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[Display omitted] • The EAEQ was designed to describe unmet environmental needs of youth with CP. • Its structure links fairly well to the ICF Core Set for adults with cerebral palsy. • Environmental needs in the community were poorly met, unlike needs at home or work. • Unmet environmental needs varied according to sex, impairment, and place of residence. • Its clinical settings use can help determine barriers and improve functioning and quality of life. To present the development of the European Adult Environment Questionnaire (EAEQ), to assess to what extent it covers the International Classification of Functioning, Disability and Health (ICF), and to describe the adequacy of the physical, social, and attitudinal environment to the specific needs of young adults with cerebral palsy (CP). Cross-sectional. Administrative regions in France, Germany, Italy, Portugal, and Sweden. Young adults with CP (N=357), with varying severity profiles, aged 19-28 years at time of interview (2018-20). Not applicable. Physical, social, and attitudinal environment unmet needs. Relevant environmental factors (EFs) for young adults with CP were identified during focus groups in England and Portugal. EFs were mapped to the ICF environmental classification and the EAEQ analytical structure resulted from this linking procedure. It comprised 61 items, linked to 31 ICF environmental classification categories, and covered 4 of its 5 chapters. Content validity assessed with the bandwidth index (percentage coverage of ICF Core Sets for adults with CP) was satisfactory (79.3%). A descriptive analysis was carried out. Participants had a mean age of 24 years, 56% were men, 38% had severely limited mobility. Less than 16% reported unmet needs for EFs relating to home, college/work/day placement, and communication in the Products and technology chapter. Unmet needs were higher (>20%) for the other items in the Public use and Land development categories. Social support, attitudes, and understanding of relatives were often adequate to the participants' needs. The proportion of unmet needs varied by sex (women were more often concerned) and raised with increasing gross motor impairment. The EAEQ describes in detail the adequacy of the environment to the specific needs of young adults with CP. Its ICF-based structure opens up possibilities for use in a universal conceptual framework. [ABSTRACT FROM AUTHOR]

Midurethral slings are the gold standard for treating stress urinary incontinence, but their complications may raise concerns. Complications may differ by the approach used to place them. This study aimed to compare serious complications and reoperations for recurrence after midurethral sling procedures when using the retropubic vs the transobturator route for female stress urinary incontinence. This analysis was of patients included in the French, multicenter VIGI-MESH register since February 2017 who received a midurethral sling for female stress urinary incontinence either by the retropubic or the transobturator route and excluded patients with single-incision slings. Follow-up continued until October 2021. Serious complications (Clavien-Dindo classification ≥ grade III) attributable to the midurethral sling and reoperations for recurrence were compared using Cox proportional hazard models including any associated surgery (hysterectomy or prolapse) and a frailty term to consider the center effect. Baseline differences were balanced by propensity score weighting. Analyses using the propensity score and Cox models were adjusted for baseline differences, center effect, and associated surgery. A total of 1830 participants received a retropubic sling and 852 received a transobturator sling in 27 French centers that were placed by 167 surgeons. The cumulative 2-year estimate of serious complications was 5.8% (95% confidence interval, 4.8–7.0) in the retropubic group and 2.9% (95% confidence interval, 1.9–4.3) in the transobturator group, that is, after adjustment, half of the retropubic group was affected (adjusted hazard ratio, 0.41; 95% confidence interval, 0.3–0.6). The cumulative 2-year estimate of reoperation for recurrence of stress urinary incontinence was 2.7% (95% confidence interval, 2.0–3.6) in the retropubic group and 2.8% (95% confidence interval, 1.7–4.2) in the transobturator group with risk for revision for recurrence being higher in the transobturator group after adjustment (adjusted hazard ratio, 1.9; 95% confidence interval, 1.2–2.9); this surplus risk disappeared after exclusion of the patients with a previous surgery for stress urinary incontinence. The transobturator route for midurethral sling placement is associated with a lower risk for serious complications but a higher risk for surgical reoperation for recurrence than the retropubic route. Despite the large number of surgeons involved, these risks were low. The data are therefore reassuring. [ABSTRACT FROM AUTHOR]

