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Introduction and Hypothesis: The choice of whether or not to preserve the uterus in the case of patients with urogenital prolapse who undergo sacral colpopexy is still debated. We compared objective and subjective outcomes of laparoscopic sacral hysteropexy (LSHP) and laparoscopic sacral colpopexy with concomitant supracervical hysterectomy (LSCP/SCH) in patients with symptomatic pelvic organ prolapse., Methods: This is a multicenter retrospective cohort study conducted at the Urogynecology Department of the Fondazione Policlinico Universitario A. Gemelli IRCCS of Rome and at the Diaconesses Croix Saint Simon Hospital of Paris. We collected data of 136 patients; 78 underwent LSHP and 58 underwent LSCP/SCH for pelvic organ prolapse between January 2016 and December 2017., Results: Patients of the two groups had similar preoperative characteristics. All patients completed 24-month follow-up evaluation. Overall, anatomical cure rate was 84.6% and 87.9% in the LSHP group and LSCP/SCH group, respectively, without statistically significant differences. In particular, in the LSHP group the anatomical success rate was 94.9%, 92.3% and 92.3% for the apical, anterior and posterior vaginal compartment whereas in the LSHP group LSCP/SCH was 100%, 91.4% and 94.8%, respectively. Subjective success rate was 89.7% among patients who underwent LSHP and 93.1% among women who underwent LSCP/SCH (p = 0.494). The median operative time (OT) was significantly shorter in LSHP. There were no significant differences between the groups in terms of estimated blood loss, conversion to laparotomy and intra- and postoperative complications. Patients' satisfaction was high in both groups without statistical differences., Conclusions: Both laparoscopic procedures are safe and effective in the treatment of pelvic organ prolapse. LSHP can be offered as an alternative in women who are strongly motivated to preserve the uterus in the absence of abnormal uterine findings., (© 2021. The International Urogynecological Association.)

Hyper-crosslinked polymers (HCPs) have been produced by the Friedel-Crafts reaction using anthracene, benzene, carbazole or dibenzothiophene as precursors and dimethoxymethane as crosslinker, and the effect of graphene oxide (GO) addition has been studied. The resulting HCPs were highly microporous with BET areas (A BET ) between 590 and 1120 m 2 g -1 . The benzene-derived HCP (B1FeM2) and the corresponding composite with GO (B1FM2-GO) exhibited the highest A BET and were selected to study their hydrogen adsorption capacities in the pressure range of 0.1 - 14 MPa at 77 K. The maximum H 2 excess uptake was 2.1 and 2.0 wt% for B1FeM2 and B1FeM2-GO, respectively, at 4 MPa and 77 K. The addition of GO reduced the specific surface area but increased the density of the resultant HCP-GO composites, which is beneficial for practical applications and proves that materials giving higher gravimetric storage capacities are not necessarily those that offer higher volumetric capacities. H 2 adsorption-desorption cycles up to 14 MPa showed irreversible deformation of both HCP and HCP-GO materials, which calls into question their application for hydrogen adsorption at pressures above 4 MPa., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: Pelvic organ prolapse is a common condition among post-menopausal women, and surgery is often the standard treatment proposed. Native tissue vaginal surgery is burdened by a high rate of recurrence, and mesh vaginal surgery has become current practice. The purpose of this study was to evaluate the safety and the effectiveness of the vaginal kit Anterior/Apical single incision mesh Elevate™ for the correction of anterior and apical compartment prolapse., Study Design: Data of patients with symptomatic anterior vaginal prolapse stage ≥ II, receiving mesh repair with the Anterior/Apical Elevate single incision system between January 2010 and January 2015 were retrieved. Prolapse was classified according to the POP-Q system. The main outcome measure was anatomical success, while subjective and safety outcomes were secondary outcomes., Results: Anatomical success rate was 87.2 % for anterior compartment prolapse and 84.6 % for combined anterior and apical prolapse, while overall functional success rate was 96.2 % after a median follow-up of 33.6 months. The most frequent short-term complications were urinary bladder injury (3.0 %) and transient urinary retention (6.9 %). The most common long-term complications were de novo or persistent symptomatic stress urinary incontinence (10.8 %) and vaginal mesh extrusion (3.8 %)., Conclusion: Mesh vaginal surgery with Anterior/Apical single incision mesh Elevate™ is a well-tolerated procedure with a very high anatomical and functional success rate. Short and long-term complications rate seem to be acceptable, and in most of cases, solvable. Further studies are needed to confirm our promising data., Competing Interests: Declaration of Competing Interest The authors report no declarations of interest., (Copyright © 2021 Elsevier B.V. All rights reserved.)

