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The aim of this study was to clinically validate the French-translated PISQ-IR in a French-speaking population of women with pelvic floor disorders. We aimed to recruit 300 women to account for potential attrition secondary to failure to respond or loss to follow-up. Women were enrolled as part of an RCT and from a separate specific study. Both studies included surgically managed patients. Data were collected at recruitment, visit 1 (V1), V2 (9–12 months postoperatively) and V3 (V2 + 5–15 days). Participants also completed a PFDI 20, ICI-Q and FSFI and were assessed by POP-Q. A total of 297 women were recruited between 18 January 2013 and 18 January 2016. Data were available for 291, 148 and 110 participants at V1, V2 and V3, respectively. The non-response rate for the NSA items varied from 5% to 30%, while for SA women, the non-response rate for the items varied from 0% to 15%. The tool was deemed reliable for five domains of the summary score. We also identified that several sections demonstrated acceptable to good temporal stability. A statistically significant score change was identified in different domains in the participants categorized as improved on either PGI-I or POP-Q. We also identified moderate to strong correlations between PISQ-IR and FSFI. The French translated PISQ-IR has several strengths in support of its validity. Our findings confirm the validity of the summary scores in addition to the item-based initial scoring system.

Objective: To evaluate the rates of serious complications and reoperation for recurrence following sacrospinous ligament fixation (SSLF) for apical pelvic organ prolapse. Methods: This was a national registry ancillary cohort comparative study. The VIGI-MESH registry includes data from 24 French health centers prospectively collected between May 2017 and September 2021. Time to occurrence of a serious complication or reoperation for genital prolapse recurrence was explored using the Kaplan–Meier curve and Log-rank test. The inverse probability of treatment weighting, based on propensity scores, was used to adjust for between-group differences. Results: A total of 1359 women were included and four surgical groups were analyzed: Anterior SSLF with mesh (n = 566), Anterior SSLF with native tissue (n = 331), Posterior SSLF with mesh (n = 57), and Posterior SSLF with native tissue (n = 405). Clavien–Dindo Grade III complications or higher were reported in 34 (2.5%) cases, with no statistically significant differences between the groups. Pelvic organ prolapse recurrence requiring re-operation was reported in 44 (3.2%) women, this was higher following posterior compared with anterior SSLF (p = 0.0034). Conclusions: According to this large database ancillary study, sacrospinous ligament fixation is an effective and safe surgical treatment for apical prolapse. The different surgical approaches (anterior/posterior and with/without mesh) have comparable safety profiles. However, the anterior approach and the use of mesh were associated with a lower risk of reoperation for recurrence compared with the posterior approach and the use of native tissue, respectively.

International audience; Objectifs : la chirurgie de l’incontinence urinaire d’effort (IUE) par bandelettes sous-urétrales (BSU) fait l’objet d’essais cliniques limités en taille, rapportant peu les complications rares et la qualité de vie (QdV). Les registres permettent de rapporter ces complications rares dans la pratique courante et de mesurer la QdV globale, du point du vue des troubles urinaires et pelviens.Méthodes : l’objectif du registre VIGI-MESH est de spécifier l’incidence de ces complications rares et graves en fonction des différents types de BSU (rétropubiennes, transobturatrices, à incision unique/mini-bandelettes) ainsi que de mesurer cette QdV après la pose de BSU. Entre février 2017 et novembre 2019, chaque chirurgie initiale ou de reprise de BSU dans un des 18 centres participants était colligée sur un formulaire par le chirurgien. Un contrôle était effectué à partir des pharmacies délivrant les dispositifs médicaux implantés et des actes codés par les centres participants. Un questionnaire recherchant une complication était envoyé à toutes les patientes à un an. Il comportait également des questions validées en français sur le bien-être ressenti et l’amélioration des symptômes (WHO, European Quality of life Questionnaire 5 Dimensions [EQ5D], Patient Global Impression of Improvement [PGI-I]) Les complications ont été gradées selon la classification de Clavien–Dindo : arrêt de l’intervention sans pose de matériel (grade III), intervention chirurgicale ultérieure secondaire à une complication (grade III), complication menaçant la vie (grade IV), décès de la patiente (grade V).Résultats : quatre-vingt-deux patientes ont eu des complications de grade ≥ III : 5,7 % (53/923) voie rétropubienne, 4,0 % (21/521) voie transobturatrice et 2,2 % (8/370) mini-bandelette. Dix complications peropératoires ont empêché la pose de BSU. La BSU a été desserrée dans les 48 h dans 6 cas. Le risque de complication était 3 fois plus faible avec une mini-bandellette par rapport à une BSU rétropubienne (RR = 0,36 [0,170,75]), le risque n’était pas significativement différent entre les approches transobturatrice et rétropubienne (RR = 0,67 [0,40–1,11]). Vingt-sept femmes (1,5 %) ont eu une reprise chirurgicale pour échec ou récidive, 15 après BSU rétropubienne (1,6 %), 7 après bandelette transobturatrice (1,4 %) et 5 après mini-bandelette (1,4 % ; p = 0,95) (Fig. 1). La procédure a consisté à retendre la BSU (9 cas), injection de Bulkamid® (2 cas) et mise en place d’une seconde BSU (16 cas). Parmi les 1167 patientes contactées par courrier, 692 réponses (59,3 %) ont été retournées à un an ou plus après la chirurgie. À la question « Que pensez-vous de votre état de santé actuel par rapport à ce qu’il était avant votre chirurgie pour incontinence ou prolapsus ? » 91,4 % (608/665) se sentaient mieux (beaucoup mieux, mieux ou un peu mieux) (PGI-I). L’amélioration ressentie était meilleure en l’absence de complications graves ≥ III (p = 0,008). Parmi les patientes, 96,2 % (630/655) ont évalué leur état de santé général comme étant bon (très bon, bon ou assez bon). L’état de santé général ressenti était similaire qu’elles aient eu ou non des complications. Par rapport à la population française du même âge, les patientes opérées d’une BSU ont déclaré avoir un meilleur état de la santé.Conclusion : les premiers résultats du registre VIGI-MESH montrent que les mini-bandelettes sont une option thérapeutique avec une efficacité à moyen terme similaire aux voies rétropubiennes et transobturatrices avec moins de complications. Ils montrent également que plus de 90 % des patientes rapportent avoir été améliorées par la mise en place d’une BSU pour IUE. Le ressenti de l’état de santé global des patientes opérées était meilleur que celui de la population française féminine du même âge. Néanmoins, une analyse à plus long terme est nécessaire pour confirmer ces premiers résultats.

