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Objective To provide guidelines from the French College of Obstetricians and Gynecologists (CNGOF), based on the best evidence available, concerning subtotal or total hysterectomy, for benign disease. Methods The CNGOF has decided to adopt the AGREE II and GRADE systems for grading scientific evidence. Each recommendation for practice was allocated a grade, which depends on the quality of evidence (QE) (clinical practice guidelines). Results Conservation of the uterine cervix is associated with an increased risk of cervical cancer (0.05 to 0.27%) and an increased risk of reoperation for cervical bleeding (QE: high). Uterine cervix removal is associated with a moderate (about 11 min) increase in operative time when hysterectomy is performed by the open abdominal route (laparotomy), but is not associated with longer operative time when the hysterectomy is performed by laparoscopy (QE: moderate). Removal of the uterine cervix is not associated with increased prevalence of short-term follow-up complications (blood transfusion, ureteral or bladder injury) (QE: low) or of long-term follow-up complications (pelvic organ prolapse, sexual disorders, urinary incontinence (QE: moderate). Conclusion Removal of the uterine cervix is recommended for hysterectomy in women presenting with benign uterine disease (Recommendation: STRONG [GRADE 1-]; the level of evidence was considered to be sufficient and the risk-benefit balance was considered to be favorable).

El diagnostico de incontinencia urinaria (IU) es clinico: la anamnesis diferencia una incontinencia urinaria de esfuerzo (IUE), una incontinencia urinaria de urgencia (IUU) (hiperactividad vesical) y una incontinencia urinaria mixta (IUM). Esta distincion es esencial, porque las estrategias terapeuticas son diferentes. La fisiopatologia es compleja y multifactorial. Es cierto que el embarazo, el parto, la edad, un cierto grado de predisposicion genetica tisular y el sobrepeso son factores de riesgo demostrados, pero todavia no se conocen los mecanismos precisos que conducen a la genesis de uno u otro tipo de incontinencia. Aparte de los raros casos en que se sospecha una enfermedad organica subyacente (neurologica o uroginecologica) y despues de haber descartado una infeccion urinaria y un residuo posmiccional, puede proponerse un tratamiento de primera linea sin exploracion urodinamica previa. En la IUE, se recomienda la reeducacion (ejercicios de contraccion voluntaria de los musculos perineales) de entrada, en ocasiones asociada a una reduccion ponderal. En la hiperactividad vesical, la reeducacion (tecnicas conductuales, ejercicios de contraccion muscular y electroestimulacion) y los anticolinergicos (con o sin estrogenos topicos despues de la menopausia) constituyen los tratamientos de primera linea, en ocasiones asociados a una reduccion ponderal. En caso de fracaso de un tratamiento de primera linea, esta indicada una exploracion urodinamica. En la IUE, tras el fracaso de la reeducacion, se propone una intervencion quirurgica con colocacion de un cabestrillo suburetral (CSU). En caso de fracaso, se discuten otras alternativas: inyecciones/balones parauretrales y esfinter artificial. En la hiperactividad vesical, en caso de fracaso de los anticolinergicos, se puede proponer a la paciente una neuromodulacion (sacra o del ciatico popliteo interno) o inyecciones intradetrusorianas de toxina botulinica. Sea cual sea el tipo de incontinencia, se puede proponer a las mujeres que presentan una IU durante el embarazo o en el posparto una reeducacion, que se ha mostrado eficaz en estas dos indicaciones. En cambio, esta reeducacion no parece tener un efecto protector de larga duracion.