The growing trend towards sustainable energy production, while intermittent, can meet all the criteria of energy demand through the use and development of high-performance thermal energy storage (TES). In this context, high-temperature hybrid TES systems, based upon the combination of fibrous carbon hosts and peritectic phase change materials (PCMs), are seen as promising solutions. One of the main conditions for the operational viability of hybrid TES is the chemical inertness between the components of the system. Thus, the chemical stability and compatibility of several commercial carbon felts (CFs) and molten lithium salts are discussed in the present study. Commercial CFs were characterised by elemental analysis, X-ray diffraction (XRD) and Raman spectroscopy before being tested in molten lithium salts: LiOH, LiBr, and the LiOH/LiBr peritectic mixture defined as our PCM of interest. The chemical stability was evaluated by gravimetry, gas adsorption and scanning electron microscopy (SEM). Among the studied CFs, the materials with the highest carbon purity and the most graphitic structure showed improved stability in contact with molten lithium salts, even under the most severe test conditions (750 °C). The application of the Arrhenius law allowed calculating the activation energy (in the range of 116 to 165 kJ mol -1 ), and estimating the potential stability of CFs at actual application temperatures. These results confirmed the applicability of CFs as porous hosts for stabilising peritectic PCMs based on molten lithium salts.

Purpose: The prevalence of pelvic organ prolapse (POP) is increasing. The number of women aged 70-80 years requiring surgical management for POP is also increasing. The purpose of this study was to compare the complications associated with three pelvic organ prolapse repair methods, sacrocolpopexy (SCP), native tissue repair (NTR), and vaginal mesh repair (VMR), in women aged 70-80 years., Methods: We performed a multi-institutional retrospective analysis of 213 women who underwent POP surgical repairs between December 2012 and December 2017. Treatment-related complications were classified using the ClavienDindo grading system and compared among the three groups. Perioperative data, anatomical success rates, patient satisfaction, and postoperative complication data were collected during the follow-up period, which lasted up to 12 months., Results: Of 213 patients, 70 (33%) underwent SCP, 85 (40%) underwent NTR, and 58 (28%) underwent VMR. By postoperative day 30, the all-inclusive complication rate was lower in the SCP group than in the NTR or VMR group; however, there was no between-group difference in complication grade. The VMR group underwent fewer concomitant hysterectomies than the other groups, and operative time was the longest for SCP. Overall, recovery time, anatomical success rate, and patient satisfaction were comparable for all three repairs., Conclusions: All three surgical techniques were equivalent in patient satisfaction, anatomical success rate, and complication rate. SCP should be recommended to elderly women who meet criteria for prolonged general anesthesia, as it was associated with fewer perioperative complications than NTR and VMR.

Introduction: The present study aim to compare the anatomic landmarks of two pelvic floor repair systems, in order to identify the potential neurovascular lesions related to different mesh fixation techniques., Methods: Abdominal and perineal dissections of 10 fresh cadavers after prolapse surgery using transobturator/transgluteal versus single incision techniques. Neuro-vascular structures of obturator region and perineum were isolated. Distances between needles and anatomical structures were measured., Results: During transobturator anterior repair, the superficial cannula passed 2.5 ± 0.6 cm medially to the obturator canal. The distance of superficial arm to the anterior obturator vessels was 2.2 ± 0.4 cm. The distance of deep cannula to the posterior obturator vessels branches was 1.3 ± 0.5 cm. In two of these cases we observed a lesion of posterior obturator vessels. During single incision repair the distance between the obturator canal and the superficial arms was 2.3 ± 0.7. The mean distances of superficial arms to the anterior and posterior obturator vessels were, respectively, 2.3 ± 0.5 cm and 3.2 ± 0.7 cm. During transgluteal posterior repair the distance between the cannula guide and the ischial spine was 1.7 ± 0.5 cm while it measured 2.3 ± 0.4 cm when single incision posterior device was placed., Conclusions: Anterior transobturator system presents an increased risk of posterior obturator vessels branches injury. During posterior transgluteal repair the distance of the ischio-anal fossa to sacrospinous ligament represents a way that could rule against the correct needle positioning with increased risk of pudendal lesions. Single incision approach offers an easier access to the sacrospinous ligament with lower risk of pudendal lesions., (© 2017 Wiley Periodicals, Inc.)