Background Vaginal mesh safety information is limited, especially concerning single incision techniques using ultra lightweight meshes for the treatment of anterior pelvic organ prolapse (POP). Objective To determine the intraoperative and postoperative complication rates after anterior POP repair involving an ultralight mesh (19 g/m2): Restorelle® Direct Fix™. Methods A case series of 218 consecutive patients, operated on between January 2013 and December 2016 in ten tertiary and secondary care centres, was retrospectively analyzed. Eligible patients had POP vaginal repair (recurrent or not) planned with anterior Restorelle® Direct Fix™ mesh (with or without posterior mesh). Surgical complications were graded using the Clavien-Dindo classification. Results Intraoperative complications were bladder wound (0.5%), rectal wound (0.5%), ureteral injuries (0.9%). 98.2% of the patient did not have per operative complications. We observed one fail of procedure. Early complications mainly included urinary retention (8.7%) urinary tract infections (5.5%) and haematoma (2.7%). One haematoma required surgical treatment and another, embolization. 80.7% of the patient did not have complications during hospitalization and 80.3% did not have complication at the follow up visit. None of the analyzed factors (age, body mass index, surgical history, grade of prolapse or concomitant procedure) was significantly associated with the risk of perioperative complications. A total of 2.8% patients had grade III complications according Clavien Dindo. None had grade IV or V. Conclusions This multicentre case-series on the early experience of the use of anterior Restorelle® Direct Fix™ mesh showed a satisfactory technical feasibility and a low rate of grade III complications according Clavien Dindo. Long term studies are necessary to assess anterior Restorelle® Direct Fix™ mesh performances and to appraise patient satisfaction feedback.

International audience; Aims: To evaluate the safety and efficacy of the Uphold LITE mesh in the treatment of pelvic organ prolapse at 12-month follow-up.Methods: Women undergoing a mesh surgery due to an anterior prolapse plus a symptomatic anterior prolapse (classed as pelvic organ prolapse quantification stage ≥2) were included in this prospective, multicentre, observational study. The primary endpoint was a composite outcome including a good anatomical correction, no prolapse symptoms, and no reintervention for an anterior or apical recurrent prolapse within 12 months of surgery. Secondary outcomes included safety, improvements in quality of life (QoL), and risk factor for recurrence. This study was registered with ClinicalTrials.gov, number NCT01559168.Results: A total of 121 patients were included. Symptomatic and anatomic cure rates were 94% (95 of 101) and 76.8% (76 of 99), respectively. The composite success rate was 72.4% (71 of 98). The rate of reoperation for apical or anterior recurrent prolapse was 3.9% (4 of 103). Anatomical anterior or apical recurrence occurred in 18.2% (18 of 97) and 7.2% (7 of 97) of patients, respectively. The composite success rate was significantly higher in centres where more than 30 patients had been treated (80% vs 50%; P = .045). The rate of serious complication was 5.4% (6 of 111). Improvements were recorded in QoL including sexual function.Conclusions: The Uphold LITE mesh procedure provides satisfactory outcomes in the treatment of anterior and apical prolapse, particularly in high-volume centres. The rates of adverse effects and reintervention for recurrent prolapse were acceptable.

International audience; Objective To assess morbidity and mortality following pelvic organ prolapse surgery in France, irrespective of the surgical technique, using a broad national database. Materials and methods: This descriptive multicenter retrospective study was conducted using a database populated via an application run by a professional association. Results 286 gynecologists contributed data to the database. Of the 4322 surgeries analyzed, an abdominal approach was used in 975 of cases (22.5%), a vaginal approach in 3277 (75.9%), and a combined approach in 68 (1.6%). After one year, abdominal surgery was associated with higher rates of de novo urinary incontinence, constipation, and intestinal obstruction, whereas vaginal surgery was associated with higher rates of urinary retention, hematoma, de novo chronic pain, and vaginal mesh extrusion. There was no significant difference between the groups in the incidence of severe complications. After one year, vaginal mesh-augmented cystocele repair was associated with higher rates of de novo urinary incontinence, de novo chronic pain, and reoperation than native tissue repair. Mesh repair was also associated with higher rates of severe complications at one year. Conclusion After pelvic organ prolapse surgery, the perioperative morbidity and mortality associated with transabdominal and transvaginal approaches are similar. However, transvaginal mesh repair is associated with greater perioperative morbidity than transvaginal native tissue repair.

Background Laparoscopic mesh sacropexy (LS) or transvaginal mesh repair (TVM) are surgical techniques used to treat cystoceles. Health authorities have highlighted the need for comparative studies to evaluate the safety of surgeries with meshes. Objective To compare the rate of complications, and functional and anatomical outcomes between LS and TVM. Design, setting, and participants Multicenter randomized controlled trial from October 2012 to April 2014 in 11 French public hospitals. Women with cystocele stage ≥2 (pelvic organ prolapse quantification), aged 45–75 yr, without previous prolapse surgery. Intervention Synthetic nonabsorbable mesh placed in the vesicovaginal space, sutured to the promontory (LS) or maintained by arms through pelvic ligaments (TVM). Outcome measurements and statistical analysis Rate of surgical complications ≥grade II according to the modified Clavien–Dindo classification at 1 yr. Secondary outcomes were reintervention rate, and functional and anatomical results. Results and limitations A total of 130 women were randomized in LS and 132 in TVM; five women withdrew before intervention, leaving 129 in LS and 128 in TVM. The rate of complications ≥grade II was lower after LS than after TVM, but did not meet statistical significance (17% vs 26%, treatment difference 8.6% [95% confidence interval, CI −1.5 to 18]; p =0.088). The rate of complications of grade III or higher was nonetheless significantly lower after LS (LS=0.8%, TVM=9.4%, treatment difference 8.6% [95% CI 3.4%; 15%]; p =0.001). LS was converted to TVM in 6.3%. The total reoperation rate was lower after LS but did not meet statistical significance (LS=4.7%, TVM=10.9%, treatment difference 6.3% [95% CI −0.4 to 13.3]; p =0.060). There was no difference in symptoms, quality of life, improvement, composite definition of success, anatomical results rates between groups except for the vaginal apex and length, and dyspareunia (in favor of LS). Conclusions LS is a valuable option for primary repair of cystocele in sexually active patients. LS is safer than TVM, but may not be feasible in all cases. Both techniques offer same functional outcomes, success rates, and anatomical outcomes, but sexual function is better preserved by LS. Patient summary Our study demonstrates that laparoscopic sacropexy (LS) is a valuable option for primary repair of cystocele. LS offers equivalent success rates to vaginal mesh procedures, but is safer with a lower rate of complications and reoperations, and sexual function is better preserved.

