Search

To determine the usefulness of mid-urethral slings (MUS) in the surgical management of women presenting with urinary stress incontinence (USI) METHOD: A consensus committee of multidisciplinary experts (CUROPF) was convened and focused on PICO questions concerning the efficacy and safety of MUS surgery compared to other procedures and concerning which approach (retropubic (RP) vs transobturator (TO)) should be proposed as a first-line MUS surgery for specific subpopulations (obese; intrinsic sphincteric deficiency (ISD); elderly) RESULTS: As compared to other procedures (urethral bulking agents, traditional slings and open colposuspension), the MUS procedure should be proposed as the first-line surgical therapy (strong agreement). MUS surgery can be associated with complications and proper pre-operative informed consent is mandatory (strong agreement). Mini-slings (SIS/SIMS) should only be proposed in clinical trials (strong agreement). Both RP and TO approaches may be proposed for the insertion of MUS (strong agreement). However, if the woman is willing to accept a moderate increase in per-operative risk, the RP approach should be preferred (strong agreement) since it is associated with higher very long-term cure rates and as it is possible to completely remove the sling surgically if a severe complication occurs. The RP approach should be used for the insertion of MUS in a woman presenting with ISD (strong agreement). Either the RP or TO approach should be used for the insertion of MUS in an obese woman presenting with USI (strong agreement). In very obese women (BMI ≥35-40kg/m

Resume Introduction La mise en place d’une bandelette sous-uretrale est le gold standard dans la prise en charge chirurgicale de l’incontinence urinaire d’effort de la femme en France. L’efficacite de ce materiel n’est plus a demontrer mais les complications per- et postoperatoires font l’objet a l’heure actuelle d’une controverse importante en Europe mais egalement outre-Manche et outre-Atlantique ayant conduit a la modification des indications operatoires. En France, la reglementation evolue egalement avec un encadrement plus strict des indications operatoires par RCP et une obligation de suivi postoperatoire a court, moyen et long terme. Objectifs Dans ce contexte, le CUROPF a entrepris de realiser une revue de la litterature rassemblant les preuves scientifiques disponibles concernant la survenue de complications per- et postoperatoires relatives a la pose de BSU. Materiel et methode La recherche bibliographique a ete realisee a partir de la base de donnees Medline et 123 articles ont ete retenus. Resultats L’analyse des donnees met en evidence des complications variees, dependantes du materiel implante, du terrain initial et de l’indication operatoire. La bandelette sous-uretrale retro-pubienne est pourvoyeuse de plus d’effraction vesicale peroperatoire (jusqu’a 14 %), plus de douleurs sus pubiennes (4 %) et plus de retention aigue d’urine et dysurie en postoperatoire (jusqu’a respectivement 19,7 % et 26 %). La bandelette sous-uretrale trans obturatrice est responsable de plus d’effraction vaginale peroperatoire (10,9 %), plus de douleur de membre inferieur d’origine neurologique (jusqu’a 26,7 %). Le risque de survenue d’un syndrome d’HAV est similaire dans les 2 voies d’abord (33 %). Mais ces risques de complications sont a ponderer par un fort impact de la chirurgie de l’incontinence urinaire sur l’amelioration de la qualite de vie globale de ces femmes. Conclusion Ainsi la connaissance de ces risques ne doit pas limiter l’indication de la prise en charge de l’incontinence urinaire d’effort par la pose de la BSU mais doit permettre de ponderer les indications operatoires en fonction du terrain, d’informer les patientes de maniere eclairee et les surveiller etroitement sur long terme.