The main purpose of this study was to understand the effect of time and temperature during the hydrothermal carbonisation (HTC) of olive stones (OS). For that purpose, the severity factor was introduced, by which the effect of the HTC conditions on the resultant products could be described. HTC was carried out at various temperatures (160, 180, 200, 220 and 240 °C) and times (3, 6, 12, 24 and 48 h) for producing 25 hydrochars. The yield to hydrochar varied from 70 to 50%. Hydrochars were all submitted to thermogravimetric and elemental analysis. The liquid fractions were also recovered and analysed in order to valorise OS as completely as possible. Thus, highly added-value products such as furfural and 5-hydroxymethylfurfural were detected. At the highest temperature and time, the hydrochar elemental composition was similar to that of lignite coals. Hydrochars were further carbonised at 900 °C, leading to materials with surface areas as high as 1200 m 2  g -1 and with narrow pore size distributions centred on 0.5 nm. The severity factor allowed finding clear tendencies in the production of hydrochars and derived carbons in terms of yield, composition, and surface area, which would have been hardly analysed if the effects of temperature and time had to be considered separately. We proved that the severity factor, which use is quite uncommon in studies dealing with materials production, is a valuable tool for studying the effects of HTC experimental conditions.

Aims: Laparoscopic sacral colpopexy (LSC) for pelvic prolapse is a complex procedure, characterized by an anterior mesh suspension to the sacral promontory and a posterior tension-free mesh fixation., Methods: Totals of 150 age-BMI and parity matched consecutive POP patients were selected from our Diaconesses Hospital database among women who underwent a laparoscopic supracervical hysterectomy (LSH) plus sacral colpopexy (LSC) from June 2005 to March 2010. We analyzed two group of LSC populations, according to different tension-free apical fixation of the posterior mesh: Promontory (P) group and Utero-Sacral (US) group. Studied endpoints were the anatomical and functional results linked to these different tension-free posterior mesh placements., Results: Baseline characteristics were similar between the groups. No differences in terms of anatomical and functional outcomes were observed between the groups. Pelvic organ mobility at rest versus under Valsalva highlighted a significant reduction of median differential vaginal apex only in the P population (preoperative: 30 mm and 32 mm; postoperative: 8 mm and 24 mm; for P and US, respectively; P < 0.01). No differences were found in terms of intra- or post-operative complications., Conclusions: Uterosacral tension-free fixation of posterior mesh during LSC could be considered a simple procedure and guarantees a more physiological movement of the pelvic organs if compared with promontory suspension., (© 2016 Wiley Periodicals, Inc.)

Background: Cystocele is a frequent and invalidating type of genital prolapse in woman. Sacropexy using synthetic mesh is considered the surgical gold standard, and the laparoscopic approach has supplanted the open abdominal route because it offers the same anatomical results with a lower morbidity. The use of mesh through the vaginal route may have many advantages: easiness to perform, shorter operative time and recovery, but may increase morbidity. In France, both laparoscopic sacropexy and vaginal mesh are commonly used to treat cystoceles. The French Haute Autorité de santé (HAS) has highlighted the lack of evaluation of safety assessment for vaginal meshes., Method/design: The main objective of the study is to compare the morbidity of laparoscopic sacropexy with vaginal mesh for cystocele repair. The primary endpoint will be the rate of surgical complications greater or equal to grade 2 of the Clavien-Dindo classification at 1-year follow-up. The secondary aims are to compare the functional results in the medium term (sexuality, urinary and bowel symptoms, pain), the impact on quality of life as well as anatomical results. PROSPERE is a randomized controlled trial conducted in 12 participating French hospitals. 262 patients, aged 45 to 75years old, with cystocele greater or equal to stage 2 of the POP-Q classification (isolated or not) will be included. Exclusion criterias are a previous surgical POP repair, and inability or contra-indication to one or the other technique. We have designed this study to answer the question of the choice between laparoscopic sacropexy and vaginal mesh for the treatment of cystocele. The PROSPERE trial aims to help better determine the indications for one or the other of these techniques, which are currently based on subjective choices or school attitudes. This is the reason why competent authorities have asked for such studies., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Genital prolapse is a frequent functional pathology in women. Its surgical treatment depends specially upon the suspension and fixation of the vaginal vault. Thus, sacrocolpopexy has become a gold standard technique to correct genital prolapse. Laparoscopy is a procedure resulting in less bleeding and decreased hospital stay than open sacrocolpopexy and is presently the approach of choice. Its objective and subjective correction rates are > 90%. Some authors proposed a dual abdominal and perineal approach to help fixing the posterior mesh and repairing the perineal body. Robotics is the actual surgeons' gadget.Its results are similar to laparoscopic sacrocolpopexy albeit a higher cost and a longer operating time. The ideal mesh is monofilamentous with large pores. Sacrocolpopexy consists in fixing two meshes, one on the anterior vaginal wall and one on the posterior vaginal wall, on the anterior sacral ligament, without tension for the posterior mesh, with or without subtotal hysterectomy, and with closure of the peritoneum at the end. In the case of associated stress urinary incontinence, proved on the clinical exam or urodynamical exam, appropriate surgical treatment is done with sacrocolpopexy. In the near future, robotics will replace laparoscopy when costs will be reduced and medical staff well trained to perform robotic or robot-assisted sacrocolpopexy.