La promontofixation cœlioscopique est considérée comme le traitement de choix du prolapsus de la femme jeune car elle associe les avantages de la chirurgie prothétique par voie abdominale, avec celles d'une technique mini-invasive. De nombreuses variantes se sont développées autour de cette intervention et rendent parfois difficile l'analyse des résultats. L'objectif de cet article est de faire une mise au point sur les différents aspects de la technique chirurgicale. Description et recommandations sur les différents aspects de la technique chirurgicale fondée l'expérience des auteurs (trucs et astuces) mais aussi à partir des données de la littérature. Nous décrirons les différents temps de la double promontofixation cœlioscopique avec conservation utérine. Bien qu'il n'existe pas de données comparatives concernant les sites et modes de fixation des prothèses, il convient de se référer aux résultats des grandes séries et de privilégier de la fixation des prothèses à l'aide de fils, en avant sur l'isthme utérin et la paroi vaginale antérieure et en arrière sur les muscles releveurs. De même, il est conseillé de fixer sans tension excessive les prothèses sur le promontoire à l'aide de fils non résorbables et d'effectuer une péritonisation de ces prothèses. Il n'est pas recommandé de mettre systématiquement une prothèse postérieure inter recto-vaginale en prévention de rectocèle secondaire. L'utilisation de prothèses non résorbables par voie haute (promontofixation) permet de traiter les prolapsus des organes pelviens avec des bons résultats et peu de complications y compris en termes d'exposition et d'infection de prothèses. Elle est considérée à ce titre comme la technique chirurgicale de référence et les différents aspects de la technique chirurgicale doivent donc à ce titre être bien codifiés. Laparoscopic sacrocolpopexy is considered as the gold standard for the surgical treatment for urogenital prolapse because it combines the advantages of abdominal route for prosthetic prolapse repair with those of a minimally invasive technique. Many variants have been described and make results difficult to analyze. The purpose of this article is to focus on the different technical aspects of this surgery. Description and recommendations on different aspects of the surgical technique based on the experience of the authors (tips and tricks) but also from the data of the literature. We will describe the different steps of laparoscopic sacrocolpopexy with two mesh and with uterine preservation. Although there are no comparative data on sites and methods of fixation of prostheses, we have to refer to the results of large series. There is a consensus on fixation of prostheses with the help of threads, forward on uterine isthmus and the anterior vaginal wall and back on the levator muscles. Similarly consensus is to fix prostheses on the promontory without excessive tension and with non-absorbable thread and close the peritoneum on these prostheses. It is not recommended to systematically put an inter-recto-vaginal prosthesis in prevention of secondary rectocele. Laparoscopic sacrocolpopexy with non-resorbable prostheses can treat pelvic organ prolapse with good results and few complications including in terms of prothetic exposure or infection. Considered as the reference surgical technique for prolapse repair, the various aspects of this procedure must therefore be well codified. [ABSTRACT FROM AUTHOR]

Copyright of Proges en Urologie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: This study analyzed the relation of 5 single-nucleotide polymorphisms (SNPs) in the VEGF (vascular endothelial growth factor) gene in patients with epithelial ovarian cancer (EOC), compared with patients carrying benign tumors or healthy ovaries. We studied serum VEGF levels and the relation with SNPs and association between VEGF SNPs and haplotypes with progression-free survival (PFS) in patients with cancer. Methods: The genotyping of VEGF gene polymorphisms (-2578 C/A, -1154 G/A, -460 T/C, +405 G/C, +936 C/T) was performed in DNA isolated from blood samples of 100 women. The different genotypes were evaluated by quantitative real-time polymerase chain reaction. Vascular endothelial growth factor protein concentration was assessed in serum using solid-phase sandwich enzyme-linked immunosorbent assay. Results: We found statistically significant differences in the distribution of VEGF genotypes among the 3 groups of patients: -2578 C/A between those with EOC and healthy ovary (P = 0.04), -460 T/C between those with EOC and healthy ovary (P = 0.03), and -460 T/C between those with benign tumors and healthy ovary (P = 0.02). Vascular endothelial growth factor serum levels were analyzed in patients with EOC. Higher levels were found in patients with clear cell carcinoma compared with those with serous, mucinous, or endometrioid tumors (P < 0.05). No clear association was observed between VEGF SNPs and serum VEGF levels. There was no significant correlation between VEGF SNPs and PFS. In haplotype analysis, CGTCT and CGTGT showed worse prognosis without reaching the statistical significance. CGCGC and AGTGC haplotypes had statistically significant differences among patients with EOC, benign tumors, and healthy ovaries (Ps = 0.046 and 0.041, respectively). Conclusions: The distribution of VEGF genotypes was different in patients with EOC, compared with those with benign tumors or women with healthy ovaries. Vascular endothelial growth factor serum levels were higher in patients with clear cell carcinoma. No correlation was found with improved PFS, but CGTCT and CGTGT haplotypes showed worse prognosis. [ABSTRACT FROM AUTHOR]