Resume Introduction Le traitement par LASER vaginal est une option therapeutique d’utilisation croissante en urogynecologie, mais son interet reste debattu. L’objectif de cette revue etait d’etablir les donnees de la litterature et d’en produire une analyse critique. Methodes Une revue systematique de la litterature a ete conduite jusque mars 2020 en utilisant les bases de donnees PubMed, Medline, Cochrane et Embase, pour identifier les etudes ayant utilise le LASER dans le domaine de l’urogynecologie. Resultats Quarante etudes ont ete inclues dans l’analyse (8 concernant le syndrome genito-urinaire de la menopause (SGUM), 19 pour l’incontinence urinaire a l’effort (IUE), 3 pour l’hyperactivite vesicale (HAV), 7 pour le prolapsus genital (POP), 3 pour d’autres indications). Les donnees etaient heterogenes, de niveau de preuve faible a tres faible. Une minorite etait comparative, et seules trois etaient randomisees. Les donnees etaient en faveur d’une efficacite modeste du LASER dans le traitement du SGUM, de l’incontinence, de l’HAV et du prolapsus a court terme sur les symptomes, la satisfaction et la qualite de vie. Peu d’effets secondaires ont ete rapportes. Cependant, des risques de biais methodologiques majeurs ont ete notes concernant l’evaluation de l’efficacite et de la securite. Aucune etude n’etait disponible a long terme. Conclusions Bien que le LASER semble montrer des resultats encourageants, le niveau de preuve de son efficacite et de sa securite d’emploi (notamment a long terme) etait faible. Des etudes de meilleure qualite apparaissaient donc necessaires, avant une hypothetique recommandation de son utilisation hors du champ de la recherche clinique.

Resume Introduction L’objectif principal de cette etude etait de valider un nouveau questionnaire evaluant la sante sexuelle, dans une population de femmes sexuellement actives ou non, operees d’une incontinence urinaire d’effort ou d’un prolapsus genital avec ou sans renfort prothetique. Materiel et methodes Apres le developpement d’une premiere version du questionnaire par des membres issus des principales societes savantes francaises impliquees dans l’etude de la sexualite de la femme, une validation linguistique du contenu du questionnaire a ete realisee par des entretiens structures semi-directifs. Ensuite, une validation psychometrique a ete effectuee dans une etude de cohorte prospective multicentrique. Le questionnaire a ete evalue en termes d’acceptabilite, de qualite, de dimensionnalite, de coherence interne, de stabilite temporelle, de sensibilite aux changements et de validite de construction. Resultats La validation linguistique a ete menee chez 25 patientes, la validation psychometrique chez 297 femmes (dont 291 avec donnees disponibles) qui ont ete operees d’une incontinence urinaire par bandelette sous-uretrale (n = 79) ou d’une cure de prolapsus genital par voie vaginale avec prothese (n = 105), par voie vaginale sans prothese (n = 22) ou par cœlioscopie (n = 85) entre le 18/01/2013 et le 18/01/2016. Parmi les 288/291 femmes qui ont complete la question no 1 permettant de connaitre leur « statut » sexuel avant la chirurgie, 159 (55 %) femmes etaient sexuellement actives (SA) et 129 (45 %) femmes etaient non sexuellement actives (NSA). Parmi ces 288 femmes, 165 ont complete le questionnaire en preoperatoire et a 12 mois, et 111 ont complete le questionnaire a 12 mois et a 12 mois + 1 semaine. Le questionnaire a ete bien accepte par les femmes. Toutes les questions ont ete conservees, mais une modification de l’ordre et de la numerotation des questions a du etre realisee. Deux dimensions cliniquement pertinentes ont ete degagees de cette analyse : une dimension « sante sexuelle » regroupant 5 questions et une dimension « gene et douleur » regroupant 3 questions. Le questionnaire global et les deux dimensions avaient une bonne fiabilite et une stabilite temporelle moderee a excellente. Un lien statistiquement significatif a ete demontre entre la question no 15 et l’amelioration rapportee par le PGI-I et le taux de succes anatomique sur la classification de POP-Q. Une forte correlation a ete mise en evidence entre le score de « sante sexuelle » et le score total du FSFI. Conclusion Le Pelvi-Perineal Surgery Sexuality Questionnaire (PPSSQ) est un auto-questionnaire en 13 questions valide dans une population de femmes sexuellement actives ou non, operees d’une incontinence urinaire d’effort ou d’un prolapsus genital par voie cœlioscopique ou vaginale, avec ou sans renfort prothetique. Niveau de preuve 4.