We report a case of a pregnancy and follow the delivery of a young woman who previously underwent a laparoscopic sacral colpopexy (LSC) for pelvic organ prolapse (POP). A 38-year-old woman with POP desires pregnancy who after unsuccessful medical treatment with pessary underwent a laparoscopic uterine ventrosuspension (LUV). However, this procedure also failed and there was an immediate relapse. Thus, LSC was then performed. After which, she became pregnant culminating in elective caesarean delivery. The LUV failure was documented by a POP-Q classification and dynamic pelvic magnetic resonance (PMR) which was carried out 1 month after the surgery. When the same assessment was conducted after the LSC, it showed an optimal POP correction. The short-term post-delivery follow-up exhibited a small prolapse relapse, which remained stable 48 months after surgery as confirmed by a new PMR. Surgical correction of POP is possible in women with pregnancy desires. The result is variable and links to the POP stage and other surgical interventions.

Study Objective: Assessment of 1-year quality of life outcome of patients treated with laparoscopic sacrocolpopexy., Design: A prospective multicenter observational study (Canadian Task Force classification II-3)., Setting: Four French medical centers., Patients: A total of 94 women who underwent laparoscopic sacrocolpopexy for pelvic organ prolapse between June 2006 and May 2007 were included in the study., Measurements and Main Results: Women attended a research clinic where they completed validated quality of life questionnaires and were examined. Women were assessed before and 1 year after surgery for the degree and impact of vaginal, urinary, and bowel symptoms with validated quality of life questionnaires, evaluation of sexual function with a validated questionnaire, and pelvic organ support was assessed by a Pelvic Organ Prolapse Quantification score. Mean age of the women was 58.8 years. Anatomic success occurred in 94% of women. Concomitant urinary continence surgery was performed in 39% of cases. All the scores of quality of life and sexuality were significantly improved at 1 year., Conclusions: Laparoscopic sacrocolpopexy for pelvic floor prolapse is a safe and effective treatment that has a positive impact on every aspect of quality of life (symptoms, social impact, sexual function) in the medium term., (Copyright © 2011 AAGL. Published by Elsevier Inc. All rights reserved.)

Objective: To compare one-year results between the classic retropupubic (TVT) and the in-out transobturator approaches (TVT-O) of tension-free vaginal tape for the treatment of stress urinary incontinence (SUI)., Patients and Methods: The first 82 patients operated for SUI by TVT-O in our institution were included in the analysis. Patients were evaluated at 1 and 12 months. The global satisfaction rate was assessed at 12 months by a self-reported questionnaire. Results were compared to those of the first 124 patients operated of SUI by TVT in the same institution and by the same surgeons between 1996 and 1999., Results: Except a younger mean age in the TVT-O group (57 versus 60 years), no other preoperative parameter was significantly different between the TVT and the TVT-O groups. The mean operating time was shorter in the TVT-O group (15 versus 30 minutes, P<0.001). No intraoperative complication occurred. The rate of bladder perforation was significantly lower in the TVT-O group (0 versus 8.8%, P=0.004). The rate of post-voiding residual less than 100 ml was higher in the TVT-O group (88 versus 61%, P<0.001). In the TVT-O group, 40% of patients had postoperative inguinal pain (mean=9 days, range 2-15 days). After 12 months from TVT-O, 85% of patients were completely dry, 6% had de novo over bladder activity, and 93.5% of patients were satisfied with the treatment they received. The 12-month results were not significantly different between the TVT and the TVT-O groups., Discussion and Conclusion: With a follow-up of 12 months, TVT-O is as efficient as TVT and has a lower risk of bladder injury, a cut by half operating time, and less postoperative dysuria.