Objectifs Lors d’une chirurgie pour incontinence urinaire d’effort et/ou prolapsus genital des dispositifs medicaux non-resorbables sont souvent utilises. Les complications dependent de l’experience du chirurgien, des caracteristiques des patientes, de la voie d’abord, de la technique de pose, et des materiaux utilises. L’observatoire VIGIMESH permet depuis 2017 un recueil prospectif de l’utilisation de ces dispositifs et de leurs complications (exposition, complications fonctionnelles [douleur, obstruction, consequences sexuelles]). Methodes A partir de fevrier 2017, dans les 13 centres participants toutes les patientes operees d’une incontinence urinaire d’effort (IUE) et/ou un prolapsus genital ou rectal pouvaient participer au suivi. Seuls les patientes ayant une bandelette sous-uretrale (BSU) ou une colposuspension, une reparation vaginale avec ou sans meche par voie vaginale ou abdominale ou une reparation endo-anale ont ete incluses. Les patientes ayant une pose de sphincter urinaire artificiel, de ballons peri-uretraux ou des injections de produits de comblements n’ont pas ete incluses. Chaque chirurgien declarait leurs interventions et complications. Celles-ci etaient verifiees avec les informations du departement d’information medicale et par des questionnaires de suivi. Resultats Au total, 1873 patientes ont ete incluses et analysees. Les chirurgies index ont ete reparties en 5 groupes ( Tableau 1 ). Les patientes operees d’une IUE isolee par BSU ont beneficie dans la moitie des cas d’une procedure retropubienne (338 cas soit 51,4 %). Quinze patientes ont eu un colpocleisis dans le groupe reparation vaginale sans materiel. Soixante-trois plaies peroperatoires (3,36 %) ont ete rapportes (34 de vessie, 2 de l’uretre, 2 du rectum et 19 du vagin). Seulement dans 8 cas ces plaies ont amene a l’arret de l’intervention et/ou de la mise en place de materiel. Cinquante-deux patientes (2,78 %) ont eu des complications graves durant la chirurgie ou dans les premiers mois postoperatoires (grade III ou plus) ( Tableau 2 et Fig. 1 ). Sept patientes ont necessite de multiples interventions pour traiter la complication. Conclusion L’observatoire est un outil qui permet de rapporter, de facon organisee, les complications des chirurgies du plancher pelvien et permettra sur le plus long terme de comparer les differents materiaux utilises et techniques d’implantation. Il permettra egalement a terme de proposer des recommandations sur la prevention et la prise en charge des complications de ces chirurgies et de leurs sequelles.

Chez la femme, l’incontinence urinaire est une affection frequente qui peut etre handicapante et couteuse (NP1). Chez la patiente qui consulte pour incontinence urinaire, il est recommande de preciser les circonstances, la frequence et la severite des fuites (grade B). Le test a la toux est recommande avant la chirurgie (grade C). Il n’est pas utile de prescrire un bilan urodynamique avant reeducation perineale pour incontinence urinaire chez la femme (grade B). Un bilan urodynamique complet est recommande avant une chirurgie pour incontinence urinaire (grade C). En cas d’incontinence urinaire d’effort (IUE) isolee, le bilan urodynamique n’est pas indispensable avant la chirurgie si l’evaluation clinique est complete (questionnaire standardise, test a la toux, catalogue mictionnel, residu postmictionnel) et concordante (AP). Il est recommande de debuter le traitement de l’IUE par des exercices musculaires du plancher pelvien (grade C). La reeducation comportementale est recommandee de premiere intention en cas de syndrome d’hyperactivite vesicale (grade C). En cas de surpoids, la perte de poids ameliore l’incontinence urinaire (NP1). Pour la chirurgie de l’IUE de la femme, la bandelette sous-uretrale (voie retropubienne ou transobturatrice) est la technique recommandee de premiere intention (grade B). La chirurgie par bandelette sous-uretrale comporte des risques operatoires, postoperatoires et d’echec qui doivent faire l’objet d’une information prealable (grade A). La cesarienne programmee et l’episiotomie systematique ne sont pas des methodes de prevention de l’incontinence urinaire (grade B). La reeducation perineale par exercice musculaire du plancher pelvien est le traitement de premiere intention de l’incontinence urinaire pre- et postnatale (grade A). Avant toute decision therapeutique chez la femme âgee, il est recommande de realiser une bandelette de depistage de l’infection urinaire, un catalogue mictionnel et une mesure du residu postmictionnel (grade C). Il est recommande de realiser un test a la toux et la recherche d’une incontinence masquee avant la chirurgie du prolapsus genital (grade C). Il est conseille de realiser un bilan urodynamique avant la chirurgie du prolapsus genital quand il existe une symptomatologie urinaire ou une incontinence urinaire masquee (grade C).

The sub uretral slings (SUS) have supplanted all other techniques in the treatment of stress urinary incontinence in first-line both at ease, results, consequences and cost. However the results are comparable with the abdominal retropubic colposuspension. The elective indication for BSU is stress incontinence. In the mixed incontinence, the results are satisfactory and depend on the degree of urge incontinence. The intrinsic sphincter deficiency with mobile uretra can be used in indications laying BSU. Only a BMI ≥ 35 is a pejorative factor on the outcome of the SUS. Currently, all routes retro pubic or obturator may be used without one being superior to another. For lack of comparative studies, using mini strips is currently under reserve. No recommendation can be given regarding the installation of urinary catheter in per and post operative. The relevance of cystoscopy for all routes used with the SUS is not formal. The SUS can be raised as an outpatient, but the patient must choose. It is the same type of anesthesia that is free and does not affect the results. The peri-urethral injections have no place as first choice because they offer a lower success rate. The SUS should be knitted polypropylene monofilament. Users should require the manufacturer that implants meet the AFNOR standard.

