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1. Effects of a physical activity and endometriosis-based education program delivered by videoconference on endometriosis symptoms: the CRESCENDO program (inCRease physical Exercise and Sport to Combat ENDOmetriosis) protocol study

Author

Géraldine Escriva-Boulley, Charles-André Philip, Sophie Warembourg, Lionel Lenotre, Patrice Flore, Patrice Faure, Thierry Michy, Vincent Letouzey, Carole Arnold, Claire Piluso, Loic Chalmel, Ramzi Kacem, Georges Fabrice Blum, Renaud Detayrac, Candice Trocmé, Isabelle Brigaud, Ulysse Herbach, Patricia Branche, Emilie Faller, and Aïna Chalabaev

Subjects
Physical activity, Endometriosis, Videoconference, RCT, Pelvic pain, Motivational theories, Medicine (General), R5-920
Abstract

Abstract Background Endometriosis is a chronic disease characterized by growth of endometrial tissue outside the uterine cavity which could affect 200 million women (The term “woman” is used for convenience. Individuals gendered as man or as nonbinary can also suffer from this disease) worldwide. One of the most common symptoms of endometriosis is pelvic chronic pain associated with fatigue. This pain can cause psychological distress and interpersonal difficulties. As for several chronic diseases, adapted physical activity could help to manage the physical and psychological symptoms. The present study will investigate the effects of a videoconference-based adapted physical activity combined with endometriosis-based education program on quality of life, pain, fatigue, and other psychological symptoms and on physical activity. Methods This multicentric randomized-controlled trial will propose to 200 patients with endometriosis to be part of a trial which includes a 6-month program with 45 min to more than 120 min a week of adapted physical activity and/or 12 sessions of endometriosis-based education program. Effects of the program will be compared to a control group in which patients will be placed on a waiting list. All participants will be followed up 3 and 6 months after the intervention. None of the participants will be blind to the allocated trial arm. The primary outcome measure will be quality of life. Secondary outcomes will include endometriosis-related perceived pain, fatigue, physical activity, and also self-image, stereotypes, motivational variables, perceived support, kinesiophobia, basic psychological need related to physical activity, and physical activity barriers. General linear models and multilevel models will be performed. Predictor, moderator, and mediator variables will be investigated. Discussion This study is one of the first trials to test the effects of a combined adapted physical activity and education program for improving endometriosis symptoms and physical activity. The results will help to improve care for patients with endometriosis. Trial registration ClinicalTrials.gov, NCT05831735 . Date of registration: April 25, 2023

Published
2023
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2. Clinical outcomes following surgical management of deep infiltrating endometriosis

Author

Perrine Leborne, Stephanie Huberlant, Florent Masia, Renaud de Tayrac, Vincent Letouzey, and Lucie Allegre

Subjects
Medicine, Science
Abstract

Abstract The main aim of the study was to evaluate severe post-operative complications following deep endometriosis surgery in a tertiary referral centre. This is a retrospective cohort study that included women who had surgery for deep infiltrating endometriosis between 1st January 2013 and 31st December 2019. Endometriosis was diagnosed based on clinical, imaging and histological parameters. We evaluated the rates of post-operative complications, potential risk factors for such complications and postoperative pregnancy rates. A total of 165 patients were included in the final analysis. The median follow-up was 63 (25–106) months. Thirty-seven patients (22.42%) had hysterectomy, 60 (36.81%) had ureterolysis and 44 (26.67%) had colorectal surgery. The overall and severe rates of post-operative complications were 16.20% (n = 23) and 2.42% (n = 4) respectively. Of the variables assessed, operative time and age were the only statistically significant risk factor for complications on multivariate analysis. Among women operated on for infertility, 34.5% (n = 20/58) got pregnant following surgery with 30% of these spontaneously. This study demonstrates acceptable overall and severe post-operative complications and pregnancy rates after deep endometriosis surgery. This information should help clinicians when counselling women to enable them making an informed choice about their management.

Published
2022
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3. Vital NETosis vs. suicidal NETosis during normal pregnancy and preeclampsia

Author

Florence Guillotin, Mathieu Fortier, Marie Portes, Christophe Demattei, Eve Mousty, Eva Nouvellon, Eric Mercier, Mathias Chea, Vincent Letouzey, Jean-Christophe Gris, and Sylvie Bouvier

Subjects
vital NETosis, suicidal NETosis, neutrophil, pregnancy, preeclampsia, Biology (General), QH301-705.5
Abstract

Background: NETosis occurs in the context of infection or inflammation and results in the expulsion of decondensed DNA filaments called NETs (Neutrophil Extracellular Traps) into the extracellular environment. NETosis activates coagulation and contributes to the thrombotic risk of inflammatory diseases. To date, two mechanisms of NETosis have been identified: suicidal NETosis, in which neutrophils die after expelling the filaments; and vital NETosis, in which expulsion appears without altering the membrane. Human pregnancy is associated with a mild pro-inflammatory state, which is increased in the event of complications such as preeclampsia (PE). NETosis has been observed in these situations, but the mechanism of its production has not yet been studied. The aim of our study was to evaluate the balance of vital vs. suicidal NETosis in normal pregnancy and in PE.Patients/Methods: Neutrophils from healthy volunteers were stimulated with plasma from normal pregnancies (n = 13) and from women developing preeclampsia (n = 13). Immunofluorescent labelling was performed to determine the percentages and origin of NETs in both groups. Inhibition with suicidal or vital NETosis inhibitors was also performed to validate our results.Results: We found a significant increase in NETs in women with PE compared to women with normal pregnancies. We showed that vital and non-vital NETosis are present in normal and preeclamptic pregnancies. We demonstrated that the higher proportion of NETs observed in PE was due to non-vital NETosis whose main component is represented by suicidal NETosis.Discussion: These results suggest the important part of non-vital NETosis in the pathophysiology of PE.

Published
2023
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4. Increased incidence of cancer in the follow-up of obstetric antiphospholipid syndrome within the NOH-APS cohort

Author

Jean-Christophe Gris, Éve Mousty, Sylvie Bouvier, Sylvie Ripart, Éva Cochery-Nouvellon, Pascale Fabbro-Peray, Jonathan Broner, Vincent Letouzey, and Antonia Pérez-Martin

Subjects
Diseases of the blood and blood-forming organs, RC633-647.5
Abstract

Malignancies can be associated with positive antiphospholipid antibodies but the incidence of cancer among women with the purely obstetric form of antiphospholipid syndrome (APS) is currently unknown. Our aim was to investigate the comparative incidence of cancers in women with a history of obstetric APS within a referral university hospital-based cohort (NOH-APS cohort). We performed a 17-year observational study of 1,592 non-thrombotic women with three consecutive spontaneous abortions before the 10th week of gestation or one fetal death at or beyond the 10th week of gestation. We compared the incidence of cancer diagnosis during follow-up among the cohort of women positive for antiphospholipid antibodies (n=517), the cohort of women carrying the F5 rs6025 or F2 rs1799963 polymorphism (n=279) and a cohort of women with negative thrombophilia screening results (n=796). The annualized rate of cancer was 0.300% (0.20%-0.44%) for women with obstetric APS and their cancer risk was substantially higher than that of women with negative thrombophilia screening [adjusted hazard ratio (aHR) 2.483; 95% confidence interval (CI) 1.27-4.85]. The computed standardized incidence ratio for women with obstetric APS was 2.89; 95% CI: 1.89-4.23. Among antiphospholipid antibodies, lupus anticoagulant was associated with incident cancers (aHR 2.608; 95% CI: 1.091-6.236). