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Objectives: To give the results of a prosthetic technique in genital prolapse surgery using a polypropylene mesh and study the complications and their treatment, mainly sexual discomfort., Materials and Methods: A prospective study conducted over a 48-month-period in 317 patients. Surgery included fixing of an anterio-posterior mesh to the tendinous arc at the front and to the levator ani at the rear, after vaginal hysterectomy (in 75% of the cases). In the event of previous surgery, a single anterior or posterior mesh was used (in 25% of the cases)., Results: The functional results are good (no 3rd grade prolapse relapse in 93% of the cases). Prosthetic exposition occurred in 62 patients (19%) and did not need surgical treatment when asymptomatic (38 patients followed at least for one year in 29 cases). On the other hand, women with normal sexual function previous to surgery showed discomfort (dyspareunia) when complications occurred such as exposition (24%) and mesh retraction (3%). Thirty-eight new surgical procedures were necessary in these patients., Conclusion: Dyspareunia may occur after use of prosthetic reinforcement. One must certainly hesitate to propose this type of surgical approach for sexually active women without comparison with other surgical techniques (such as laparoscopic sacropexy). On the other hand, the use of mesh in vaginal surgery for genital prolapse appears to be useful and safe in elderly women who have no more sexual activity.

Background: Breast and gynecological tumors are the most common cancers in women. The aim of this study was to show the epidemiologic features of gynecological and breast cancers in the French administrative district of La Somme., Methods: This study focused on the 1982-1999 period. Incidence, mortality and survival rates were calculated., Results: In 1997-1999, the world standardized breast incidence and mortality rates were 81.6 and 20.2 per 100,000 females per year. Breast and genital tract cancers accounted for 47% of all cancers in women. The incidence and mortality of uterine cervix cancers showed a clear decline over the past 10 years, whereas the trend of breast cancers was dominated by continuing increase. However, mortality was stable for breast cancers. Five year relative survival rates were respectively 80% for breast cancers, and 68%, 76%, 38%, for uterine cervix, uterine body and ovary cancers respectively. Incidence and mortality rates in Somme were in the middle risk range of other cancer French registries., Conclusion: The results of this study indicate that genital tract and breast cancers constitute a serious public health problem pointing out the importance of screening activities in the Somme area.

The authors report their experience based on 200 consecutive examinations. Peniscopy is an outpatient examination of the penis using a magnification system: commercial magnifying glass or colposcope. It consists of examining the whole penis in detail with the naked eue and then with a magnitification system after application of 5% acetic acid to the glans and prepuce in order to identify subclinical lesions. Biopsies can be performed when necessary. Three basic types of lesions may be observed: concylomas, macules, papules. However, the signs of mucocutaneous lesions are difficult to interpret, especially when they are subclinical. There are 2 types of false lesions: physiological papules of the corona of the glans and a diffuse acidophilic reaction. Topical treatment or laser destruction of the lesions can be performed at the same time as the examination, when necessary. The current indications for this technique are discussed. When learning this technique, the authors recommend the extensive use of biopsies and training with an experienced examiner.

42 subclinical HPV related vulvar lesions have been studied by Southern Blot Hybridization and histological samplings. 15 women had normal Pap smears. Cervical intraepithelial neoplasia was present in 24 other women, 15 of them had HPV on Southern Blots. Macular or papular areas on the vulva were strongly correlated with HPV infection, since 6 out 9 of them harboured HPV 16, 42 or X. Histologically, flat condyloma was present in 6 cases. However, 33 nonspecific acetowhite reactions of the vulva were free of HPV. It is therefore important to recognize such aspects on colposcopical examination of the vulva to avoid unnecessary treatment.

The authors report 256 male genital examinations to determine papillomavirus lesions (HPV) in men whose female partners presented HPV cervical lesions. 46 p. cent of the examinations performed with a colposcope were abnormal. Histologically, anomalies are present in 62 p. cent of the samples and, overall, 39 p. cent of the men presented, most of the time, infraclinical lesions. Knowing that males are probably safe from malignant degeneration, it is most likely that the treatment of male lesions decreases the frequency of recurrences in women and represent a factor in limiting the extension of the epidemic. The approach of the couple in consultation is discussed.

Endometrial cancer has become one of the most frequent female cancers, second only to breast cancer. It must be looked for in women presenting several high risk factors for endometrial cancer, the common denominator of which is absolute or relative hyperoestrogenism. Hysteroscopy and guided biopsy are the most reliable techniques for the diagnosis of endometrial cancer and its precursors. These techniques must be used in symptomatic patients and in asymptomatic but high risk women whose selection remains controverted as regards the mass detection method.