Resume Objectif Evaluer l’efficacite et la taux de complications d’une mini-bandelette sous-uretrale sur une periode d’un an. Materiel et methode Etude prospective multicentrique (quatre centres) de 154 patientes presentant une incontinence urinaire d’effort et beneficiant de la pose du TVT Secur™ sans geste associe. Les patientes ont ete operees du 24 juillet 2006 au 18 decembre 2007 et ont toutes ete controlees a deux mois et 118 a un an. Resultats Cent cinq patientes avaient une incontinence d’effort pure dont 12 presentaient une insuffisance sphincterienne. Quarante-neuf d’entre elles avaient une incontinence mixte dont 12 une insuffisance sphincterienne. En preoperatoire, on notait 69 patientes se plaignant d’urgenturies et 12 de difficultes mictionnelles. Une anesthesie locale avait ete realisee pour 97 patientes (63 %). Parmi les complications peroperatoires on notait : cinq hemorragies, une plaie vesicale, une plaie vaginale, 21 residus post-mictionnels superieurs a 100 ml et une douleur de cuisse. Ont ete rapportes deux expositions prothetiques, un granulome, une infection urinaire et sept cordes laterales au niveau du vagin. Onze patientes ont ete reoperees pour echec (dix sont gueries) et 24 patientes etaient perdues de vue a un an. Les patientes atteintes d’urgenturies ont ete gueries pour 61,2 % d’entre elles a deux mois et 75,5 % a un an. Des urgences de novo sont apparues dans 12,8 % a deux mois et 12,3 % a un an. Les troubles de la miction presents dans 9,5 % des cas a deux mois, etaient de 3,7 % a un an. A un an, le taux de guerison etait de 70,3 %, d’amelioration de 11 % et d’echec de 18,7 %. Le taux de guerison restait identique entre deux mois et un an. Les patientes ameliorees a deux mois (24 %) ne representaient plus que 11 % a un an et le taux de recidive etait de 12,8 %. Conclusion Les resultats sont inferieurs a ceux du TVT ou du TVT-O. Une etude randomisee permettrait de definir la place reelle de cette mini-bandelette.

Resume Objectif Presenter un nouveau dispositif de bandelette sous uretral mini invasif derive du TVT classique, decrire la technique de pose, evaluer les complications et les resultats a court terme. Materiel et methode Etude prospective multicentrique (quatre centres) de 110 patientes presentant une incontinence urinaire d’effort et beneficiant de la pose du TVT Secur™ sans geste associe. La bandelette est identique a celle des TVT retropubien et obturateur, plus courte, pose, soit en « U », soit en « hamac » sans orifice de sortie, pour pallier aux complications dues aux espaces traverses des autres techniques. Le dispositif et la technique de pose sont decrits par les auteurs. L’originalite du TVT Secur™ reside dans le mecanisme d’insertion de la bandelette a un inserteur metallique. Toutes les patientes ont ete revues a deux mois et les complications avec notamment les douleurs (cotation EVA) ainsi que les resultats objectifs ont ete releves. Resultats Incontinence urinaire d’effort pure et isolee pour 71 patientes, incontinence mixte pour 39 et insuffisance sphincterienne pour 23. Urgenturies preoperatoires pour 49 patientes et dysurie pour dix d’entre elles. La methode « hamac » a ete utilisee dans 85,5 % des cas. Le type d’anesthesie a ete local pur pour 69,1 % (0–98,8 % suivant les centres) avec une duree operatoire moyenne de 8′30″. Sous anesthesie locale, la douleur moyenne peroperatoire etait cotee 2,8/10 et 0,7 en fin d’intervention. Les complications peroperatoire ont revelees une plaie de vessie, une plaie vaginale et quatre saignements de plus de 100 ml. Dans les suites immediates une retention totale cedant a 24 heures et 13 residus postmictionnels compris entre 100 et 200 ml ont ete mentionnes. A deux mois, les auteurs ont constates les resultats suivants : 19,6 % d’urgenturie de novo, 13,2 % de dysurie de novo, une exposition de bandelette, un granulome, une infection urinaire et sept cordes laterales perceptibles mais non douloureuses. Treize patientes ont signale avoir eu des douleurs moderees sur une duree de quatre a 30 jours. Les resultats objectifs precoces sont globalement de 70,4 % de patientes seches (83 % pour IUE isolee pure, 72,2 % pour IUE avec insuffisance sphincterienne, 50 % pour les incontinences mixtes). L’anesthesie locale pure etait recommandee par 98 % des patientes. Conclusion La diminution des complications ne devant pas se faire au detriment des resultats, il faut envisager des etudes de suivi multicentriques prenant en compte des modifications standardisees. Enfin, les indications de ce nouveau dispositif devront etre definies.

Introduction In 2001, the trans-obturator route was proposed for the surgical positioning of tape with a view to avoiding the retropubic space and its disadvantages. The route, originally described outside-in by Delorme was presented inside-out by de Leval. Since then, anatomical discussions have attempted to prove that one technique is safer than the other. Objective Demonstrating the safety of the two techniques through personal and published experience. Material and methods Non-randomized, prospective, observational, open-label, longitudinal study of 100 female patients (50 tension-free vaginal tape (TVT)-O ® and 50 Monarc ® ). All the female patients presented with isolated stress urinary incontinence. Only four patients presented with mixed incontinence in the Monarc (MON) group. Sphincter incompetence was observed four times in the MON group and three times in the TVT-O group. Almost all the patients were undergoing their first procedure. All the patients underwent surgery under assisted local anesthesia in a day-hospital setting. All the patients underwent a full gynecological examination and a urodynamic assessment. Only those patients presenting with patent established urinary incontinence, corrected by the TVT test, underwent surgery. Post-operative control was conducted at 3 months and 1 year when a physical examination and urodynamic assessment were implemented. Results All the patients underwent control up to time point 12 months. The duration of hospitalization was 10 h for 48 patients in the MON group and 49 in the TVT-O group. The duration of hospitalization was 24 h for one patient in each group and 4 days for one patient in the TVT-O group due to transient urine retention. The only per-operative complication was a vaginal perforation in the lateral angle of the vagina for a MON patient. Tape repositioning was necessary. Early post-operative complications were observed in the MON group: three cases of urinary tract infection, one of transient urine retention, three of pain in the thighs spontaneously resolving within 4 days and one of permanent pain in one leg at time 1 year, which remained bearable. For the TVT-O group the post-operative complications consisted in: one case of urinary tract infection, one of transient retention and four of pain in the thigh. No hematoma was reported in either group. Amongst the late complications, the de novo symptoms included one case of imperious urges to urinate in the TVT-O group and objective dysuria in two cases in the MON group versus seven in the TVT-O group. There was no statistically significant between-group difference in the complications. No tape exposure was observed. Overall, the recovery rate was 90% at 1 year for MON versus 94% for TVT-O ( p = NS) with two cases of recurrence between 3 months and 1 year in that series. Mixed incontinence was corrected at time point 1 year in 75% of cases for MON, with one case of recurrence in the year. For the patients presenting with sphincter incompetence, competence was maintained at 3 months and 1 year in all cases in the MON group. The three TVT-O were cured at 3 months, but two recurrences were observed at 1 year. Almost all the patients were satisfied or very satisfied at time point 1 year and those who had sexual relations (54%) did not report any disorder at time point 1 year. Discussion The outside-in technique necessitates more marked peri-urethral dissection and vesical complications are possible. The cadaveric studies by the outside-in partisans show a vascular and nervous risk, which has little reflection in terms of complications in the literature. Post-operative leg pains are encountered with both techniques and are usually only transient. All the studies of the two routes report a recovery rate of over 90% for pure stress incontinence. Conclusion The author's experience, like that reported in the literature, shows that the two trans-obturator access routes are equally safe and do not require per-operative cystoscopic control. The clinical results would appear to be equivalent, in terms of recovery, to the rates obtained with retropubic TVT. Attempting to find anatomical or etiological arguments in order to prove one technique superior to the other appears somewhat parochial.

