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Gynecologie Obstetrique & Fertilite - Sous presse. Epreuves corrigees par l'auteur. Disponible en ligne depuis le mardi 26 avril 2016

Resume Bien qu’elle demeure relativement mal cernee, l’utilisation des progestatifs au sein des differentes contraceptions augmente regulierement en France (particulierement le dispositif intra-uterin, l’implant sous-cutane et les microprogestatifs). Sa prescription se fait dans un certain nombre de cas hors des indications d’autorisation de mise sur le marche (particulierement pour les macroprogestatifs) et elle regroupe une grande variete de molecules, voies d’administration et posologies. Pour ces raisons, un comite d’experts a ete reuni et a repondu aux 35 questions posees par un comite d’organisation. Le choix de ces questions etait largement inspire des points litigieux ou peu consensuels rencontres en pratique clinique courante lors de la prescription d’une contraception progestative. Les reponses apportees ont ete largement basees sur les donnees issues de la litterature medicale. Dans les cas ou l’absence d’etude ne permettait pas de repondre de facon formelle a la question posee, le comite d’experts a propose la reponse la plus consensuelle possible. L’ensemble des reponses apportees par le comite d’experts a ensuite ete soumis a un comite d’evaluation avant validation finale du document. La contraception progestative presente differents niveaux d’action (local et/ou central), variables d’une molecule a l’autre. Elle beneficie d’une efficacite satisfaisante (celle des macroprogestatifs n’a jamais ete evaluee) mais suppose le respect de schema posologique strict (en particulier pour la contraception microprogestative). Il n’a jamais ete mis en evidence d’augmentation significative du risque de cancer du sein par l’utilisation de contraception progestative. Cependant, pour plusieurs raisons, l’interpretation des etudes portant sur le sujet doit rester prudente. Si les effets souvent mal connus des differents progestatifs sur la densite minerale osseuse semblent pouvoir varier selon les molecules, en particulier en raison du taux d’estradiol plasmatique qu’elles induisent, il n’existe pas d’argument direct pour considerer la contraception progestative comme facteur de risque de fracture osseuse. Concernant le risque de maladie thromboembolique veineuse, les progestatifs seuls ne sont pas consideres comme un facteur de risque. La contraception progestative est recommandee : lors d’une mauvaise tolerance des estrogenes exogenes ; pour contrebalancer une hyperestrogenie endogene ; en cas de contre-indication metabolique ou cardiovasculaire aux estroprogestatifs ; en cas de fluctuations hormonales a l’origine de dysphories premenstruelles ou de migraines catameniales. Enfin, la contraception progestative constitue une contraception de choix dans certaines situations particulieres (allaitement, adenomyose…).

Using pure progestin contraception has four main objectives; all pure progestins on the market do not satisfy these four main objectives: (i) not to give artificial estrogens like ethinyl estradiol or any kind of estrogens at high doses. This is necessary when there is an estrogeno-dependent pathology; (ii) to diminish endogen estrogen circulating levels by using anti-gonadotrope progestins; (iii) not to induce dangerous proteins synthesis by a too important estrogenic hepatic impact due to an effect, known as hepatic passage. This is required in case of metabolic pathologies or more largely, in case of important vascular risk factors or also in case of an estrogen-dependent hepatopathy; to diminish hormonal fluctuations for women who have problems due to varying endogen hormones. Knowing each product's pharmacology enables to choose the product best adapted to each clinical situation. When choosing, one has to take into account the contraceptive efficiency, as well as the fact that those products are often given over long periods of time to women with particular pathologies.

The impact of stress urinary incontinence (SUI) is not limited to physical and psychological consequences classically evaluated for this disease. In fact, some studies emphasize the indisputable existence of sexual disorders directly imputable to SUI. Sexual function is an important evaluation element before and after surgical treatment of SUI. Many validated questionnaires about sexual disorders exist, the most frequently utilized in present literature being the female sexual function index (FSFI). Suburethral slings, in spite of discordant results, do not seem to impair global sexuality of patients, some authors reporting a benefit effect of surgery, related to a decrease of coital incontinence after surgery and a decrease of apprehension before sexual intercourse.