Purpose: This study evaluated the validity of endorectal ultrasonography in predicting rectal infiltration in patients with deep pelvic endometriosis., Methods: Patients were recruited consecutively in the Department of Surgical Gynecology of Diaconesses Hospital from April 1996 to July 2003. Inclusion criteria were the suspicion of deep pelvic endometriosis on the basis of outpatient history and/or clinical symptoms with a mass palpable on bimanual examination that might infiltrate the rectal wall. There were no exclusion criteria. Endorectal ultrasonography was performed by the same investigator with a 7.5-MHz to 10-MHz rigid probe, producing a 360 degrees view of the rectal wall and adjacent areas. We used surgical and histopathologic findings as the "gold standard" to evaluate the validity of endorectal ultrasonography., Results: This study was based on 37 patients (mean age, 35.8 (range, 26-46) years) who underwent surgery. The time between endorectal ultrasonography and surgery ranged from 4 to 529 (mean, 88.7) days. Eight patients had endometriosis nodules penetrating the rectal wall. Endorectal ultrasonography showed sensitivity, specificity, a positive predictive value, and a negative predictive value of 87.5, 97, 87.5, and 97 percent, respectively, in the diagnosis of infiltration of the rectal wall by endometriosis., Conclusions: Endorectal ultrasonography is a reliable technique for visualizing rectal infiltration in patients with deep pelvic endometriosis. It should be more widely used by gynecologists because knowing about rectal infiltration before surgery is fundamental to defining the best possible surgical approach.

Physiopathological and clinical interpretation of the descending perineum as described by A. Parks in 1970 remains difficult. This review is based on the literature between 1966 and 2004. The observed symptoms are more often due to associated lesions. The descending perineum on X-ray is not always symptomatic. Colpocystography shows the descent of the perineum and pelvic disorders from the anterior and middle parts of the perineum whereas defecography seems to provide a better diagnosis of dyschesia due to posterior damage (such as rectocele or endo-anal intussusception). The first step of treatment is reeducation and medical treatment because there is no consensus for surgical therapy. Soft sacrocolpopexy by the abdominal approach with three meshes, one under the bladder, one in front of and one behind the rectum can be proposed for complete descending perineum. Transanal rectal resection by staple could be useful when the descending perineum is only associated with a rectocele and/or an intra-anal intussusception.

Objective: The aims of this study were: (1) to define and classify those connective structures of the female pelvis that are of potential clinical interest, (2) to evaluate the adequacy of the Terminologia Anatomica (official nomenclature) and (3) to establish a correspondence between the official nomenclature and the most commonly used terms., Study Design: The results of 30 macroscopic and laparoscopic dissections of fresh cadavers with and without vessel injection of colored latex solutions were compared with the descriptions and definitions in the Terminologia Anatomica and the most frequently cited English and non-English literature from 1890 to 2003., Results: We identified 3 groups of fasciae, parietal pelvic fascia, visceral pelvic fascia, and extraserosal pelvic fascia, which could be divided into diverse clinically relevant anatomical structures characterized by different locations, spatial orientation, and consistency. These structures differed considerably with regard to number and nomenclature from those described in the Terminologia Anatomica and part of the literature., Conclusion: Our results suggest that the official terminology applied to the connective structures of the female pelvis could be profitably revised and expanded. We offer a complete description of these structures and suggest a classification that may be useful for teaching and clinical purposes.

Purpose of Review: This paper aims to review and comment on the developments in laparoscopic sacrocolpopexy published during the last year., Recent Findings: We classified the findings reported recently in the literature for laparoscopic sacrocolpopexy as technical or tactical findings. Technical findings concern the material of the mesh, the methods of mesh fixation, the use of adapted vaginal retractors and the interest in robotic assistance. Tactical findings consist of specific modifications to the standard surgical procedure aimed at reducing the side effects and complications and ameliorating the effectiveness of this intervention. These modifications include the possibility of avoiding the placement of a posterior mesh and the fixation of the posterior mesh to the puborectal muscles or the perineal body instead of the posterior vaginal wall. A specific section has been dedicated to reviewing and commenting on those interventions associated routinely with laparoscopic sacrocolpopexy., Summary: Laparoscopic sacrocolpopexy is a safe surgical procedure in constant evolution which allows excellent results in the treatment of utero-vaginal prolapse. Large prospective, randomized studies comparing the different technical and tactical modifications recently introduced are needed in order to further enhance the effectiveness of this intervention.

Study Objective: To assess the feasibility and results of laparoscopic sacrocolpopexy (LSC) with two separate meshes along the anterior and posterior vaginal walls in correcting multicompartment pelvic organ prolapse (POP)., Design: Prospective study (Canadian Task Force classification I)., Setting: Tertiary care university-affiliated teaching hospital., Patients: Forty-six consecutive women with radiologic diagnosis of multicompartment POP with or without genuine stress urinary incontinence and no history of surgery for either disorder., Intervention: LSC with or without laparoscopic Burch colposuspension or tension-free vaginal tape procedure., Measurements and Main Results: LSC was performed in 89% of patients. Mean operating and hospitalization times were 171 +/- 37 minutes and 4.0 +/- 2.1 days, respectively. Intraoperative complications were 7% of bladder injuries successfully treated by laparoscopic suture. The success rate for POP was 83%. The main recurrence was rectocele (12%), which occurred only among women undergoing LSC plus laparoscopic Burch colposuspension (P = 0.036). The LSC was effective in treating symptoms in 95% of women. Because of excessive mesh tension, one patient (2%) developed obstructed defecation, and two (5%) had de novo urinary incontinence. In no patient did occlusion or mesh infection and/or erosion in adjacent organs occur., Conclusion: LSC appears to be feasible and effective in treatment of multicompartment POP. Performing concomitant Burch colposuspension significantly enhances the risk of rectocele recurrence or development.