Subclinical vulvar lesions have been studied using the magnifying colposcope after 5% acetic acid application in 65 women with H.P.V. related cervical lesions and/or cervical intraepithelial neoplasms. Different vulvoscopic patterns are described: micropapillae (51%), diffuse acetowhite reaction (18%), papules (13%) and leukoplakia (11%). A normal appearance was found in 7% of the cases. Histological diagnosis is far different: normal histological appearance or minimal histological changes are noted in 57% of the biopsy specimens, flat condylomas of the vulva in 38% and vulvar intraepithelial neoplasms (V.I.N.) in 15%. The most frequent clinical aspects, i.e., acetowhite reaction and micropapillae are seldom related to V.I.N. The significance of these H.P.V. histologically-related vulvar lesions is still difficult to assess. Unlike cervical intraepithelial neoplasms, the malignant potential of V.I.N. remains uncertain. The risk of progression to invasive cancer in young women is low, probably less than 5%. On the other hand, vulvae may harbour H.P.V. able to influence subsequent recurrences of dysplasias of the cervix. Further studies are needed, especially Southern blot hybridization of vulvar biopsy specimens, to determine whether these histological abnormalities definitely harbour viruses and need subsequent treatment.

Over a period of 16 years, 92 patients presenting recurrent genital prolapse, following one or several surgical interventions, were operated on via the abdominal route with the insertion of prosthetic material. The current technique used consists of promonto-fixation of the cervix using 2 Mersylene* bands, combined in the majority of cases with a retropubic colopopexy. The anatomical failure rate was 9.2% after a mean follow up of 6.7 years. Morbidity associated with this surgical technique was low: no septic or occlusive complications were noted. This technique provides a satisfactory and long lasting solution, both anatomically and functionally, to the delicate surgical problem of recurrent genital prolapse.

Excision of intestinal implants in association with ovarian conservative surgery appears to be a safe procedure in most cases of intestinal endometriosis. Newer surgical techniques (selective laser vaporisation of abnormal tissue), advances in medical therapy (danazol, LH-RH agonists) and earlier diagnosis before obstructive phenomena, might allow conservative medical or surgical management before the development of major complications.

In a series of 29 HIV-seropositive women (mean age 27.4 years; 75.9 per cent acquired HIV by intravenous drug abuse) observed over a 2 years' period, we were able to determine the main epidemiological characteristics of cervico-vaginal and vulvar lesions caused by human papillomavirus (HPV). More than 58 per cent of cervico-vaginal smears showed cytological evidence of HPV infection (koilocytosis), and 6 cervical biopsies showed histological abnormalities (from CIN I to invasive carcinoma). Condyloma acuminata was found in 38 per cent of the cases, always associated with cervical HPV lesions. Systematic colposcopy of the whole female genital tract frequently detected multifocal HPV infection. HIV-seropositive women constitute a high-risk group for cervico-vaginal and vulvar HPV infection. They clearly need close supervision with frequent cervical smears and, preferably, colposcopy and biopsy for early detection and eradication of genital dysplasias and viral lesions.

Four cases are presented. The first cancer was in a non-seminomatous location while the second tumor was a seminoma in all four patients, one being of mixed origin. A literature review demonstrated reports on 30 similar cases. Biopsy of the contralateral testis to detect a possible cancer in situ in no way modifies treatment as a function of findings, these patients being followed up because of the first cancer. A possible role evaluated is that of chemotherapy for the first cancer, but this is unconfirmed and 30% of patients had not received chemotherapy. It is difficult to determine lymph node extension during development of the 2nd tumor if radiotherapy or lymph node resection has been performed. Assay of tumoral markers in spermatic veins blood is a useful exploration. Surveillance of these castrated patients, with frequently elevated LM, can be assisted by selective assay of beta-HCG. Therapy must be by chemotherapy, to replace lymph node excision and radiotherapy which cannot be repeated.

Data from a series of 58 patients admitted with pyosalpinx, and representing 17.3% of cases of upper genital infections, were used to provide detailed information on therapy. Diagnosis was confirmed by celioscopy or laparotomy in all cases, and treatment essentially multiple antibiotic therapy by parenteral administration of wide spectrum compounds. Three subgroups of patients were distinguished: group 1 (15 cases) received immediate surgery due to severity of clinical picture or doubt as to diagnosis: in 54% the treatment was radical (hysterectomy-castration); group II (26 cases) received medical treatment only; group III (17 cases) underwent surgery after failure of medical treatment; operation was conservative in 52% of cases. Failure of medical treatment was related to a pyosalpinx volume of 8 cm3 or more in 86% of cases. No patient needed recovery surgery, while 3 had long term complications. Microbial flora was mainly anaerobic, diagnosis being dependent of celioscopy findings. Medical treatment alone allowed young women desiring pregnancy to conserve their genital apparatus in 44.8% of cases. When there is a lack of response to treatment, incomplete regression or recurrence then only surgery can be curative: the uterus and ovarian parenchyma should be conserved as far as possible because of new therapeutic perspectives.

Pelvic lymphadenectomy for genital cancer can lead to numerous complications, particularly lymphoceles. Two types of drainage were compared in a series of 124 patients treated by extended lymphadeno-colpo-hysterectomy. In the first group (n = 83), hermetic peritonization with aspiration drainage was performed, and in the second group (n = 41), non-peritonization combined with omentoplasty was performed. Lymphoceles developed in 20% of patients in the first group (17 cases), requiring 7% of repeat operations (5 cases). Lymphoceles occurred in only one patient in the second group. The combined use of the reabsorption qualities of peritoneum and omentum avoids lymphoceles complications, particularly in patients previously treated by external radiotherapy.