Resume Objectif. – Decrire les pratiques de prescription et de suivi d'un implant contraceptif (Implanon ® ), en pratique liberale courante en France et evaluer la frequence et les motifs de retraits prematures. 1 Patientes et methodes. – Une etude de cohorte de 1000 femmes auxquelles Implanon ® a ete prescrit par un echantillon representatif de prescripteurs, gynecologues et medecins generalistes, a ete mise en place en juin 2002. La periode de recrutement etait prevue sur une duree de deux ans (juillet 2002–juillet 2004). Le suivi a ete effectue selon la pratique habituelle des medecins investigateurs sur une periode de trois ans, ce qui correspond a la duree d'efficacite de l'implant. Resultats. – Une analyse intermediaire a ete realisee au 31 decembre 2003. Huit cent soixante-douze femmes ont ete incluses a cette date, dont 784 (89,9 %) par les gynecologues et 88 (10,1 %) par les medecins generalistes. L'implant a ete pose chez 691 femmes (79,2 %) et 360 (52,1 %) d'entre elles ont ete revues au moins une fois en visite de suivi. La duree moyenne de suivi a ete de 10,5 mois. Trente-huit retraits prematures ont ete observes soit un taux actuariel a 16 mois de 8,8 % [IC 95 % 5,0–12,7] tenant compte des durees de suivi et sous l'hypothese que les patientes non encore revues a cette date aient toujours l'implant. Discussion et conclusion. – Le taux estime de retrait premature est inferieur a celui observe dans les essais cliniques internationaux et ce resultat devra etre confirme lors de l'analyse finale qui sera effectuee a la fin de la periode de trois ans de suivi.

Resume Objectif. – Decrire l'efficacite et acceptabilite de l'interruption volontaire de grossesse par methode medicamenteuse pratiquee sans hospitalisation dans le cadre d'un reseau ville–hopital. Patientes et methodes. – Quatre cent trente-trois patientes demandant un avortement medicamenteux avant 7 SA ont ete incluses entre le 1er fevrier 2003 et le 31 juillet 2004. La consultation avant et la consultation de controle apres l'avortement se deroulent chez le gynecologue de ville. La distribution des comprimes s'effectue a l'hopital : la patiente absorbe devant la sage-femme trois comprimes de mifepristone (600 mg) et recoit deux comprimes de misoprostol (400 μg) qu'elle prendra 48 heures plus tard a son domicile. En cas de problemes ou de complications intercurrentes, la patiente a la possibilite de telephoner ou de consulter le gynecologue de ville, ou bien de se rendre aux urgences de l'hopital. Le gynecologue de ville est forme a l'IVG medicamenteuse par l'hopital et peut contacter a tout moment un medecin referent du planning familial pour un renseignement ou pour adresser une patiente. Resultats. – Le succes de la methode est evalue sur 339 patientes revues par un medecin du reseau ou ayant donne des nouvelles par telephone car 94 patientes ont ete perdues de vues (21,7 %). L'efficacite est de 93,8 % (318/339). Vingt et une aspirations chirurgicales ont ete pratiquees (6,2 %) dans 1,5 % des cas en raison de la demande de la patiente, dans 3,5 % des cas sur avis du medecin en l'absence de complications et dans 1,2 % des cas en raison d'un echec de la methode (deux grossesses evolutives et deux hemorragies importantes avec transfusion). La sage-femme du planning familial a recu un appel telephonique de 21 patientes apres la prise de la mifepristone (4,8 %). Vingt-cinq patientes sont venues consulter aux urgences de gynecologie de l'hopital (5,7 %) et 22 patientes sont allees consulter le gynecologue de ville avant la date prevue de la consultation de controle (5 %). Vingt-deux patientes (5 %) ont ete adressees par le gynecologue de ville a un medecin du planning familial pour un avis ou une prise en charge hospitaliere. Les questionnaires sur l'acceptabilite ont ete recuperes pour 26 % des patientes ; 96,2 % jugent que le deroulement de l'IVG etait globalement acceptable. Discussion et conclusions. – C'est l'importance du nombre d'aspirations faites pour retention trophoblastique qui explique le taux d'echec de cette serie. L'amelioration de l'efficacite de l'avortement medicamenteux realise dans le cadre d'un reseau ville–hopital passe donc par une formation complete a l'avortement medicamenteux de tous les intervenants (gynecologues de ville, internes des urgences, medecins du planning) en insistant particulierement sur la conduite a tenir devant des images echographiques obtenues lors de la visite de controle. L'acceptabilite du deroulement de la procedure est excellente pour les patientes. Concernant les professionnels, la pratique d'interruptions de grossesse dans le cadre d'un reseau de soins n'implique pas une surcharge importante de travail puisque environ 5 % des patientes reclameront des consultations supplementaires et 6,2 % necessiteront une aspiration chirurgicale a l'hopital. Ces donnees permettent d'etre optimiste sur la pratique en France d'interruptions volontaires de grossesse hors etablissement de soins dans le cadre de reseaux de sante, sachant que le relais hospitalier de delivrance des medicaments indispensable a la realisation de cette etude est desormais obsolete puisque la mifepristone est disponible en pharmacie d'officine depuis septembre 2004.