Purpose: This study was designed to estimate the prevalence of anal sphincter injury after forceps delivery in a large population of females managed by trained obstetricians in a French hospital and to identify factors predictive for anal sphincter injury., Methods: We performed a prospective study of healthy females older than 18 years with no history of anal incontinence, anorectal abnormalities, or anorectal surgery after their first vaginal delivery. All females were interviewed using a standardized questionnaire concerning intestinal transit and continence status. Physical examination and endoanal ultrasonography were performed after delivery., Results: Between November 1999 and November 2000, 93 females were included in the study after their first forceps delivery. Eleven patients (11.8 percent) had a partial defect involving the external sphincter, visible on ultrasonography. One patient (1.1 percent) had a partial defect of external sphincter with complete defect of internal sphincter (sequelae of primary repair of a third-degree perineal tear). Seventeen patients (18.2 percent) had flatus incontinence, and four patients (4.3 percent) had liquid stool incontinence. A high daily number of stools was significantly associated with sphincter defect visible on ultrasonography (P=0.02). The development of anal incontinence was not related to sphincter defect on ultrasonography. There was a strong association between perineal tear and sphincter defect visible on ultrasonography (odds ratio, 4.5 (range, 1.2-16.7))., Conclusions: Anal sphincter injury after forceps delivery was identified in <13 percent of our large population of healthy females. Our study does not confirm previous observations that anal sphincter injury is common after forceps delivery; previously published studies may have overestimated the prevalence of this condition. The only factor with significant predictive value for anal sphincter injury was perineal tear. Anal endosonography should be recommended after obstetric perineal tear.

Radical hysterectomy represents the treatment of choice for FIGO stage IA2-IIA cervical cancer. It is associated with several serious complications such as urinary and anorectal dysfunction due to surgical trauma to the autonomous nervous system. In order to determine those surgical steps involving the risk of nerve injury during both classical and nerve-sparing radical hysterectomy, we investigated the relationships between pelvic fascial, vascular and nervous structures in a large series of embalmed and fresh female cadavers. We showed that the extent of potential denervation after classical radical hysterectomy is directly correlated with the radicality of the operation. The surgical steps that carry a high risk of nerve injury are the resection of the uterosacral and vesicouterine ligaments and of the paracervix. A nerve-sparing approach to radical hysterectomy for cervical cancer is feasible if specific resection limits, such as the deep uterine vein, are carefully identified and respected. However, a nerve-sparing surgical effort should be balanced with the oncological priorities of removal of disease and all its potential routes of local spread.

Objectives: The role of urethral support in continence has been stressed since 1994, resulting in a new technique for repair of stress urinary incontinence: Tension-free Vaginal Tape (TVT). This technique has been performed in France since 1996 and we analyse the results of this technique in 124 consecutive patients treated for stress urinary incontinence., Material and Method: The 124 patients did not present any prolapse requiring surgical repair and presented clinical urine leaks on effort after filling the bladder with 250 ml of physiological saline (stress test). 29 patients had already been operated for a disorder of pelvic tone, combined with an urological procedure in 22 cases; all patients completed an urodynamic assessment. 54 patients presented clinical signs of urgency in addition to stress urinary incontinence and 6 of them had cystomanometric signs of urgency. The mean maximum urethral closure pressure was 47 cm H2O (range: 12-120). All patients were operated under local anaesthesia (0.25% Xylocaine with adrenaline) according to the same standardized protocol. The mean follow-up was 35.2 months (range: 19-54). The operative and postoperative morbidity, the results demonstrated by stress test, the subjective result assessed by a patient satisfaction questionnaire and long-term complications were analysed., Results: 110 patients (98.7%) were totally continent, 10 (8%) were improved and 4 (3.3%) were failures. 117 patients (94.3%) were satisfied. Signs of urgency resolved in 38 out of 54 patients (63%). The result was not influenced by closure pressure. Complications consisted of 11 bladder perforations (8.9%) and 3 haematomas, none of which required reoperation. Micturition was easily resumed in 122 patients, while acute retention was observed in 2 cases, on D2 and D3. In 76 patients (61.3%), the first residual urine was less than 100 ml. Long-term follow-up did not reveal any cases of rejection of the TVT, but 3 vaginal erosions were treated by simple plasty., Conclusion: With a follow-up of three years and an experience of 5 years, this series demonstrates the value of the TVT technique for treatment of female stress urinary incontinence based on the good results (objective: 89%; subjective: 95%), reproducibility, simplicity and low morbidity.