Placement of a mid-urethral sling is the gold standard in the surgical management of stress urinary incontinence in women in France. The cure rate of this material is no longer to be demonstrated, but the per- and post-operative complications are currently the subject of a growing controversy not only in Europe but also across the Channel and across the Atlantic, having led to the modification of operative indications. In France, recommendations are also evolving with a stricter framework for indications for surgery by multidisciplinary consultation meeting and an obligation for postoperative follow-up in the short and long term.In this context, CUROPF realized a review of the literature bringing together the available scientific evidence concerning the occurrence of per- and post-operative complications relating to the installation of mid urethral sling. The bibliographic search was carried out using the Medline database and 123 articles were selected.Analysis of the data highlights various complications, depending on the implanted material, the patient and the indication for surgery. The retro-pubic mid urethral sling provides more bladder erosion during surgery (up to 14%), more suprapubic pain (up to 4%) and more acute urinary retention (up to 19,7%) and postoperative dysuria (up to 26%). The trans obturator mid-urethral sling is responsible for more vaginal erosion during the operation (up to 10,9%), more lower limb pain of neurological origin (up to 26,7%). The risk of developing over active bladder is similar in both procedures (up to 33%). But these risks of complications must be balanced by the strong impact of urinary incontinence surgery on the overall quality of life of these women.Thus, surgical failure and long term complications exist but should not limit the surgical management of stress urinary incontinence with mid urethral tape. Women should be treated with individualized decision-making process and long-term follow -up is necessary.

SOUNDS strengthens the evidence basis of sacral neuromodulation (SNM) for overactive bladder (OAB) through real-world data.To analyze diary-based effectiveness, quality of life (QoL), disease severity, symptom bother, and safety data for SNM with the InterStim system up to 3 yr after implantation.Twenty-five representative French sites enrolled 291 patients with OAB followed according to the local standard of care. Overall, 229 patients received a de novo or replacement InterStim implant and had four follow-up visits, two within the first yr and annually thereafter. A total of 190 patients completed the fourth follow-up visit after a mean of 33.7 ± 3.7 mo.The effectiveness outcomes measured were changes in daily voids and leaks and the therapy responder rates. Other outcomes included validated QoL data (Ditrovie and EuroQol 5-dimension 5-level questionnaires), disease severity (Urinary Symptom Profile [USP]), symptom bother rated using a numeric rating scale (NRS), and safety data. Follow-up data were compared to baseline results using the Wilcoxon signed-rank test.Average daily voids and leaks were significantly reduced at all time points up to 3 yr after implantation (p0.05) except for voids at 21 mo in the group receiving a replacement device. The therapeutic response for urinary urge incontinence at the fourth follow-up was 72% for the de novo group and 86% for the replacement group. Disease-specific QoL (Ditrovie), OAB-specific symptom severity (USP domain 2), and NRS-rated disease bother were significantly improved at all visits (p0.001). Device- or procedure-related adverse events occurred in 49% of patients, with 68% of the events classified as minor (Clavien-Dindo grade I or II). Surgical revisions were performed in 33% of patients, including permanent removal in 13%, over a mean exposure time of 44.4 ± 15.3 mo.This study confirms the safety and effectiveness of SNM for OAB and improvements in QoL and disease bother in real life.Our study in French patients with overactive bladder showed that disease symptoms and bother were significantly reduced and quality of life was significantly improved over a study duration of approximately 3 yr after implantation of a device to stimulate nerves that control the bladder. This trial is registered at ClinicalTrials.gov as NCT02186041.