Resume Objectif. – Realiser une revue de la litterature concernant les risques et la prevention des incontinences urinaire et anale survenant apres un accouchement. Methode. – Une revue de la litterature internationale a ete effectuee entre 1999 et 2003 en utilisant le site de la National Library of Medicine et les mots cles : « fecal incontinence and delivery » et « urinary incontinence and delivery ». Resultats. – Cinq cent un articles concernent ce sujet. La plupart sont des etudes retrospectives, dont deux concernent des registres regionaux ou nationaux de tres grande taille. Ces deux etudes analysent 2 886 126 accouchements et ont demontre que les principaux facteurs de risque de dechirure perineale sont : la primiparite, le poids du nouveau-ne, les presentations posterieures, la prolongation de la deuxieme phase du travail et les extractions instrumentales. Les autres etudes ont demontre que des taux d'episiotomie superieurs a 30 % n'ont pas d'impact benefique en terme perineal ; l'episiotomie mediane est deletere et multiplie par 2 a 22 le risque de perinee complet. Seules six etudes controlees randomisees ont ete publiees. Elles concluent au benefice de la kinesitherapie perineale pratiquee pendant la grossesse (diminution du risque d'incontinence urinaire a trois mois de 32 a 20 %, p Conclusion. – Les facteurs de risque des lesions perineales, aujourd'hui bien connus, rendent necessaire la realisation d'etudes, controlees et randomisees « interventionnelles » qui permettront de choisir les meilleures techniques de prevention et de reparation du perinee.

Resume Objectif. – Mettre au point et decrire une technique chirurgicale pour le traitement des hernies ombilicales de moins de 5 cm de diametre avec une reduction des reliquats cicatriciels. Patientes et methode. – Apres avoir analyse les differentes techniques utilisees pour la reparation des hernies ombilicales, les auteurs proposent une technique pratiquee chez neuf patientes. Le traitement chirurgical prevoit l’exerese du sac de la hernie apres une incision cutanee en double M, la reparation en paletot de la paroi, la plicature des muscles droits abdominaux et la reconstruction de l’ombilic. Resultats. – Les resultats obtenus chez neuf patientes avec un recul a deux ans demontrent la validite de la technique et l’importante reduction des reliquats cicatriciels. Discussion et conclusions. – Les reliquats cicatriciels consecutifs au traitement chirurgical des hernies ombilicales sont tres importants et visibles parce qu’ils sont localises au milieu de l’abdomen. Chez le sujet de sexe feminin, la cicatrice ombilicale represente une gene psychologique tres importante. L’utilisation de la technique en double M a pour interet d’une cicatrice invisible et apporte un bon resultat fonctionnel.

In 1995-1996, four studies published in different medical papers showed an increased risk of veinous thromboembolism among women using third-generation contraceptives compared with those using second-generation pills. These papers had an important mediatic impact. Nevertheless, rereading of the scientific information showed important bias in these studies (methodology, prescription, diagnosis). More recently, two studies published in the British Medical Journal analysing the venous thromboembolism (VTE) relative risk with the third generation contraceptives and using the same database (General Practitioner Research Database) found contradictory results, introducing some confusion. The use of a third-generation progestagen does seem to have led to an unexpected and yet unexplained return of a higher risk of venous thromboembolism but the risk has certainly been overestimated in the first studies.

L'examen clinique en periode catameniale est essentiel pour evoquer le diagnostic. La realisation pre-operatoire d'une IRM permet d'etablir une cartographie complete des lesions sous-peritoneales (cloison recto-vaginale, ligaments utero-sacres, vessie et ureteres) et peritoneales (endometriomes, implants peritoneaux) et l'EESAR permet le diagnostic d'une infiltration de la paroi rectale de facon fiable et confirme la presence d'un nodule de la cloison rectovaginale. Les donnees de ces deux examens permettent au chirurgien de prevoir les gestes necessaires au traitement complet, en particulier les exereses digestives, et d'en informer la patiente pour qu'elle puisse assumer sa decision d'etre operee.