Resume But Faire un etat des lieux de la prevalence de l’incontinence anale du post-partum, en exposer les facteurs de risque, evaluer les modalites et les resultats des moyens actuels de prise en charge. Materiel et methode Revue de la litterature realisee a partir d’une recherche bibliographique sur PubMed, Medline, Embase et Cochrane. Les termes utilises etaient : anal incontinence postpartum, fecal incontinence postpartum, perineal rehabilitation, anal surgery. Resultats La prevalence de l’incontinence anale du post-partum variait selon les etudes de 4 % (primipare) a 39 % (multipare) a 6 semaines du post-partum, tandis que l’incontinence fecale pouvait atteindre respectivement 8 a 12 % a 6 ans de l’accouchement. Comparativement a la cesarienne, l’accouchement par voie basse augmentait le risque d’incontinence anale (OR : 1,32 [IC 95 % : 1,04–1,68]). Les extractions instrumentales augmentaient le risque d’incontinence anale (OR : 1,47 [IC 95 % : 1,22–1,78]) par rapport a l’accouchement par voie basse spontanee mais il s’agissait principalement de l’extraction par forceps (OR : 1,50 [IC 95 % : 1,19–1,89]) et non par ventouse (OR : 1,31 [IC 95 % : 0,97–1,77]). L’âge maternel (> 35 ans : OR : 6 [IC 95 % : 1,85–19,45]), le nombre de naissances (3 naissances : OR : 2,91 [IC 95 % : 1,32–6,41]) et la survenue d’un perinee complet (OR : 2,3 [IC 95 % : 1,1–5]) etaient associes a une augmentation du risque d’incontinence anale quelle que soit la voie d’accouchement comparativement a un groupe de femmes sans incontinence anale. Les resultats de la reeducation perineale sont a interpreter avec prudence du fait de l’absence d’essais controles randomises. Une reevaluation a 6 mois du post-partum en vue d’un traitement chirurgical par sphincteroplastie pourrait etre envisagee en cas de persistance des symptomes. Les resultats de la sphincteroplastie etaient satisfaisants mais avec un taux de succes s’estompant dans le temps (60 a 90 % a 6 mois contre 50 a 40 % a 5 et 10 ans). Conclusion L’incidence et le retentissement de l’incontinence anale du post-partum necessite une prise en charge specifique. Des recommandations sur sa prise en charge seraient utiles.

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 44 - N° 9 - p. 802-811

Objective To determine the effect of the use of auto-cross-linked hyaluronic acid (ACP) gel following hysteroscopic surgery on the prevention of intra-uterine adhesions (IUAs) and the pregnancy rate. Study design An observational retrospective study of 90 patients who underwent hysteroscopic removal of IUAs was conducted between 2008 and 2013 at a tertiary university care centre. Thirty-two patients received ACP gel during hysteroscopic removal of IUAs, and the remaining 58 patients did not receive ACP gel. Controls were matched to cases according to infertility and severity of IUAs using the American Society for Reproductive Medicine (ASRM) score. Four to six weeks after surgery, patients underwent diagnostic hysteroscopy to determine the re-occurrence of IUAs or the presence of adhesions. The patients were contacted by telephone to answer a questionnaire concerning their fertility. The main outcomes were pregnancy rate and postoperative IUAs. Results Pregnancy (viable or not) rates were not influenced by the use of ACP gel. The viable pregnancy rate was eight of 24 (33.3%) in the ACP gel group and 12 of 49 (24.5%) in the control group ( p =0.427). The mean interval between surgery and pregnancy was 11.8 [standard deviation (SD) 10.5] months in the ACP group compared with 13.4 (SD 14.1) months in the control group ( p =0.744). The mean ASRM score after surgery (hysteroscopic diagnosis at 4–6 weeks postoperatively) was equivalent in the two groups: 2.7 (SD 3.0) in the ACP gel group vs 2.6 (SD 3.2) in the control group ( p =0.854). The mean follow-up was 45.2 months (interquartile range 33.2–52.7), with a loss to follow-up of 25% in the ACP gel group compared with 15.5% in the control group ( p =0.817). Conclusion Application of ACP gel did not prevent recurrence of IUAs and was not associated with an increased pregnancy rate. ACP gel should be used with caution pending assessment in a randomized control trial in a larger population.