The main objective of this study was to validate a new questionnaire evaluating sexual health, in a population of sexually active women or not, who have surgery for stress urinary incontinence or pelvic organ prolapse with or without mesh reinforcement.After the development of a first version of the questionnaire by members from the main French societies involved in the study of women's sexuality, a linguistic validation of the content of the questionnaire was carried out through semi-structured interviews. Then, a psychometric validation was carried out in a prospective multicenter cohort study. The questionnaire was evaluated in terms of acceptability, quality, dimensionality, internal consistency, temporal stability, sensitivity to changes and construction validity.Linguistic validation was carried out in 25 patients. Psychometric validation was carried out in 297 women (291 with available data) operated on for urinary incontinence by midurethral sling (n=79) or for pelvic organ prolapse by the vaginal route with mesh (n=105), without mesh (n=22) or by laparoscopic sacrocolpopexy (n=85) between January 18, 2013 and January 18, 2016. Within the 288/291 women who had filed the question No. 1 allowing to know their sexual "status", 159 (55%) women were sexually active and 129 (45%) women were not sexually active before surgery. Within the 288 women, 165 had completed the questionnaire preoperatively and at 12 months and 111 had completed the questionnaire at 12 months and 12 months+1 week. The questionnaire was well accepted by the women and of good quality. All the questions were kept, but a change in the order and numbering of the questions had to be made. Two clinically relevant dimensions were identified in this analysis: a "sexual health" dimension comprising 5 questions and a "discomfort and pain" dimension comprising 3 questions. The overall questionnaire and both dimensions had good reliability and moderate to excellent temporal stability. A statistically significant association was demonstrated between question 15 and the improvement reported by PGI-I and the anatomical success rate on POP-Q classification. A strong correlation was found between the "sexual health" score and the total FSFI score.The Pelvi-Perineal Surgery Sexuality Questionnaire (PPSSQ) is a 13-question self-questionnaire validated in a population of sexually active women or not, operated on for stress urinary incontinence or pelvic organ prolapse by laparoscopy or vaginal surgery, with or without mesh.4.

Vaginal LASER therapy is increasingly used in the field of urogynecology, but several points remain unclear. Our goal was to produce a systematic review of available evidence and provide a critical appraisal of available data.A systematic review until march 2020 was conducted using PubMed/MEDLINE, Cochrane and Embase databases. All studies about vaginal LASER use in the field of urogynecology were included.Forty studies have been included (8 for genitourinary syndrome of menopause, 19 for stress urinary incontinence, 3 for overactive bladder, 7 for urogenital prolapse, 3 for other indications). Data were heterogeneous, and level of evidence was weak or very weak. Few studies were comparative, and only 3 were randomized). Mild improvement of symptoms and quality of life and limited satisfaction were seen for genitourinary syndrome, stress urinary incontinence, overactive bladder and prolapse. Few adverse events were reported. However, major methodological biases were noted regarding efficacy and safety evaluation. No long-term results were available.While Vaginal LASER therapy seem to provide encouraging results, the level of evidence supporting its use was weak, especially regarding long-term outcomes. Studies of better quality are warranted before any recommendation can be made. Current use should be limited to clinical research.