Choice of antimicrobial agents and length of therapy of infections of the female genital tract and chemotherapy are presented with particular mention to their side effects. Clinical approach and antibiotic regimens of pelvic inflammatory diseases are discussed.

To compare the efficacy and safety of atosiban and salbutamol in the treatment of preterm labor.A multicenter, double-blind, double-placebo, randomized, controlled trial. Women (n=241) diagnosed with preterm labor at 23-33 gestational weeks were enrolled and received either atosiban (n=119) or salbutamol (n=122). At randomization, women were stratified by gestational age (or =28 weeks and28 weeks). Atosiban (i.v. bolus dose of 6.75 mg, then 300 microg/min for 3h and 100 microg/min for up to 48h) and salbutamol (2.5-45 microg/min) were administered by i.v. infusion for up to 48h. Retreatment with study drug or an alternative tocolytic agent was allowed. Main outcome measures included tocolytic effectiveness which was assessed in terms of the number of women undelivered after 48h and 7 days. Tocolytic efficacy and tolerability were assessed in terms of the proportion of women undelivered and who did not require alternative tocolytic therapy at 48h and 7 days of starting treatment. Safety was assessed in terms of maternal side effects and neonatal morbidity.Tocolytic effectiveness at 48h was 93.3 versus 95.0% (P=0.67) and after 7 days was 89.9 versus 90.1% (P=0.93) in the atosiban and salbutamol groups, respectively. Tocolytic efficacy and tolerability within 48h was 79.8 versus 75.2% (P=0.15), and after 7 days was 58.8 versus 46.3% (P=0.021) in the atosiban and salbutamol groups, respectively. Maternal adverse events, including serious events, occurred more frequently in the salbutamol group. Neonatal outcomes were comparable between the study groups.The oxytocin antagonist atosiban was found to be better tolerated by both mother and fetus than salbutamol, with a comparable neonatal and infant safety profile, and atosiban was as effective as salbutamol in delaying threatened preterm birth. This study supports the clinical use of atosiban in the treatment of preterm labor.

To evaluate in a series of patients with borderline ovarian tumors the clinical findings and the outcome after laparoscopic management.Retrospective study of 25 patients with borderline ovarian tumors first treated by laparoscopic approach.Thirteen patients had mucinous tumors and 12 had serous tumors. Twenty-one patients had ultrasound examination which detected 24 ovarian cysts including multilocular cysts in 50% of cases and unilocular sonolucent cysts in 25% of cases. The serum CA 125 and CA 199 levels were elevated in 30.7% and 23% respectively. Among the 25 patients first treated by laparoscopic approach, 24 had stage I disease: six of them had cystectomy, seven unilateral salpingo-oophorectomy, two bilateral salpingo-oophorectomy and two laparoscopic hysterectomy with bilateral salpingo-oophorectomy. Seven patients had laparoconversion for presumption of ovarian cancer (5) and failure of laparoscopic procedure (2). One patient with stage III disease had laparoscopic biopsies and subsequent laparotomy. Among the 25 patients, 15 had conservative treatment and 10 had radical treatment. Three recurrences occurred after cystectomy. The mean follow-up was 41 months. Twenty-three patients were alive without evidence of disease, one died of intercurrent disease and one patient was lost to follow-up.Our data suggest that the laparoscopic approach to borderline ovarian tumors is possible in early stage disease but associated with a high risk of recurrence after cystectomy.