Resume Objectif Le traitement des polypes endometriaux est fonde sur la resection hysteroscopique. L’objectif de notre etude etait de comparer l’hysteroscopie operatoire par morcellement a la resection a l’anse bipolaire pour l’exerese des polypes endometriaux. Patientes et methodes Une etude observationnelle comparative retrospective monocentrique a ete realisee, incluant 25 patientes ayant beneficie d’une resection de polypes endometriaux de janvier 2012 a decembre 2013. La taille moyenne des polypes etait de 9,2 mm dans le groupe morcellement contre 12,5 mm dans le groupe resection a l’anse ( p = 0,06). Resultats Douze patientes ont beneficie d’une resection de polype par morcellement au MyoSure ® , et 13 par resection a l’anse bipolaire Versapoint ® 24F. La duree operatoire moyenne etait de 16 minutes dans le groupe morcellement et de 17 minutes dans le groupe resection a l’anse ( p = 0,76). Une resection complete a ete obtenue dans 100 % des cas des resections de polype par morcellement et a l’anse bipolaire. Concernant les complications per- et postoperatoires, aucune complication n’a ete observee dans les deux groupes. Discussion et conclusion L’hysteroscopie par morcellement est une technique qui semble comparable a la resection a l’anse bipolaire pour le traitement des polypes endometriaux.

Adnexal torsion is the fifth most common gynecologic surgical emergency, requiring clinician and radiologist awareness. It involves the rotation of the ovarian tissue on its vascular pedicle leading to stromal edema, hemorrhagic infarction, and necrosis of the adnexal structures with the subsequent sequelae. Expedient diagnosis poses a difficult challenge because the clinical presentation is variable and often misleading. Adnexal torsion can mimic malignancy as it can take a subacute, intermittent, or chronic course, and thereby can be complicated to diagnose. The torsion may occur in the normal ovary but is usually secondary to a preexisting adnexal mass. Early surgery is necessary to avoid irreversible adnexal damage and to preserve ovarian function especially in children and young women. Pelvic ultrasound forms the foundation of diagnostic evaluation due to its ability to directly and rapidly evaluate both ovarian anatomy and perfusion. Moreover, it is a noninvasive and accessible technique. However, the color Doppler appearance of the ovary should not be relied upon to rule out torsion because a torsed ovary or adnexa may still have preserved arterial flow due to the dual blood supply. MR and CT may be used as problem-solving tools needed after the ultrasound examination but should not be the first-line imaging modalities in this setting due to ionizing radiation and potential time delay in diagnosis. The goal of this article is to review the adnexal anatomy, to familiarize radiologists with the main imaging features, and to discuss the main mimickers and the most common pitfalls of adnexal torsion. Main points Adnexal torsion is an uncommon gynecological disorder caused by partial or complete rotation of the ovary and/or the Fallopian tube about the infundibulopelvic ligament. The ovaries receive a dual blood supply from the ovarian artery and uterine artery. The lack of pathognomonic symptoms and specific findings on physical examination makes this entity difficult to diagnose. Since the right adnexa are most commonly involved, symptoms may mimic acute appendicitis. Persistence of adnexal vascularization does not exclude torsion. In the pediatric age group, gray-scale ultrasound is the best modality of choice. Obtaining CT and/or MR images should not delay treatment in order to preserve ovarian viability.