International audience; BackgroundReal-world data that support the use of sacral neuromodulation (SNM) for lower urinary tract dysfunctions are of continued interest.ObjectiveTo evaluate the effectiveness, quality of life (QoL), patient-reported outcomes (PROs), and safety of SNM with the InterStim™ system in real life during 1-yr postimplant.Design, setting, and participantsThis is a prospective, multicenter, observational study at 25 representative public and private French sites. Eligible patients received SNM therapy for overactive bladder (OAB) and non-obstructive urinary retention based on local standard of care. Overall, 320 patients were enrolled; 247 received permanent implant or replacement; 204 implanted patients completed second follow-up after mean of 10.0 ± 3.8 mo.Outcome measurements and statistical analysisEffectiveness outcomes were change in voids, leaks, and catheterizations/day. Other outcomes included validated QoL and disease severity scores as well as PROs and adverse event data. Outcomes at follow-ups were compared with baseline using the Wilcoxon signed-rank test.Results and limitationsVoids in urinary frequency (UF) and leaks/day in urinary urge incontinence (UI) patients were significantly reduced after 10 mo in both de novo (mean baseline voids/day UF de novo: 12.7 vs 8.6 after 10 mo; p < 0.001; mean baseline leaks/day UI de novo: 4.3 vs 1.1 after 10 mo; p < 0.001) and replacement patients (mean baseline voids/day UF replacement: 11.5 vs 7.9 after 10 mo; p < 0.001; mean baseline leaks/day UI replacement: 5.4 vs 1.0 after 10 mo; p < 0.001). Disease bother, Urinary Symptom Profile score, and Ditrovie questionnaire score were also significantly improved. Revisions postimplant occurred in 20% of patients including in 9% due to permanent explantation during a mean exposure time of 24.3 mo.ConclusionsThrough a real-life study, SOUNDS (Sacral neuromOdUlation with InterStim™ therapy for intractable lower uriNary tract DySfunctions) confirms the clinical effectiveness, safety, and positive effect of SNM on QoL and PROs for the treatment of OAB patients.Patient summaryThese analyses on French patients who received sacral neuromodulation (SNM) for retention or OAB during a 10-mo period showed that SNM improved OAB symptoms, quality of life, and reduced disease bother.Trial registrationClinicalTrials.gov: NCT02186041

Resume Le prolapsus est une pathologie courante puisque la prevalence atteint 50 % chez la femme d’âge moyen multipare et qu’elle augmente avec l’âge. Le traitement du prolapsus symptomatique peut etre conservateur et reposer sur la reeducation ou la mise en place de pessaire. On differencie deux categories de pessaires : les pessaires de comblement et les pessaires de soutien. Leur utilisation a pour but de reduire la symptomatologie liee au prolapsus. Leur utilisation est simple, le choix du pessaire dependra de l’interrogatoire, de l’examen clinique et de l’adhesion de la patiente. Dans plus de 80 % des cas, on peut adapter le pessaire a l’anatomie de la patiente. Le suivi doit est regulier afin d’eviter les complications, celles-ci etant exceptionnellement severes. Lorsque le pessaire est adapte, le taux de satisfaction des patientes est important pour un taux de complication faible. C’est un traitement a envisager en premiere intention.

Objectifs Les reunions de concertation pluridisciplinaires (RCP) en pelvi-perineologie prennent une importance grandissante dans la prise en charge des cas complexes en pelvi-perineologie et leur tenue pourrait devenir obligatoire pour poser certaines indications dans un futur proche. Le but de cette etude etait d’etablir un etat de lieux sur le territoire national concernant l’existence et les modalites de ces reunions. Methodes Une enquete a ete realisee aupres des urologues francais membres de l’Association francaise d’urologie via un questionnaire en ligne en 15 questions. Des statistiques descriptives ont ete menees. Resultats Les donnees demographiques relatives aux 207 urologues ayant repondu sont detaillees dans le Tableau 1 . Un acces a une RCP de pelvi-perineologie existait dans 37 % des cas. Les RCP impliquaient les CHU dans 57 % des cas. Le responsable etait urologue, gynecologue, digestif, MPR ou autre dans respectivement 38 %, 28 %, 8 %, 12 % et 14 % des cas. Outres les urologues, participaient des gynecologues (88 %), chirurgiens digestifs (74 %), gastro-enterologues (44 %), radiologues (37 %), MPR (40 %), kinesitherapeutes (43 %), algologues (12 %), infirmieres (19 %), geriatres (5 %) ou sage-femmes (9 %). Les activites etaient toujours des discussions de dossiers ( Tableau 2 ), parfois des presentations pedagogiques (34 %) et tres rarement des examens physiques des patients. Une liste d’emergement et un compte rendu ecrit existaient dans deux tiers des cas, mais un secretariat dedie dans seulement 29 % des cas. Conclusion Les RCP de pelvi-perineologie sont heterogenes et insuffisamment developpees en France, car beaucoup d’urologues declarent ne pas y avoir acces. Leur structuration, leur developpement et leur coordination sont des enjeux majeurs a court terme.