Resume L'existence d'une tendance hyperandrogenique chez les sportives est une opinion repandue. La compilation de la litterature consacree a ce sujet pose cependant des problemes d'interpretation, tenant a la diversite et a la variabilite d'intensite des activites physiques considerees, ainsi qu'a la chronologie des prelevements. Chez les femmes n'ayant pas d'ambitions de competition, 1 heure d'exercice submaximal augmente de 40 a 50 % la testosterone, avec retour a la normale 4 a 6 heures apres l'arret. Selon certains, cette elevation de testosterone a l'exercice s'observerait essentiellement en phase folliculaire et serait minime en periode luteale. Selon d'autres, elle ne s'observerait que chez les femmes amenorrheiques. Chez ces sportives occasionnelles l'entrainement ne modifie pas la testosteronemie. Les donnees sont differentes pour les sportives de haut niveau. Au decours immediat d'un exercice de grande intensite, celles-ci presentent une elevation constante et marquee de 195 % de la testosterone plasmatique, de 211 % du cortisol et de 327 % de la prolactine, la FSH ne variant pas et la LH restant stable ou etant diminuee de 30 %. Le retour a la normale s'effectue dans les 6 a 12 heures suivant l'arret de l'exercice pour la testosterone, plus lentement pour d'autres parametres comme le sulfate de dehydroepiandrosterone. En periode de competition intense et repetee, on observe une diminution progressive de la testosterone plasmatique, du rapport testosterone sur sex-hormone binding globuline et du rapport testosterone sur cortisol. En periode d'entrainement regulier, sans competition, la baisse de testosterone est moderee, mais le cortisol augmente. La reascension de la testosteronemie survient des le ralentissement de l'activite physique, a telle enseigne que le rapport de la testosterone libre sur le cortisol est propose comme marqueur de l'epuisement musculaire, notamment chez les sportifs de sexe masculin, cette donnee etant moins nette chez les femmes. Les nageuses ont des reponses endocriniennes bien differentes. Chez elles, au decours immediat d'un effort intense et prolonge, la testosterone decroit de plus du tiers, tandis qu'au decours d'un effort moins intense mais tres prolonge elle presente une legere elevation. Les nageuses auraient ainsi une tendance a une hyperandrogenie moderee, expliquee en partie par le fait qu'il s'agit souvent de tres jeunes filles possedant un capital adipeux tres faible et presentant de frequentes irregularites menstruelles. La litterature decrivant toutes ces modifications est donc difficile a synthetiser, et il faut se garder d'interpretations trop simplistes dans un systeme ou les interactions sont multiples.

To study the effect of the surgical repair (isthmorraphy) of the large scar dehiscence after cesarean on symptoms and fertility for women who desire pregnancy.In this retrospective study, 14 symptomatic patients, who desire a new pregnancy underwent a surgical repair by laparotomy, laparoscopic or vaginal technique. Five women experienced failure of Assistance Reproductive Technique (IVF or ICSI) for idiopathic secondary infertility. The dehiscent scars were evaluated by ultrasound, hysterography, hysteroscopy and magnetic resonance imaging.Symptoms improvement was found in 92% of case. Ten pregnancy (71%) was obtained after surgical repair, 6 spontaneous and 4 after Assistance Reproductive Technique. Among the 5 women initially followed in the reproductive unit, 4 became pregnant, 3 after IVF or ICSI and 1 spontaneous. No operative complication occurred. The subsequent pregnancy was unremarkable with no uterine rupture.Large scar defect after cesarean can take shape of a complete absent of the anterior wall of the uterus. No incident has been proved in this condition. There is a lack of data concerning these isthmocele. The experience of hysteroscopic repair cannot be applied to these real large diverticule of the scar cesarean. The results of this study suggest a link between the isthmocele and reversible symptoms after surgery. The first results concerning the subsequent fertility after surgical repair seem interestingWhen a large scare defect (isthmocele) is found in symptomatic woman (pelvic pain, bleeding uterine, infertility), a surgical repair can be proposed, especially for woman who desire a new pregnancy.

The object of this study was to evaluate access to preventative care, screening and treatment of women in vulnerable socio-economic groups presenting with cervical cancer and the progression of their disease.This is a retrospective study of 123 patients with cervical cancer treated at the hôpital Bichat (Paris) or the hôpital Verdier (Bondy) between 1st January 1996 and 31 December 2005."CMU" or "AME" is the entitlement for fully state funded medical care and was used in this study to indicate social deprivation. Social deprivation is associated with homelessness (43.9 vs 1.23%; P = 0.0001) and unemployment (90 vs 30%; P = 0.0001). Women from deprived groups seldom enter screening programs (25 vs 56.1%; P = 0.008). Once symptomatic they delay seeking medical attention (1.8 months later than for non-deprived groups; P = 0.027), present more often to accident and emergency departments (51.22 vs 17.07%; P = 0.0003), and do not see any primary care practitioner (41.46 vs 8.64%; P0.0001). There was no significant difference with regard to treatment instituted in the two groups. The non-deprived patients residing in Bondy had similar access to care as the deprived patients treated in Paris. The average follow-up period was 30.43 months (+/- 26.64).Cervical screening is not taken up adequately throughout the general population. Access to health care is poorly tailored to the needs of the socially deprived. Social deprivation did not demonstrate an association with levels of pelvic recurrence, metastasis or death. The low doctor to patient ratio in certain geographical areas reduces access to medical care.