Resume Objectif Les bandelettes sous-uretrales (BSU) retropubiennes peuvent se compliquer de plaie vesicale. Il n’existe pas de consensus concernant la duree du sondage vesical apres plaie vesicale survenant lors de la mise en place d’une BSU : elle varie de quelques heures a quelques jours. Dans notre pratique nous retirons la sonde urinaire immediatement en fin d’intervention. Materiel et methode Etude retrospective de type exposes/non exposes. Groupe 1 (exposes) : 8 femmes ayant eu une plaie de vessie en cours de BSU et groupe 2 (non exposes) : 32 femmes (ratio non exposes/exposes : 4:1). Resultats L’âge (ans), l’IMC (kg/m 2 ) et la PCUM (cmH 2 O) moyen (ecart-type) etaient : 62(13) vs 59(10), 25(4) vs 26(4) et 42(18) vs 43(16), dans le groupe 1 et dans le groupe 2, respectivement ( p = 0,55, 0,56 et 0,92). Aucune rehospitalisation ou complication postoperatoire n’a ete observees dans les 2 groupes. Une douleur sus-pubienne postoperatoire depassant une valeur de 30/100 sur une echelle numerique simple a ete observee dans 1/8 (12 %) et 3/32 (10 %) cas, dans le groupe 1 et dans le groupe 2, respectivement ( p = 1,00). Les taux de succes sur l’incontinence urinaire a l’effort n’etait pas significativement differents dans les deux groupes : 8/8 (100 %) vs 28/32 (87 %), dans le groupe 1 et dans le groupe 2, respectivement ( p = 0,56). Les niveaux de satisfaction etaient comparables dans les deux groupes : score PGI-I a 1(tres satisfaite) dans 6/8 (75 %) et dans 24/32 (75 %) cas, dans le groupe 1 et dans le groupe 2, respectivement ( p = 1,00). Des urgenturies de novo ont ete observees dans 0/8 (0 %) vs 3/32 (10 %) cas, dans le groupe 1 et dans le groupe 2, respectivement ( p = 1,00). Conclusion Dans cette petite serie retrospective de plaie de vessie lors de la pose d’une BSU retropubienne, l’abstention de drainage vesical ne semble pas s’etre accompagnee d’une augmentation de la morbidite postoperatoire. Niveau de preuve 4.

Resume Objectif Determiner quels sont les mecanismes d’action prouves de la reeducation perineale dans le cadre de l’incontinence urinaire de la femme. Methode Revue de la litterature sur PubMed, Embase, Cochrane Database, utilisant les mots cles : female ; urinary incontinence ; overactive bladder syndrome ; stress urinary incontinence ; bladder training ; bladder diary ; pelvic floor muscle training ; pelvic floor rehabilitation ; physiotherapy ; cognitive therapies . Sur 2906 articles (etudes animales ou anatomiques exclues), 66 articles ont ete retenus. Resultats Les etudes concernant les exercices de contraction volontaire des muscles pelvi-perineaux ont montre une augmentation significative de la force de contraction de ces muscles et celle-ci etait correlee avec l’amelioration des scores d’incontinence urinaire et le pad-test (coefficient de correlation r entre 0,23 et 0,34) pour les femmes ayant une incontinence urinaire a l’effort. Ces etudes n’ont pas observe d’augmentation de la pression de cloture uretrale maximum (PCUM), ni de correction de l’hypermobilite uretrale correlee a l’amelioration de l’incontinence apres les seances de reeducation. Les etudes concernant l’electrostimulation des muscles pelvi-perineaux ont observe une augmentation de la force de contraction de ces muscles apres reeducation et une diminution de l’intensite des contractions detrusoriennes, sans modification de la PCUM. Il existait tres peu de donnees sur les mecanismes d’action precis du biofeedback et des therapies cognitivo-comportementales. Conclusion Dans les etudes ayant evalue objectivement les mecanismes d’action de la reeducation perineale, il a ete observe que les exercices de contraction volontaire des muscles pelvi-perineaux et l’electrostimulation entrainaient une augmentation de leur force de contraction, sans modifier la PCUM.

The female perineum, which is divided into the anterior urogenital triangle and the posterior anal triangle, is a surface structure often overlooked. Female perineal diseases may present with nonspecific clinical signs due to its close anatomical relationship between the different compartments. Diagnosis of the origin of a perineal disorder may also be a difficult problem encountered in pelvi-perineal imaging. Therefore, a precise knowledge of the female perineal anatomy and the associated disease processes is essential to radiologists, pathologists, and surgeons alike who are involved in the evaluation of the patient who presents with a perineal mass. Cross-sectional imaging plays a crucial role for proper management. Due to the robust contrast resolution of MR, MR imaging is the modality of choice for evaluation of the extent of a complex perineal lesion, its relationship to the adjacent structures. It has a greater sensitivity and specificity for the diagnosis than the other non-invasive imaging techniques and is helpful in guidance for surgical planning. The purpose of this article is to highlight the spectrum of imaging findings of female perineal diseases.