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 36 - N° 3 - p. 267-275

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 35 - N° 5 - p. 429-454

Resume Objectifs. – Le renforcement prothetique dans la cure chirurgicale des troubles de la statique pelvienne par voie vaginale est actuellement en plein essor. Cette technique n'est pas sans poser des problemes de tolerance. La complication la plus frequemment decrite est l'exposition de prothese que ce soit par erosion ou retard de cicatrisation. Il faut la differencier du granulome d'une part et des infections de materiel, d'autre part, qui peuvent conduire a de reelles cellulites pelviennes. Son mecanisme principal est lie a un defaut de cicatrisation. Le but de notre etude est de definir des facteurs de risque d'exposition de prothese. Patientes et methodes. – Deux cent soixante-dix-sept dossiers de patientes prises en charge chirurgicalement pour des troubles de la statique pelvienne ont ete inclus dans notre etude. La cure chirurgicale a ete realisee par voie vaginale avec mise en place de prothese de polypropylene. Cette etude est retrospective continue sur une duree de 24 mois. Resultats. – Trente-quatre cas d'exposition de prothese ont ete observes dans les deux mois apres l'intervention, ce qui represente une incidence de 12,27 %. Les facteurs de risque sont l'hysterectomie simultanee [odds ratio 5,17 (p = 0,001)] et la realisation d'une colpotomie en T inverse [odds ratio 6,06 (p = 0,01)]. Les facteurs protecteurs sont la conservation uterine et la realisation d'une colpotomie minimale realisable chez les patientes deja hysterectomisees ou dont on a conserve l'uterus [odds ratio 5,16 (p = 0,0001)]. Discussion et conclusion. – Les seuls facteurs de risque retrouves, dans notre etude, sont d'ordre technique. En effet, les donnees autres tels l'âge, le statut menopausique ou encore les antecedents medicaux de la patiente ne sont pas significatifs. Il faut donc favoriser la conservation uterine et limiter le nombre et l'etendue des colpotomies necessaires a la mise en place de la prothese.

Resume Introduction Le renforcement prothetique dans la cure chirurgicale des troubles de la statique pelvienne est actuellement en plein essor. Cette technique n’est pas sans poser des problemes de tolerance ; en effet, un nombre non negligeable d’exposition de prothese est a deplorer. L’exposition de prothese est la complication la plus frequemment rencontree, elle est aussi appelee erosion ou granulome. Son mecanisme est un defaut de cicatrisation. Elle est a differencier de phenomene infectieux majeur tel qu’une cellulite pelvienne. Objectifs Le but de notre etude etait de definir le devenir et la meilleure prise en charge des patientes presentant ces expositions de materiel prothetique. Materiels et methodes Notre etude descriptive et retrospective sur 24 mois a permis de colliger 34 dossiers de janvier 2002 a decembre 2003. Ces patientes ont beneficie d’une cure de prolapsus par renforcement prothetique par voie vaginale qui s’est compliquee d’une exposition de prothese. L’intervention pratiquee, intitulee TVM (Tension free Vaginal Mesh), comprend la pose sans fixation d’une prothese synthetique dans les espaces de decollement vesico-vaginal et/ou recto-vaginal. Resultats Le siege de l’exposition a ete 33 fois sur 34 en regard de la cicatrice de la colpotomie anterieure (97,06 %). La prise en charge de ces expositions s’est faite en deux temps, tout d’abord on a utilise un traitement antibiotique local. Ce traitement a suffi pour guerir 9 patientes (26,47 %). En cas d’echec, une intervention de resection partielle de la prothese a ete pratiquee en ambulatoire ou durant une courte hospitalisation de 24 heures. Cette resection unique a suffi pour 20 patientes (88 %). Deux patientes ont necessite une deuxieme intervention d’excision de prothese (8 %) et une patiente a necessite 3 retraits (4 %). Il est a noter qu’une patiente, a l’occasion de la resection partielle de prothese, a presente une fistule vesico-vaginale. Cet evenement nous impose de recommander la pratique, en peroperatoire, d’un test au bleu ou d’une cystoscopie. Conclusion Dans le cadre de cette chirurgie, il est important de surveiller attentivement l’apparition d’une exposition de prothese. Il est necessaire ensuite de realiser une prise en charge en 2 temps. Tout d’abord, il faut commencer par un traitement medical local, antibiotique ou œstrogenique. Puis en cas d’echec, un traitement chirurgical de retrait partiel de la prothese se justifie. Il faut enfin recommander la plus grande prudence lors de l’exerese d’une partie de prothese en realisant un controle de la vessie.

Prosthetic reinforcement in the surgical repair of pelvic prolapse by the vaginal approach is not devoid of tolerability-related problems such as vaginal erosion. The purposes of our study are to define the risk factors for exposure of the mesh material, to describe advances and to recommend a therapeutic strategy. Two hundred and seventy-seven patients undergoing surgery due to pelvic prolapse with transvaginal mesh technique were included in a continuous, retrospective study between January 2002 and December 2003. Thirty-four cases of mesh exposure were observed within the 2 months following surgery, which represents an incidence of 12.27%. All the patients were medically treated, nine of whom were found to have completely healed during the check-up performed at 2 months. In contrast, 25 patients required partial mesh exeresis. Risk factors of erosion were concomitant hysterectomy [OR = 5.17 (p = 10(-3))] and inverted T colpotomy [OR = 6.06 (p = 10(-2))]. Two technical guidelines can be defined from this study as regards the surgical procedure required in order to limit mesh exposure via the vaginal route. The uterus must be preserved, and the number and extent of colpotomies needed to insert the mesh must be limited.