Resume Introduction La promontofixation par laparotomie (PFL) a demontre son efficacite dans le traitement du prolapsus sur un grand nombre de patientes et avec un recul important. La technique laparoscopique reproduit les memes temps operatoires avec une morbidite reduite et beneficie depuis peu du developpement de l’assistance robotique. De nombreuses variantes techniques se sont developpees autour de cette intervention et rendent parfois difficile l’analyse des resultats. L’objectif de cet article est d’etablir des recommandations pratiques a partir des donnees de la litterature sur les differents aspects techniques operatoires. Methodes Ce travail s’appuie sur une revue exhaustive de la litterature concernant les meta-analyses, essais randomises, registres, revues de la litterature, etudes controlees et grandes etudes non controlees publies sur le sujet. Les recommandations ont ete elaborees par un groupe de travail multidisciplinaire puis relues et amendees par un groupe de relecteurs egalement multidisciplinaire (urologues, gynecologues, gastro-enterologues et chirurgiens). La methodologie suit au mieux les recommandations de la Haute autorite de sante (HAS) avec un argumentaire scientifique pour chaque question (accompagnee du niveau de preuve [NP] et les recommandations, gradees (A, B, C et accord d’experts) et validees a l’issue de la phase de relecture. Resultats Lors d’une cure de prolapsus genito-urinaire par promontofixation associant hystero- et vaginopexie anterieure, il n’y a pas d’argument pour mettre systematiquement une prothese posterieure inter-rectovaginale en prevention du risque de rectocele secondaire (grade C). En l’absence de colpocele posterieure, le benefice apporte par la prothese posterieure n’est, en effet, pas etabli (NP3). Le traitement par mise en place d’une prothese (posterieure) des rectoceles, elytroceles et enteroceles est mal evalue (NP3), il n’est donc pas possible de se prononcer sur leurs resultats dans ces indications (accord professionnel [AP]). Les indications consensuelles de la rectopexie ventrale laparoscopique sont representees par le prolapsus du rectum symptomatique (grade C), dont les resultats anatomiques et fonctionnels sont les mieux evalues (NP3). Il n’existe aucune donnee comparative de qualite qui permette de conclure sur le mode et le type de fixation des protheses de promontofixation. Nous ne pouvons que rapporter les usages les plus courants sans autre conclusion. La fixation de la prothese anterieure a l’isthme uterin et a la paroi vaginale anterieure est faite le plus souvent a l’aide de fils et au promontoire a l’aide de fils non resorbables. La grande majorite des auteurs conseille d’effectuer une peritonisation des protheses pour limiter le risque d’occlusion postoperatoire. Il est recommande d’utiliser des protheses non resorbables de type I (polypropylene macroporeux) ou de type III (polyester) et de ne plus utiliser les protheses de type II (polytetrafluoroethylene [PTFE], silicone) (grade C) en raison d’un taux eleve d’erosion prothetique en utilisant ces materiaux : PTFE (9 %) ou silicone (19 %) (NP3). En raison de resultats anatomiques inferieurs a court et moyen termes (NP2), l’utilisation de protheses biologiques n’est pas recommandee (grade B). Les resultats anatomiques et fonctionnels ne sont pas differents entre laparotomie et cœlioscopie (NP1), mais la comparaison des resultats a long terme entre les deux voies n’est pas etablie. La cœlioscopie permet une reduction des pertes sanguines, de la duree d’hospitalisation et de convalescence (NP1), et la gravite des complications postoperatoires est superieure en laparotomie. La voie cœlioscopique est donc recommandee lorsqu’une promontofixation est indiquee (grade B). Lors de la promontofixation cœlioscopique, il n’a pas ete montre de difference de resultats anatomique, et fonctionnel, que l’on ait recours ou non a une assistance robotique (NP2). Cette derniere n’ameliore pas les suites postoperatoires et ne diminue pas le taux de complications par rapport a la cœlioscopie (NP3). Il ne peut donc etre actuellement recommande l’assistance robotique par rapport a la cœlioscopie classique lors de la realisation d’une promontofixation (grade B). Conclusion La technique de promontofixation utilisant des protheses non resorbables permet de traiter les prolapsus des organes pelviens avec des bons resultats, avec peu de complications y compris en termes d’exposition et d’infection de protheses. Elle est consideree a ce titre comme la technique chirurgicale de reference a laquelle toutes les autres techniques de correction des prolapsus devraient se comparer. Il parait donc important d’etablir des recommandations claires sur les nombreuses variantes techniques operatoires qui se sont developpees autour de cette intervention. © 2016 Publie par Elsevier Masson SAS.