We report a unusual case of mammary schistosomiasis revealed by breast microcalcifications. This localisation of schistosomiasis is exceptional but should be suspected in women who come from endemic areas. Other cases previously reported in the literature are also described.

Genital actinomycosis is a rare bacterial infection affecting women of child-bearing age, which is sometimes related to the use of an IUD or an intra-vaginal pessary. Nevertheless, this relationship is at best tenous and actinomycosis is not the only bacterial infection caused by IUD use. Genital actinomycosis often occurs as a pelvic tumour which is sometimes difficult to correctly diagnose and consequently treat accordingly. Rapid diagnosis is essential in order to avoid any irreparable tissue damage. Treatment of this condition consists of a combination of antibiotics and surgery to achieve complete recovery. Three cases are described.

A homogeneous series of 104 patients with genito-urinary prolapse or urinary incontinence is reported. Surgical treatment combined promotofixation with (n = 45) or without (n = 59) subtotal hysterectomy, retropubic colpopexia and in certain cases posterior colpoperineorraphia with myorraphia of the levator ani (n = 28). Anatomic results were excellent for bladder and uterine ptosis. Moderate results were obtained for rectoceles and procedures involving the posterior perineum. A rectovaginal prosthesis or complete repair of the rectovaginal wall appeared to be required to improve results for rectoceles. Urine function was good for urinary incontinence: 91% success. Results depended on the pressure of the uretral closure. A complete urodynamic work-up is required prior to surgery in case of sphincter failure. Poor results were also related to excessive posterior traction which can open the cervico-uretral angle. Treatment of genito-urinary prolapse with promotofixation in combination with retropubic colpopexia is a reliable reproducible technique which gives excellent long-term results if excessive promontory traction is avoided and if, in certain cases, the rectovaginal wall is repaired or a prosthesis implanted when maximum uretral closure pressure is weak.

Objective: To compare the reliability of different methods for investigating the endometrium., Design: A prospective study from November 1990 to October 1991., Setting: Department of surgery and gynaecology Diaconesses Hospital, Paris., Subjects and Interventions: In a total of 178 symptomatic patients, hysteroscopy with curettage in a day-centre under general anesthesia was performed. Before this operation, 79 women had had endometrial cytology, 98 women had had endometrial biopsy with the endometrial Pipelle, 112 women had ultrasonography and 120 women hysterography., Main Outcome Measures: Endometrial cytology and biopsy, ultrasonography, hysterography and hysteroscopy were correlated with curettage., Results: the Pipelle's diagnostic accuracy appeared better than that of cytology. The hysteroscopic diagnosis agreed with the histologic diagnosis showed by the curettage except for atypical hyperplasia. The positive predictive value for identifying endometrial atrophy with ultrasonography is 100%. A vaginal ultrasonographic examination showing an endometrial thickness of < or = 5 mm can be used to exclude endometrial carcinoma as the cause of post menopausal bleeding., Conclusions: The combination of hysteroscopy and endometrial biopsy is the diagnostic method of choice for the endometrium. It is possible to avoid some useless curettages for diagnosis in women with abnormal uterine bleeding.

Three techniques for closing the ovary have been compared. The test was carried out on 30 rats' ovaries. After the ovary had been cut with scissors it was closed with rapid acting Tissucol (a biological glue) or closed with interrupted stitches of 10/0 Vicryl, or left to close by itself. Sixty days later the ovaries were looked at macroscopically and histologically. The macroscopic score was established according to the presence of adhesions, the size of the ovary, the presence of cysts; and the histological score was carried out according to the presence of granulomatous macrophage lesions, the degree of fibrosis and the existence of germ cell cysts. The results were identifically the same as far as these five different criteria were concerned. All the same, Tissucol brought about less fibrosis and less atrophy of the ovary. Tissucol, therefore, is a good alternative for suturing the ovary as compared with stitching or no formal closure after the removal of ovarian cysts, particularly laparoscopically.

We report a case of tubular bilharziosis discovered on a surgical specimen after salpingectomy. Tubular bilharziosis is not exceptional in endemic zones but is rarely found in Europe. The species most often isolated is Schistosoma haematobium. Contamination occurs via vascular anastomoses between the bladder and the genital organs. Bilharziosis has been shown to be a cause of extra-uterine pregnancy although its effect on fertility is yet to be established.