Ovarian low malignant potential tumor account for 10 to 20 percent of ovarian epithelial tumors. They differ from typical ovarian cancers in that they do not grow into the ovarian stroma. Likewise, if they spread outside the ovary, for example, into the abdominal cavity, they do not usually grow into the lining of the abdomen. These cancers tend to affect women at a younger age than the typical ovarian cancers and are less life-threatening than most ovarian cancers. Guidelines for surgical treatment of borderline ovarian tumors are similar to those for ovarian cancer and include hysterectomy with bilateral salpingo-oophorectomy. However, patients with borderline ovarian tumors tend to be younger than women with invasive ovarian cancer. For many of these patients, fertility is an important issue. Previous studies have suggested the safety of conservative surgery with unilateral salpingo-oophorectomy or cystectomy for patients with stage I borderline ovarian tumors. Despite infrequent data, this observation has been expanded to include women with advanced-stage disease. Recurrence is noted more often after this type of treatment, but does not seem to have a negative effect on survival. Management of conservative treatment (complete staging, cystectomy or oophorectomy, oophorectomy or adnexectomy) are still under debate since none avoids the malignant transformation risk. Thus, close follow-up is mandatory and the optimal moment for final oophorectomy remains unclear. When ovarian preservation is impossible, oocyte/ovarian cryopreservation or emergency ovarian induction before the surgical procedure to obtain embryos are promising but still under evaluated options.

Several surgical treatment modalities have been described in cases of isolated or multiple ovarian endometriotic cysts. The aim of this preliminary study was to investigate and test the efficacy of ethanol sclerotherapy (EST) for recurrent endometriotic cysts, before ovarian stimulation in infertile patients with an adequate ovarian status. In the setting of a prospective comparative study, EST was proposed to 31 infertile patients with recurrence of ovarian endometriomas before inclusion in assisted reproduction cycles. Reproductive outcome was compared with that of patients who had previous laparoscopic cystectomy for recurrent endometriomas. The mean size of endometriomas treated with sclerotherapy was 38.6 +/- 11.2 mm in diameter. Ovarian cysts recurred in 12.9% of cases; at a mean time of 10 months after EST. Ovarian reserve and ovarian response to stimulation were better in the EST group than in the control group. Consequently, clinical and cumulative pregnancy rates of the study group were higher than those of the control group (48.3% versus 19.2%, P = 0.04; and 55.2% versus 26.9%, P = 0.03, respectively). Ethanol sclerotherapy may be a good alternative to surgical management of recurrent endometriotic cysts before assisted reproductive treatment. It could be advised for selected infertile patients.

Localisation of endometriosis on the sciatic nerve is exceptional. We report the case of a patient presenting an endometriotic nodule of the left ischio-rectal excavation, with an extension contiguous to the sciatic nerve, responsible of invalidating sciatalgia. Two laparoscopies did not allow to localise the lesion. Finally the endometriotic nodule was treated by a direct access of the left ischio-rectal excavation through a pararectal incision. In this article we discuss the means to localise such lesion and the surgical approach to propose.

Cystadenofibroma of the ovary is a relatively rare benign tumor. Such tumors are characterised by their malignant macroscopical appearance which may lead to an inappropriate aggressive surgical approach. We present two cases of cystadenofibromas of the ovary. The first has been treated by extensive surgery, including pelvic and para-aortic lymphadenectomy. The second has been treated in a more appropriate way, by conservative surgery.

To appreciate the evolution of the current surgical practice for female for stress urinary incontinence (SUI) in the gynaecologic surgery departments of Parisian public hospitals in three different periods of 12 months (2002-2003, 2003-2004, and 2006).The 16 departments were surveyed by postal questionnaire about their surgical practice for the treatment of female SUI. The number, the type of operation, the type of suburethral tapes and their surgical routes were detailed.The participation rate in the survey was 87.5% (14/16) for the first two studied periods and 75% (12/16) for the last one. The number of SUI procedure decreases between the three periods (586, 505, and 263 procedures, respectively; p0.001). Suburethral slings represent the technique of choice for SUI (86.2% in 2002-2003; 92.7% in 2003-2004, and 98.1% in 2006). Other practices are exceptional. The transobturator approach has widely progressed and became the preferred one in 2006 (31.1%; 64.5%; 95.4% in 2006; p0.001). No transobturator route was privileged. TVT procedures have decreased between the three studied periods (48.3%, 36.5%, and 4.6% in 2006; p0.001). TVT-O is the preferred sling in 2006 (120/258, 46.5% of suburethral tapes).Suburethral tape placement is nowadays the main surgical treatment for female SUI amongst members in gynaecology departments in Parisian public hospitals. The transobturator approach is preferred.