To analyse the prevalence of postpartum anal incontinence, its risk factors, and its management.A comprehensive systematic review of the literature on PubMed, Medline, Embase and Cochrane using: postpartum anal incontinence, postpartum fecal incontinence, perineal rehabilitation, anal surgery.The prevalence of postpartum anal incontinence varied from 4% (primipare) to 39% (multipare) at 6 weeks postpartum, whereas fecal incontinence can reach respectively 8 to 12% 6 years after delivery. Identified risk factors were: vaginal delivery (OR: 1.32 [95%CI: 1.04-1.68]) compared to cesarean section, instrumental extractions (OR: 1.47 [95%CI: 1.22-1.78]) compared to spontaneous vaginal delivery but it was only with forceps (OR: 1.50 [95%CI: 1.19-1.89]) and not with vaccum (OR: 1.31 [95%CI: 0.97-1.77]). Maternal age over 35 years (OR: 6 [95%CI: 1.85-19.45]), number of births (3 births: OR: 2.91 [95%CI: 1.32-6.41]) and the occurrence of anal-sphincter injury (OR: 2.3 [95%CI: 1.1-5]) were associated with an increased risk of anal incontinence regardless of the type of delivery compared to a group of women without anal incontinence. Perineal rehabilitation should be interpreted with caution because of the lack of randomized controlled trials. A reassessment at 6 months postpartum in order to propose a surgical treatment by sphincteroplasty could be considered if symptoms persist. The results of the sphincteroplasty were satisfactory but with a success rate fading in time (60 to 90% at 6 months against 50 to 40% at 5 and 10 years).Postpartum anal incontinence requires special care. Recommendations for the management of postpartum anal incontinence would be useful.

This was a comprehensive literature review using Pubmed, Medline, Embase and Cochrane, whose aim was to analyse the prevalence of anal sphincter injuries, their risk factors, their management and their functional prognosis. The prevalence of 3rd and 4th degree perineal tears varies between studies from 2.95% regardless the parity to 25% in nulliparous women. Twenty-eight percent to 48% of these lacerations were clinically occult. Perineal tears were associated with (multivariate analysis) forceps (6.021 [IC 95% 1.23-19.45]), nulliparity (OR 9.8 [IC 95% 3.6-26.2]), gestational age over 42 SA (OR 2.5 [IC 95% 1-6.2]), fundal pressure (OR 4.6 [IC 95% 2.3-7.9]), midline episiotomy (OR 5.5 [IC 95% 1.4-18.7]) or fetal weight in interval of 250g (OR 1.3 [IC 95% 1.1-1.6]). There was no difference between the sphincter repair techniques. Post-partum laxative use showed less painful bowel motion and earlier postnatal discharge. Data concerning rehabilitation were contradictory. The rate of anal incontinence 6 months after vaginal delivery were 3.6% following third degree of perineal tear and 30.8% in case of fourth degree of perineal tear. Thirty years after anal sphincter disruption, the prevalence of fecal incontinence reached 6.9%.

The treatment of endometrial polyps is based on hysteroscopic resection. The aim of the current study was to compare the results associated with hysteroscopic morcellation and those observed with bipolar loop resection.A single-center observational retrospective comparative study was performed, including 25 patients who underwent hysteroscopic resection of endometrial polyps from January 2012 to December 2013. The mean size of polyp was 9.2 mm in the group compared to 12.5mm in the resection group loop (P=0.06).Twelve patients underwent resection of the polyp morcellation with MyoSure(®) and 13 with bipolar resection loop Versapoint(®) 24F. The mean operative time was 16 minutes in morcellation group and 17 minutes in the bipolar resection group (P=0.76). Complete removal was achieved in 100% of cases in morcellation group and in bipolar loop resection. Regarding intraoperative and postoperative complications, no complication was observed in the two groups.Results associated with hysteroscopic morcellation and bipolar loop resection seen to be comparable.

