive tract wounds and haemorrhages. We used analysis of variance tests to compare means, χ2-tests and Fisher’s exact tests for comparisons of numbers. A probability of P < 0.05 was adopted as the limit of significance.Results. – The frequency of haemorrhages was significantly higher in the patients with a history of caesareans. Bladder and intestine injury rates are significantly higher in the previous caesarean section group, but not significant for the bowel injuries. We compared the cumulative frequency of complications between the two groups. In the group with previous caesarean section, we recorded 18.3% of intra operative complications. In the group without history of caesarean section, we recorded 3.58% of complications. There is a significant difference between the cumulative frequency of complications in the two populations of patients in favour of the sub group without a history of caesarean scar (P < 0.0001).Discussion and conclusion. – A history of single or multiple previous caesarean section increases the intra operative risk in vaginal hysterectomies. The surgeon must take into account the history of caesarean section and be attentive to the previous operating time of the bladder and uterine region especially at the time of opening the anterior peritoneal cul-de-sac. Nevertheless, uterine scarring as a sequel to caesareans must not be a contraindication to the vaginal route. [Copyright &y& Elsevier]

The aim of our work was to design an instrument capable of measuring intra-vaginal pressures in patients suffering from a genital prolapse. This project is based on achievable, reliable measurement intra-vaginal pressure as described in technical literature. It reflects the intra-abdominal pressure for which it can be substituted during urodynamic exploration. We have devised a measuring instrument that satisfies the anatomical constraints imposed by the vaginal cavity and have defined a study protocol in order to verify the relevance and feasibility of this functional and dynamic examination. This new exploration means uses oesophageal manometric probes that have been adapted for intra-vaginal use, as well as a data recording channel. Our preliminary results demonstrate the feasibility and reproducibility of intra-vaginal pressure measurements. Vectorial display can be used to illustrate the axes of forces present in each effort and for each patient according to her position. Its use makes it possible to investigate the physiological changes in pressure vectors occurring when a woman makes physical efforts (coughing or pushing) and when she changes position (standing or recumbent). Our study has demonstrated the feasibility of intra-vaginal pressure measurements. We will have to clarify the role of this data and, in particular, that of the pressure axes, by continuing our prospective study, in order to determine their possible impact on optimizing the choice of surgical technique. The use of magnetic resonance imaging and the tools of structural mechanics modeling will be added in our research protocol. [Copyright &y& Elsevier]

Objectives. – Surgical treatment in which a vaginal mucosa island is buried leads to a risk of epithelial inclusion cyst formation. The aim of this study is to describe this complication, assess incidence, precise facilitating factors and discuss treatment.Patients and method. – This study concerned 84 patients operated on between January 1996 and December 1998. They were treated with modified vaginal wall sling procedure. Fifty women were post-menopausal and 22 had estrogenotherapy. All patients had post-operative surveillance. The mean post-operative follow-up was 19 months (range: 1–68 months). Epithelial inclusion cyst formation diagnosis reposed exclusively on clinical assessment.Results. – Seven out of the 84 patients (8.3%) were diagnosed with epithelial inclusion cyst formation within 19 months of their operation (range: 3–34 months). Out of the seven patients, four were post-menopausal and three had received estrogenotherapy for many years. In six cases, epithelial inclusion cyst was symptomatically revealed by perineal pain or dysuria. These cases were successfully treated by cyst marsupialisation without recurrent incontinence.Discussion and conclusion. – The results of this short study show that epithelial inclusion cyst formation is a specific complication of surgical procedures burying a full thickness of vaginal mucosa and that estrogen impregnation seems to be the main facilitating factor. Successful treatment of symptomatic cases of epithelial inclusion cyst can be achieved by marsupialisation. [Copyright &y& Elsevier]

We wish to discuss the importance of MRI in association with the clinical pelvic examination for the study of vaginal prolapse, especially for the posterior compartment (rectocele, elytrocele). The increased sensitivity of static and dynamic MRI allowed a clinicoradiology relation more exactly for the study of prolapse. We describe a clinical observation where the RMI used before and after surgery is more reliable than the only clinic examination. [Copyright &y& Elsevier]