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 42 - N° 5 - p. 499-501

Objective To evaluate the influence of type of hospitalization on outcomes of stress urinary incontinence (SUI) surgery using a midurethral sling procedure. Methods A retrospective secondary analysis was conducted using data from a prospective multicenter randomized trial of SUI surgery at several sites in France between January 1, 2003, and December 31, 2007. Type of hospitalization was chosen according to the surgeon’s policy. Results Among 149 participants, 31 (20.8%) were treated as outpatients and 118 (79.2%) as inpatients. Perioperative complications were recorded for 1 (3.2%) outpatient and 12 (10.1%) inpatients ( P = 0.388). At 24 months of follow-up, none of 25 outpatients and 6 (5.6%) of 107 inpatients had a positive stress test result ( P = 0.497). Dryness was reported at this time point by 22 (88.0%) outpatients and 89 (83.2%) inpatients ( P = 0.922). The median satisfaction score (measured by visual analog scale [scores of 0–100]) at 12 months was 100.0 (interquartile range [IQR] 93.5–100.0) among outpatients versus 96.5 (IQR 80.0–100.0; P = 0.003) among inpatients. Similar results were observed at 24 months ( P = 0.003). Conclusion Complication and failure rates were similar in both groups, but satisfaction was higher among outpatients.

With an experience of 287 vaginal way operations using synthetic material, the authors make a review about the tolerance of the tissues. Three tissues were used (polytetrafluoroethylene, Dacron and Lyodura). The procedures are: Mouchel, big and small slings, Stamey and para vaginal refect procedures. At 30 months, the tolerance is 70% for Mouchel and 90% for sling procedures. The rejection rate with Dacron is globally 19.3% vs. 30.3% for Gore Tex ® . The authors describe materials' history, clinical symptoms and histopathologic signs of the intolerance. They think that the synthetic tissue tolerance is proportional to the exhibit surface and to the distance which separates it from the scar. The substratum of the intolerance process answers with two explanations: infection and foreign body reaction. Different theories are explained. Infection can be an ethiologic factor in early rejection. With rigid material, a small ulcer is formed and serves as a nidus for an ascending infection. Foreign material acts as an adjuvant by decreasing the number of bacteria necessary to produce an infection.The tissue reaction may be an immune response to Dacron, a delayed hypersensitivity reaction, or a graft vs. host antigen-antibody reaction. The ideal synthetic mesh material for pelvic surgery has yet to be developed.

To evaluate clinical effectiveness and complication rates at 5 years following the total Trans Vaginal Mesh (TVM) technique to treat pelvic organ prolapse. Prospective, observational, multi-centre study in patients with prolapse of stage II or higher. Of the 90 women enrolled in the study, 82 (91 %) were available for the 5-year follow-up period. At the 5-year endpoint, success, defined as no surgical prolapse reintervention and leading edge

Resume Contexte La cystocele constitue la forme clinique la plus frequente du prolapsus genital de la femme. Il s’agit d’une pathologie frequente et invalidante. Le traitement chirurgical de reference en est la promontofixation indirecte par prothese synthetique sous-vesicale par laparotomie. L’abord cœlioscopique tend a supplanter la laparotomie. L’utilisation de la voie d’abord vaginale pour la mise en place d’une prothese sous-vesicale pourrait presenter de nombreux interets : simplicite de realisation, duree operatoire moindre, convalescence plus courte, mais pourrait exposer a une morbidite accrue en ce qui concerne les complications liees aux protheses. La promontofixation indirecte cœlioscopique et la mise en place de protheses par voie vaginale sont couramment pratiquees en France bien que la HAS ait souligne l’absence d’evaluation suffisante de la securite et de la tolerance de la mise en place des protheses synthetiques par voie vaginale. Methode L’objectif principal de l’etude est de comparer la morbidite de la promontofixation cœlioscopique a la chirurgie par voie vaginale pour le traitement des cystoceles par prothese synthetique sous-vesicale. Le critere principal d’evaluation sera le taux de complications chirurgicales superieur ou egal au grade II de la classification de Clavien-Dindo survenant dans l’annee de suivi. Les objectifs secondaires sont de comparer les resultats fonctionnels a moyen terme (sexualite, signes fonctionnels urinaires et digestifs, douleurs), le retentissement sur la qualite de vie, ainsi que les resultats anatomiques. PROSPERE est une etude prospective randomisee multicentrique qui sera menee dans 12 centres hospitaliers francais. Deux cent soixante-deux patientes ayant une cystocele superieure ou egale au stade 2 POP-Q isolee ou non, âgees de 45 a 75 ans, seront inclues. Les patientes ne doivent pas avoir d’antecedent de chirurgie du prolapsus ou de conditions defavorables ou contre-indiquant l’une ou l’autre des voies d’abord. La realisation de cette etude devrait permettre de repondre a la problematique non resolue actuellement du choix de la voie d’abord pour la pose des renforts prothetiques sous-vesicaux. Cet essai permettrait de mieux determiner les indications respectives de l’une ou l’autre de ces voies d’abord, qui reposent actuellement sur des attitudes d’ecoles et des choix subjectifs.

It is difficult to make a choice among the many surgical procedures designed for the correction of stress urinary incontinence by the vaginal route because their results have not been correctly compared. The Bologna (B) operation uses two flaps from the anterior vaginal wall that are anchored to the abdominal wall; the Ingelman-Sundberg (IS) operation is a suburethral sling made from two transplants from the pubococcygeus muscle. A prospective randomized study has been carried out in order to compare these two procedures. A selection of cases has been based upon the presence of genuine or potential stress incontinence, genital prolapse and available tissues (anterior vaginal wall excess and palpable pubococcygeus muscles) for both procedures. No significant difference was noted for clinical results (91.7% and 93.7% of patients cured by the B and IS operations, respectively) or for transmission rate gain at 3 months and 1 year. Maximum urethral closing pressure was maintained in both treatment arms. No significant postoperative complication or persistent dysuria occurred. The Bologna procedure is best indicated in case of frank anterior vaginal excess, and the Ingelman-Sundberg procedure when strong anterior parts of pubococcygeus muscles are available. Both are excellent in the cure of stress incontinence associated with genital prolapse.