Open sacrocolpopexy have demonstrated its efficiency in surgical treatment of pelvic organ prolapse with an important backward on a large number of patients. Laparoscopic sacrocolpopexy reproduced the same surgical technique with reduced morbidity and may benefits from the recent development of robotic. Numerous technical variants have been developped around the original procedure but results seems not ever equivalent. Our objectives are to establish practical recommendations issues from the data of the litterature on the various technical aspects of this technique.This work leans on an exhaustive lecture of the literature concerning meta analyses, randomized tries, registers, controlled studies and the largest non controlled studies published on the subject. Recommendations were developed by a multidisciplinary workgroup then reread and amended by an also multidisciplinary group of proofreaders (urologists, gynecologists, gastroenterologists and surgeons). The methodology follows at best the recommendations of the HAS with a scientific argument for every question (accompanied with the level of proof, NP) and the recommendations, the officers (In, B, C and agreement of experts) and validated at the end of the phase of review.Surgical treatment of uro-genital prolapse by abdominal route classically associated hystero and anterior vaginopexy on the sacral ligament with a synthethic mesh. There are no argument to systematically associated a posterior vaginopexy to prevent secondary rectocele (level C). The consensual indication of laparoscopic rectopexy is represented by symptomatic rectal prolapse, the anatomical and functional results of which are the best estimated (level C). The surgical treatment of rectocele, elytrocele and enterocele with a posterior vaginopexy is not well estimated (level 3). Thus, it is not possible to conclude on the results of a posterior vaginal fixation with a mesh in these indications (AP). In the absence of colpocèle, the interest brought by the posterior vaginal mesh is not established (level 3). There is no comparative studies which allows to conclude on the type and mode of fixation of the prostheses of sacrocolpopexy. We would only report the most common practices without other conclusion. The anterior mesh is usually fixed upper on the anterior part of uterus cervix and lower on the anterior vaginal wall. These fixations are most of the time made by suture and on the promontory with non absorbable suture. The great majority of the authors recommend to make a peritonisation of prostheses to limit the risk of post-operative occlusion. It is now recommended to use only 2 kind of not absorbable prostheses: type I (macroporous polypropylene) or type III (polyester) and not to use any more prostheses type II (PTFE, Silicone) (level C) because of a high rate of mesh erosion: PTFE (9 %) or Silicone (19%) (level 3). Biological prostheses are no more recommended, because of short and medium-term lower anatomical results (level B). Anatomical and functional results are not stastistically differents between laparotomy and coelioscopy (NP1) but the comparison of tong-term results between both ways is not yet established. Coelioscopy allows significant reduction of blood losses, hospital stay and return to normal activity (level 1). Furthemore, there is a higher level of post-operative complications in laparotomy (level 1). When sacrocolpopexy is indicated, coelioscopy is thus recommended (level B). During coelioscopic sacrocolpopexy, anatomical and functional result have not shown any significance difference when using or no a robotics assistance but real randomised studies does not exist (level 2). In comparison to coelioscopy, robotic seems not to improve post-operative consequences and not to decrease the rate of complications of sacrocolpopexy (level 3). Robotic assistance cannot be yet recommended when a coelioscopic sacrocolpopexy is indicated (rank B).Sacrocolpopexy using not absorbable meshes allows to cure pelvic organ prolapses with very good results with few complications in terms of prothetic exposure and infection and thus is now considered as the referent prothetic surgical technique in this indication. Thus, it seems very important to establish clear recommendations on the numerous operating technical variants which developed around the original technique. © 2016 Published by Elsevier Masson SAS.