Objective.– Rate scales are used to analyse urinary incontinence. There are many scales making it difficult to compare the different studies of urinary incontinence. The purpose of this study was to evaluate and compare the rate scales pertaining specifically to urinary incontinence. Patients and method. – A review of the literature was performed for publications specifically addressing rate scales of urinary incontinence. Each scale was evaluated using the following four criteria: principal characteristics (reference source, number of items addressed, scoring method, language), objectives (type of incontinence, severity and quality of life measures), psychometric properties (scientific validity, reliability and responsiveness) and linguistic validation. Results. – Thirteen scales were identified. These were divided into two groups: (1) those based on "classifications" and (2) those based on specific questionnaires. Scales based on classifications were not precise and are never scientifically validated. Scales based on questionnaires were more elaborate and more detailed; nevertheless, the study of their psychometric properties was often incomplete. Discussion and conclusion. – Classification-based rate scales are inadequate to analyse urinary incontinence. Questionnaire-based rate scales are superior, but at minimum, they should address the previously stated objective and psychometric criteria. The choice of questionnaire should depend on whether it is to be used in clinical practice or for research protocol. [ABSTRACT FROM AUTHOR]

Objectives. – The aim of this study was to determine the symptoms of bladder and ureteral endometriosis and to review the treatment approaches.Materials and Methods. – We conducted a retrospective studyover the period November 1989–July 2000. We reviewed the medical data of all women with bladder or utereral endometriosis who underwent a major surgery (ureteral reimplementation on psoas bladder, partial resection of the ureter, partial cystectomy).Results. – Eight women met the defined selection criterion, three with bladder injuryand five with ureteral injury. The only adverse postoperative complication was a passive ureteral reflux following ureteral reimplementation on psoas bladder. No recurrence on the urinary tract were reported.Conclusion. – Surgical treatment is indicated for patient suffering from symptomatic bladder or ureteral endometriosis. Isolated bladder injuries due to endometriosis are mostly treated by laparoscopic surgery. Ureteral endometriosis may deteriorate the renal function. The initial step of the treatment may include an uterolysis by coelioscopy or an ureteral dilatation by ureteroscopy together with a medical treatment. The renal function must be closely monitored. In case of persistent or recurrent endometriosis, an ureteral resection would be justified. [Copyright &y& Elsevier]

Abstract: Objective:: We report two cases of perineal cellulitis due to the surgical treatment of female stress urinary incontinence with a trans-obturator sub-urethral tape of Uratape® (Porgès). Methods:: Treatment and follow up of their complication were performed at the CHRU of Lille. Results:: In both cases, this complication is related to prolonged vaginal exposition of the tape. Vaginal erosion always occurs next to the silicon coated section of the tape. Conclusion:: Such a complication has never been described yet. It shows a lack of data concerning human tissue tolerance of sub-urethral tapes constituents. Such examples should call for caution against new materials, all the more so as they have not yet been validated by large scale studies. [Copyright &y& Elsevier]

Peritoneovaginal fistula is a rare complication of hysterectomy. A patient with pelvic pain and vaginal discharge due to peritoneovaginal fistula, 6 months after hysterectomy, is presented. The laparoscopic approach with an intravaginal blue-test, provided the evidence of the peritoneovaginal fistula. The transvaginal approach offered a surgical closure of the fistula and a resolution of the symptoms. In addition, we have reviewed the literature, the symptoms, the differential diagnosis and the management of this problem. [Copyright &y& Elsevier]

The article presents the study that investigates the impact of the healing and implantation process on the mechanical properties on vaginal tissues after surgery. The topics discussed include estimated percentage of women who suffered from pelvic organ prolapse, the effectiveness of synthetic prosthesis in treating the disorder, and the mismatch between native tissue and mesh.