A prospective randomized study was carried out to discover the influence of the timing of shoulder physiotherapy after-axillary dissection for breast cancer upon the incidence and duration of lymphatic fluid production and seroma after these operations. Sixty-eight patients underwent a modified radical mastectomy, 31 were submitted to early physiotherapy and 37 to delayed physiotherapy after removal of the suction drainage. In 32 patients this surgery was conservative of the breast; in 16 the physiotherapy was early and in 16 delayed. The shoulder was left free when the physiotherapy was delayed. The mean volume of lymphatic fluid produced after these 100 axillary dissections was 437 cc (range: 50 to 800 cc) with a mean duration of 6.3 days (range: 2 to 11 days). There was a linear relation between the volume and the duration of the lymphatic fluid production. This volume was significantly higher in radical mastectomy than in conservative procedures (486 cc vs 333 cc - p less than 0.02). There was no significant difference in the production of lymphatic fluid with early or delayed physiotherapy, whatever the group of patients: radical or conservative surgery - age - number of excised lymph nodes - lymph node involvement. Five seromas occurred in patients with delayed physiotherapy. Delaying physiotherapy after axillary dissection for breast cancer does not seem to reduce the incidence of lymphatic complication, but the use of a conservative procedure rather than a modified radical mastectomy seems to be able to do so.

Although rarely published, operative injuries to thoracic duct in neck are by no means exceptional, and can occur during all types of surgery to lower cervical and supraclavicular regions. A case is reported and used as a basis for an analysis of diagnostic means and therapeutic possibilities of injuries detected during operation or those developing manifestations at a later stage. In the case reported, long-term medical treatment resulted in arrest of lymphorrhea within 37 days.

Routine mammography screening can detect radiologically evident but subclinical breast anomalies. Insofar as these anomalies can correspond to carcinoma, either in situ or invasive, surgeons are increasingly forced to operate on non-palpable breast lesions. A regulated and strict surgical technic is necessary to ensure exeresis of a radiologically detected focus, while avoiding sufficient adjacent healthy parenchyma and thus reducing the esthetic prejudice to a minimum. Technical artifices are described to assist compliance with these imperatives. First, the periareolar incision is chosen, as a principle, for its cosmetic qualities. Insofar as it provides an often limited approach it can be extended radially. The latter is concealed during closure without major alteration to the areola. Second, the radiating exeresis assists detection and is safer. It also provides glandular reconstruction of good esthetic quality and facilitates follow up surveillance.

Results of a 7-year follow-up review of a patient with intratubal cancer and lumbo-aortic glands invasion are reported. The highly lympholytic character of these tumors and the existence of elective lumbo-aortic lymph node metastases suggest that surgery should include routine bilateral lumbo-aortic curettage in tubal cancer, particularly stages I and IIA. As well as providing improved assessment of degree of extension of the disease it can also avoid the frequently poorly tolerated abdominopelvic radiotherapy.

The authors present a retrospective study of 1,000 total abdominal hysterectomies performed between 1969 and 1975, and they report the main complications. Early complications are dominated by: rare thrombo-embolic accidents (2.2%) since the advent of prophylactic heparin therapy; infectious complications, dominated by the abscess of the abdominal wall and asymptomatic urinary infections, and for which simple measures prevent resorting to prophylactic antibiotherapy. The role of the hysterectomy seems minimal in the occurrence of a prolapse or a stress-related urinary incontinence: prolapses after hysterectomy (1.4%) seem more related to tissue aging than to the procedure which modifies very little the supporting system of the pelvis. A post-operative urinary incontinence is, most of the time, the result of an incomplete pre-operative work-up: failure to recognize a potential stress-related incontinence, or an incontinence secondary to an unstable bladder. Prolapse and incontinence must always be treated independently. In the psychological and sexual repercussion, age, ovariectomy and the distress related to the procedure, involving the heart of womanhood, seem to be the most important factors.

This is a retrospective study including 102 cases records of female patients presenting with epithelial carcinoma of the ovary. Survival, as in the other series, depended upon the stage of the cancer at the time of diagnosis, mean survival rates being 77.1, 57.7, 26.6 and 19.3 for stages I, II, III and IV respectively. However, most of all, survival was related to the quantity of remanent tumoral tissue following the initial laparotomy. The 5-year survival rates were 84%, 42% and 10% when there was no residual tumor, when the latter measured less than 2 cm, and more than 2 cm, respectively. In contradistinction to what is generally found in such studies, the diagnosis here was established at earlier stages, since 53% of the cases of interest were female patients with stage I or II carcinoma. The chief argument, therefore, is based on the methods of early diagnosis and, judging from what is generally admitted in literature, on the place of extended surgery.