To evaluate the results associated with hysteroscopic morcellation for submucous myomas removal, and to compare with those observed associated with bipolar loop resection.A retrospective comparative study was conducted in two universitary centers from January 2012 to December 2013. A total of 83 patients, who presented with submucous myomas type 0,1 and 2, were included. The number of myomas type 0,1 was 36 (71 %) and 15 (29 %) myomas type 2 in morcellation group versus 44 (59 %) myomas type 0,1 and 31 (41 %) type 2 in electrosurgical resection group (P=0.17). Hysteroscopic morcellation or electrosurgical resection with bipolar loop for removal submucous myomas were performed.Thirty-four patients underwent hysteroscopic morcellation using MyoSure(®), and 49 had hysteroscopic resection using Versapoint-24F(®) bipolar loop. The mean operative duration was 30minutes in morcellation group, compared to 31minutes in bipolar resection group (P=0.98). Complete myoma removal was achieved in 22 (64 %) patients in morcellation group, and in 34 (69 %) in bipolar resection group (P=0.65). There were no difference in the occuring of adverse events between the two. The prevalence of postoperative intra-uterine adherence was 10 % in morcellation group and 13.8 % in bipolar resection group (P=0.69).In the current short comparative series, hysteroscopic morcellation and bipolar loop resection were associated with comparable results for removal of submucous myomas.

Retropubic mid-uretral sling (MUS) procedure may be complicated by bladder injury (intraoperative cystotomy). There is no scientific consensus on the length of catheter drainage following bladder injury during MUS procedure: it varies from hours to days. We have made it our policy to immediately remove the catheter. The objective of the current study was to assess the results associated with immediate removal of catheter drainage following intraoperative bladder injury during retropubic MUS procedure.Retrospective case-control study. Group 1 (cases): 8 women who have experienced bladder injury during retropubic MUS procedure and group 2 (controls): 32 women (ratio of controls to cases: 4:1).Mean (sd) age, BMI and MUCP were 62(13) vs. 59(10), 25(4) vs. 26(4) and 42(18) vs. 43(16), in group 1 and group 2, respectively (P=0.55, 0.56 and 0.92). Minimum follow-up duration was 12 months. None patient was lost to follow-up in group 1 (cases) and 2 patients were lost to follow-up in group 2 (controls) at 12 months follow-up. No rehospitalization or postoperative complication was noted in both groups. Immediate suprapubic postoperative pain exceeding 30/100 on VAS occurred in 1/8 (12%) and 3/32 (10%), in group 1 and group 2, respectively (P=1.00). Urinary stress incontinence cure rates were not significantly different between the two groups: 8/8 (100%) vs. 28/32 (87%), in group 1 and group 2, respectively (P=0.56). The level of satisfaction was comparable in both groups: PGI-I score was equal to 1(very satisfied) in 6/8 women (75%) and in 24/32 women (75%), in group 1 and group 2, respectively (P=1.00). De novo urgency was observed in 0/8 (0%) vs. 3/32 (10%), in group 1 and group 2, respectively (P=1.00).In the current short retrospective series, immediate removal of catheter drainage following intraoperative bladder injury during retropubic MUS procedure was not associated with an increased prevalence of complications.4.

The main risk factor of adnexal torsion is a previous adnexal torsion (LE3). There is no clinical, biological or radiological sign that may exclude the diagnosis of adnexal torsion (LE3). The presence of flow at color Doppler imaging does not allow exclusion of the diagnosis (LE2). An emergent laparoscopy is recommended for adnexal untwisting (Grade B), except in postmenopausal women where oophorectomy is recommended (grade C). A persistent black color of the adnexa after untwisting is not an indication for systematic oophorectomy (grade C), since a functional recovery is possible (LE3). Ovariopexy is not routinely recommended following adnexal untwisting (grade C). The clinical signs of intra-cystic hemorrhage and those of rupture of the corpus luteum are not specific (LE4). MRI is not recommended to confirm the diagnosis of intra-cystic hemorrhage (grade C). Malignant transformation of an ovarian cyst is very rare. The presence of a benign ovarian cyst is not associated with an increased risk of ovarian cancer at long-term follow-up (LE2). For these women, an ultrasound follow-up is not recommended (grade C). Dermoid ovarian cyst containing nerve tissue can trigger the production of pathogenic auto-antibody-anti-NMDA, leading to encephalitis. A high proportion of thyroid tissue in a mature teratoma (struma ovarii) may cause hyperthyroidism.