Copyright of Proges en Urologie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article focuses on a systematic review conducted by the authors related to identification of biomarkers for diagnosing colorectal cancer and polyps. Topics discussed include detection of the cancer through fecal DNA markers, serum protein biomarkers, high positive predictive value (PPV) of immunochemical fecal occult blood test (iFOBT) as compared to guaiac fecal occult blood test (gFOBT) and high cost involved in screening on the basis of biomarkers.

Study Objective To compare perioperative outcomes and cost of robotic-assisted and laparoscopic transperitoneal infrarenal para-aortic lymphadenectomy (TIPAL) for treatment of gynecologic malignant conditions. Design Prospective non-randomized study (Canadian Task Force classification II-2). Setting Tertiary center for women's health. Patients Sixty-two patients with gynecologic cancer operated on by the same surgical team. Interventions Thirty-two patients underwent TIPAL via robotic-assisted laparoscopy, and 30 via conventional laparoscopy. Comparison analyses of perioperative outcomes and estimated costs were performed. Measurements and Main Results There were no differences between robotic-assisted and laparoscopy insofar as age, body mass index, presurgical morbidity, operating time (92.5 minutes for robotics vs 96.6 minutes for laparoscopy), number of aortic nodes (12 vs 12), hospitalization stay (2 vs 2 days), or rate of complications (12.5% vs 13.3%). Blood loss tended to be lower in the robotic group (75.0 vs 92.5 mL; p = .08). Surgical cost was higher in the robotic group ($3.42 vs $2.55; p < .001), although hospitalization cost was similar. Conclusion Robotic-assisted and laparoscopy provide similar perioperative outcomes. However, the robotic-assisted approach is associated with higher surgical cost. [ABSTRACT FROM AUTHOR]

The aim of this study is to assess the impact of lymphadenectomy (LND) on morbidity, survival, and cost for high-risk histologic types of endometrial cancer (EC).We analyzed a multicenter retrospective cohort of 389 women with high-risk histotypes of EC (poor differenced tumors [G3], clear cell, serous papillary, and mixed mesodermal tumors) preoperatively confined to the corpus and diagnosed between 2000 and 2013. All patients underwent hysterectomy and bilateral salpingo-oophorectomy. A matched-pair analysis identified 97 pairs (97 with LDN and 97 without) equal in age, body mass index, comorbidities, International Federation of Gynecology and Obstetrics stage, and adjuvant treatment. Demographic data, pathologic examination results, perioperative morbidity, and survival were abstracted from medical records. Cost was provided by the cost unit of the local hospital. Disease-free and overall survival were analyzed using the Kaplan-Meier curves and Cox multivariable regression analysis.Both study groups were homogeneous in demographic data and pathologic examination results. At a median follow-up of 24.5 months (range, 5.4-146.3), disease-free survival (hazard ratio, 1.09; 95% confidence interval, 0.70-1.90) and overall survival (hazard ratio, 0.86; 95% confidence interval, 0.56-1.33) were similar in both groups regardless of nodal count. Positive nodes were found in 23.7%. Predictor factors of nodal involvement were advanced age (P = 0.024), deep myometrial invasion (P < 0.001), and high CA 125 levels (P = 0.003). In the LDN group, operating time, late postoperative complications, and surgical cost were higher (P < 0.05). There were no statistical differences between both groups relative to surgical morbidity. Early postoperative complications and hospital stay were lower in the LDN group. The global cost was similar for both groups (6027€ for the LND group and 5772€ for the no-LND group).Lymphadenectomy in high-risk histotypes of EC does not increase perioperative morbidity or global cost and has not benefit on survival. [ABSTRACT FROM AUTHOR]