International audience; Urinary incontinence is a frequent affliction in women and may be disabling and costly {LE1}. When consulting for urinary incontinence, it is recommended that circumstances, frequency and severity of leaks be specified {Grade B}. The cough test is recommended prior to surgery {Grade C}. Urodynamic investigations are not needed before lower urinary tract rehabilitation {Grade B}. A complete urodynamic investigation is recommended prior to surgery for urinary incontinence {Grade C}. In cases of pure stress urinary incontinence, urodynamic investigations are not essential prior to surgery provided the clinical assessment is fully comprehensive (standardised questionnaire, cough test, bladder diary, post-void residual volume) with concordant results {PC}. It is recommended to start treatment for stress incontinence with pelvic floor muscle training {Grade C}. Bladder training is recommended at first intention in cases with overactive bladder syndrome {Grade C}. For overweight patients, loss of weight improves stress incontinence {LE1}. For surgery, sub-urethral tape (retropubic or transobturator route) is the first-line recommended technique {Grade B}. Sub-urethral tape surgery involves intraoperative risks, postoperative risks and a risk of failure which must be the subject of prior information {Grade A}. Elective caesarean section and systematic episiotomy are not recommended methods of prevention for urinary incontinence {Grade B}. Pelvic floor muscle training is the treatment of first intention for pre- and postnatal urinary incontinence {Grade A}. Prior to any treatment for an elderly woman, it is recommended to screen for urinary infection using a test strip, ask for a bladder diary and measure post-void residual volume {Grade C}. It is recommended to carry out a cough test and look for occult incontinence prior to surgery for pelvic organ prolapse {Grade C}. It is recommended to carry out urodynamic investigations prior to pelvic organ prolapse surgery when there are urinary symptoms or occult urinary incontinence {Grade C}.

The purpose of this study is to compare the retropubic tension-free vaginal tape (TVT) procedure with the inside-out transobturator approach (TVT-O).Multicenter randomized controlled trial. One hundred forty-nine patients were randomly allocated to either TVT (n = 75) or TVT-O (n = 74). Interview, medical examination, pain scores, success rates, and quality of life assessment were recorded pre-operatively, and 2, 6, 12, and 24 months post-operatively.One hundred forty-nine patients underwent surgery, and 132 completed a 24-month follow-up. Bladder injury rate was 5% (4/75) in the TVT group and 2% (2/74) in the TVT-O group (p = 0.68). There was no significant difference between the two groups, concerning overall cure rate and the patients' satisfaction rate at 24 months follow-up. The range of mean pain scores was significantly higher after the TVT-O procedure post-operatively but not at 24 months follow-up.TVT and TVT-O procedures both have an outcome associated with an increase in quality of life with no significant differences in satisfaction rates at 2 years follow-up.

To evaluate clinical outcomes at 3 years following total transvaginal mesh (TVM) technique to treat vaginal prolapse.Prospective, observational study in patients with prolapse ≥ stage II. Success was defined as POP-Q-stage 0-I and absence of surgical re-intervention for prolapse. Secondary outcome measures were: quality of life (QOL), prolapse-specific inventory (PSI), impact on sexual activity and complications.Ninety women underwent TVM repair, 72 a hysterectomy. Anatomical failure rate was 20.0% at 3 years. Three patients required re-intervention for prolapse. Improvements in QOL- and PSI-scores were observed at 1 and 3 years. Vaginal mesh extrusion occurred in 14.4% patients. After 3 years, 4.7% asymptomatic extrusions remained present. Of 61 sexually active women at baseline, a significant number of patients (41%) ceased sexual activity by 3 years; de novo dyspareunia was reported by 8.8%. One vesico-vaginal fistula resolved after surgery.Medium-term results demonstrate that the TVM technique provides a durable prolapse repair.

AIM: To study peri-surgical complications after cure of genital prolapse by vaginal route using interposition of synthetic prostheses Gynemesh Prolene Soft (Gynecare) following the Trans Vaginal Mesh (TVM) technique. METHODS: The present retrospective multicentered study comprised 684 patients who underwent surgery at seven French centers between October 2002 and December 2004. All patients had a genital prolapse >or=3 (C3/H3/E3/R3) according to International continence society (ICS) classification. According to each case, prosthetic interposition was total, or anterior only or posterior only. Patients were systematically seen 6 weeks, 3 months and 6 months after surgery. Multivaried statistical analysis followed a model of logistic regression applied to each post-surgical complication. RESULTS: The mean age of patients was 63.5 years (30-94). The mean follow-up period was 3.6 months. 84.3% of patients were post-menopause, 24.3% had hysterectomy, 16.7% previous cure of prolapse, and 11.1% cure of stress urinary incontinence (SUI). During the procedure, hysterectomy was combined in 50.3% of cases, cervix amputation in 1.5%, and cure of SUI in 40.9%. 15.8% were treated for a cystocele only. 14.8% had only a rectocele +/- elytrocele and 69.4% had a prolapse touching both compartments, anterior and posterior. In peri-surgical complications, (2%) were five bladder wounds (0.7%), one rectal wound (0.15%) and seven hemorrhages greater that 200 mL (1%). Among early post-surgical complications (during the first month after surgery) (2.8%) were two pelvic abscesses (0.29%), 13 pelvic hematomas (1.9%), one pelvic cellulitis (0.15%), two vesicovaginal fistulas and one rectovaginal fistula (0.15%). Among late post-surgical complications (33.6%) there were 77 granulomas or prosthetic expositions (11.3% [6.7% in the vaginal anterior wall, 2.1% in the vaginal posterior wall and 4.8% in the fornix]), 80 prosthetic retractions (11.7%), 36 relapse of prolapse (6.9%) and 37 SUI de novo (5.4%). Multivaried analysis shows that previous history of hysterectomy or placing of an isolated anterior prosthesis increase the risk of peri-surgical complication; preserved uterus and isolated posterior prosthesis lessen the risk of granulomas and prosthetic retractions; and association of a Richter's intervention increases the rate of prosthetic retractions. CONCLUSION: Cure of genital prolapse with synthetic prostheses interposed by vaginal route is now reliable and can be reproduced with a low rate of peri- and early post-surgical complications. However, our study shows a certain number of late post-surgical complications after insertion of strengthening synthetic vaginal implants (prosthetic expositions and prosthetic retractions). These retrospective results will soon be compared to a prospective study.