To analyze the proven mechanisms of action of pelvic rehabilitation in women presenting with urinary incontinence.Review of literature (PubMed, Embase, Cochrane Database) using following keywords: female; urinary incontinence; overactive bladder syndrome; stress urinary incontinence; bladder training; bladder diary; pelvic floor muscle training; pelvic floor rehabilitation; physiotherapy; cognitive therapies. Among 2906 articles (animal and anatomical studies have been excluded); 66 have been selected because they focused on the evaluation of the pathophysiological mechanisms of pelvic floor rehabilitation concerning female urinary incontinence.Studies on pelvic floor muscles training exercises showed a significant increase in the force of contraction of these muscles and it was correlated with improved scores of urinary incontinence and pad test (coefficient of correlation r ranged from 0.23 to 0.34) for women presenting with stress urinary incontinence. These studies have not observed an increase in the maximum urethral closure pressure (MUCP) or correction of urethral hypermobility related with the improvement of incontinence after rehabilitation sessions. Studies concerning pelvic floor stimulation observed an increase in the force of contraction of pelvic floor muscles after rehabilitation and a decrease in the intensity of detrusor contractions without changing the MUCP. There is very little data on the precise mechanisms of action of biofeedback and cognitive behavioral therapy.In studies that objectively evaluated the mechanisms of action of pelvic rehabilitation, it was observed that pelvic floor muscles voluntary exercises and electrostimulation resulted an increase in force of contraction of these muscles without changing the MUCP.

Cette etude evalue la faisabilite de la detection du ganglion sentinelle (GS) par technique isotopique seule chez les patientes ayant un cancer invasif du sein ainsi que la capacite des chirurgiens a s’adapter face a un changement de procedure chirurgicale.

Background To evaluate whether predictive factors of axillary lymph node metastasis in female breast cancer (BC) are similar in male BC. Patients and methods From January 1994 to May 2011, we recorded 80 non-metastatic male BC treated at Institut Curie (IC). We analysed the calibration and discrimination performance of two nomograms [IC, Memorian Sloan-Kettering Cancer Center (MSKCC)] originally designed to predict axillary lymph node metastases in female BC. Results About 55% and 24% of the tumours were pT1 and pT4, respectively. Nearly 46% demonstrated axillary lymph node metastasis. About 99% were oestrogen receptor positive and 94% HER2 negative. Lymph node status was the only significant prognostic factor of overall survival (P = 0.012). The area under curve (AUC) of IC and MSKCC nomograms were 0.66 (95% CI 0.54–0.79) and 0.64 (95% CI 0.52–0.76), respectively. The calibration of these two models was inadequate. Conclusions Multi-variate models designed to predict axillary lymph node metastases for female BC were not effective in our male BC series. Our results may be explained by (i) small sample size (ii) different biological determinants influencing axillary metastasis in male BC compared with female BC.

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 42 - N° 7 - p. 703-704

Background: To evaluate whether predictive factors of axillary lymph node metastasis in female breast cancer (BC) are similar in male BC. Patients and methods: From January 1994 to May 2011, we recorded 80 non-metastatic male BC treated at Institut Curie. We analysed the calibration and discrimination performance of two nomograms (Institut Curie (IC), Memorian Sloan-Kettering Cancer Center (MSKCC)) originally designed to predict axillary lymph node metastases in female BC. Results: 55% and 24% of the tumours were pT1 and pT4 respectively. 46% demonstrated axillary lymph node metastasis. 99% were estrogen receptor positive and 94% HER2 negative. Lymph node status was the only significant prognostic factor of overall survival (p = 0.012). The area under curve (AUC) of IC and MSKCC nomograms were 0.66 (95%CI, 0.54–0.79) and 0.64 (95% CI, 0.52–0.76) respectively. The calibration of these two models was inadequate (Table 1). Conclusion: Multivariate models designed to predict axillary lymph node metastases for female BC weren't effective in our male BC series. Our results may be explained by a) small sample size b) different biological determinants influencing axillary metastasis in male BC compared to female BC. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P1-01-19.