Objectives The purpose of our study was to demonstrate, describe, and assess the results of the technique of laparoscopic cystectomy sparing the uterus, fallopian tubes, ovaries, and vagina. Patients and methods Between July 2004 and December 2005, 13 women with neurogenic vesical dysfunction (mean age: 53.3±13.0 yr) underwent laparoscopic cystectomy sparing the uterus, fallopian tubes, ovaries, and vagina. A noncontinent transileal Bricker diversion was performed extracorporeally in each case. Parameters studied were the pre-, peri- and postoperative data. Results Mean duration of the operation was 325±36min, and mean blood loss was 323.1±246.3ml. No conversion was required. One perioperative complication was observed: a tear in a branch of the right hypogastric vein, which was sutured under laparoscopy. One patient was transfused during surgery (2 units of blood). No early or late postoperative complications were observed. One patient required transfusion of 2 units of red blood cell concentrate on the first day after surgery. None of the patients required opiate analgesia in the postoperative period. The analgesic regimen used was paracetamol and nefopam in all cases. The pain score on an analogic visual scale was less than 4 in all cases. Resumption of transit was not delayed in any of the patients. Mean hospital stay was 11.6±1.9 d. Over an average follow-up of 7.4±5.4 mo, none of the patients developed late complications. Before surgery, 77% of the women were sexually active; 80% of them were sexually active 4 mo after the surgery. Conclusions Laparoscopic cystectomy sparing the uterus, fallopian tubes, ovaries, and vagina is feasible. This operation has low morbidity and requires only a limited stay in hospital.

Sixty four cases of ureteroceles in a context of pyeloureteric duplication were reviewed. They were detected antenatally in 69% of cases. Upper pole nephroureterectomy was performed as first-line procedure in 32 cases. In 37.5% of cases, this procedure was followed by lower tract reconstruction, essentially because of symptomatic reflux in the inferior renal pelvis. Complete renal and vesical reconstruction was performed as the first-line procedure in 6 cases. An ureteropelvic anastomosis allowed preservation of the superior renal pelvis in 4 cases, including one case with secondary lower tract reconstruction. Intravesical reimplantation of the two ureters was performed in 8 cases. Primary endoscopic opening of the ureterocele was performed in 10 cases and complementary surgery was required in 7 cases. Other procedures were used more rarely: temporary ureterostomy, nephrostomy, resection of the protruding dome of a cecoureterocele. Current management is usually neonatal. The first step consists of prevention of infection. The therapeutic approach depends on the quality of the superior renal pelvis assessed by DMSA renal scintigraphy. Immediate complete reconstruction of the kidney and bladder is now rarely indicated. When the superior renal pelvis is not functional, resection should be considered with aspiration of the ureterocele. A complementary bladder procedure is required in some cases (40% in our series) to treat symptomatic reflux in the inferior renal pelvis. When the superior renal pelvis is functional, ureteropelvic anastomosis is a good solution, especially when the superior ureter is very large and poorly functional, but endoscopic opening of the ureterocele can also be proposed, which may need to be followed be intravesical reconstruction.