Our goal was to report the preliminary results of a transvaginal mesh repair of genital prolapse using the Prolift™ system. This retrospective multicentric study includes 110 patients. All patients had a stage 3 (at the hymen) or stage 4 (beyond the hymen) prolapse. Total mesh was used in 59 patients (53.6%), an isolated anterior mesh in 22 patients (20%) and an isolated posterior mesh in 29 patients (26.4%). We report one bladder injury sutured at surgery and two haematomas requiring secondary surgical management. At 3 months, 106 patients were available for follow-up. Mesh exposure occurred in five patients (4.7%), two of them requiring a surgical management. Granuloma without exposure occurred in three patients (2.8%). Failure rate (recurrent prolapse even asymptomatic or low grade symptomatic prolapse) was 4.7%. According to the perioperative and immediate post-operative results, Prolift™ repair seems to be a safe technique to correct pelvic organ prolapse. Anatomical and functional results must be assessed with a long-term follow-up to confirm the effectiveness and safety of the procedure.

The aim of this study was to describe our experience in the management of bladder injuries occurring at intervesicovaginal dissection during the tension-free vaginal mesh (TVM) procedure. Seven hundred four patients were treated for prolapse by vaginal route using the TVM procedure. Bladder injury was diagnosed during the procedure in five patients. Polypropylene mesh was placed in the intervesicovaginal space after a careful repair of the bladder injury. Major postoperative complications were not diagnosed during the short-term follow up. We describe the occurrence and treatment of bladder injuries during the dissection phase in the TVM procedure. Such injuries can occur during the dissection. Placing an intervesicovaginal mesh is acceptable if cautious bladder repair is performed.

In 2001, the trans-obturator route was proposed for the surgical positioning of tape with a view to avoiding the retropubic space and its disadvantages. The route, originally described outside-in by Delorme was presented inside-out by de Leval. Since then, anatomical discussions have attempted to prove that one technique is safer than the other.Demonstrating the safety of the two techniques through personal and published experience.Non-randomized, prospective, observational, open-label, longitudinal study of 100 female patients (50 tension-free vaginal tape (TVT)-O and 50 Monarc). All the female patients presented with isolated stress urinary incontinence. Only four patients presented with mixed incontinence in the Monarc (MON) group. Sphincter incompetence was observed four times in the MON group and three times in the TVT-O group. Almost all the patients were undergoing their first procedure. All the patients underwent surgery under assisted local anesthesia in a day-hospital setting. All the patients underwent a full gynecological examination and a urodynamic assessment. Only those patients presenting with patent established urinary incontinence, corrected by the TVT test, underwent surgery. Post-operative control was conducted at 3 months and 1 year when a physical examination and urodynamic assessment were implemented.All the patients underwent control up to time point 12 months. The duration of hospitalization was 10h for 48 patients in the MON group and 49 in the TVT-O group. The duration of hospitalization was 24h for one patient in each group and 4 days for one patient in the TVT-O group due to transient urine retention. The only per-operative complication was a vaginal perforation in the lateral angle of the vagina for a MON patient. Tape repositioning was necessary. Early post-operative complications were observed in the MON group: three cases of urinary tract infection, one of transient urine retention, three of pain in the thighs spontaneously resolving within 4 days and one of permanent pain in one leg at time 1 year, which remained bearable. For the TVT-O group the post-operative complications consisted in: one case of urinary tract infection, one of transient retention and four of pain in the thigh. No hematoma was reported in either group. Amongst the late complications, the de novo symptoms included one case of imperious urges to urinate in the TVT-O group and objective dysuria in two cases in the MON group versus seven in the TVT-O group. There was no statistically significant between-group difference in the complications. No tape exposure was observed. Overall, the recovery rate was 90% at 1 year for MON versus 94% for TVT-O (p=NS) with two cases of recurrence between 3 months and 1 year in that series. Mixed incontinence was corrected at time point 1 year in 75% of cases for MON, with one case of recurrence in the year. For the patients presenting with sphincter incompetence, competence was maintained at 3 months and 1 year in all cases in the MON group. The three TVT-O were cured at 3 months, but two recurrences were observed at 1 year. Almost all the patients were satisfied or very satisfied at time point 1 year and those who had sexual relations (54%) did not report any disorder at time point 1 year.The outside-in technique necessitates more marked peri-urethral dissection and vesical complications are possible. The cadaveric studies by the outside-in partisans show a vascular and nervous risk, which has little reflection in terms of complications in the literature. Post-operative leg pains are encountered with both techniques and are usually only transient. All the studies of the two routes report a recovery rate of over 90% for pure stress incontinence.The author's experience, like that reported in the literature, shows that the two trans-obturator access routes are equally safe and do not require per-operative cystoscopic control. The clinical results would appear to be equivalent, in terms of recovery, to the rates obtained with retropubic TVT. Attempting to find anatomical or etiological arguments in order to prove one technique superior to the other appears somewhat parochial.

Objectives : To report the outcome and complications of a series of tension-free vaginal tape (TVT) operations and compare the results with the literature. Materials and methods : A total of 256 cases with a minimum follow-up time of 3 months (May 1998–September 2001) were included (193 isolated TVT, 23 combined with vaginal hysterectomy and 63 combined with prolapse surgery). These cases included 21% of the patients presenting with mixed incontinence, 14% with sphincter deficiency and 9.8% with recurrent incontinence. The isolated TVT were carried out under local anesthesia an ambulatory procedure, the others were done under spinal anesthesia. Results : Almost all the patients underwent a clinical check-up after 3 months and 1 year and also underwent urodynamic exploration; they were then questioned by means of a questionnaire after 2 and 3 years. The global cure rate was 90, 91, 83 and 87%, respectively. The authors observed 6.4% of recurrences between 3 months and 1 year and 7.2% between 2 and 3 years. For mixed incontinence at the three first check-ups, the cure rate was 75, 85 and 60%, respectively, with 7.4 and 20% of recurrences between these two intervals. The cure rates of the patients who had presented with sphincter deficiency were 76, 79 and 73%, respectively, with 16% recurrences during the first year. In the case of recurrent incontinence, a cure was obtained in 72 and 71% of cases, with 18% of recurrences. The complications consisted of 5.5% cases of perforated bladder, 0.4% hematomas of the Retropubic space, 3.1% urinary infections, 0.4% urethral injuries, 5.1% transient urine retention, 12.0% de novo urinary urgency and 20% de novo dysuria. It should be noted that half of the pre-operative urgencies had disappeared after the operation. No defective healing and rejection phenomenon was observed. Discussion : The authors reviewed the results reported in 35 articles, and compare these with their own results. They also reviewed all the complications encountered, account for them and suggested how they can be avoided. There are discrepancies between the various studies, particularly with regard to the complications. Conclusion : This minimally invasive operation should be further assessed so that it can demonstrate its effectiveness, and become the “Gold standard”. Randomized studies are awaited with this in view.

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 38 - N° 2 - p. 186-187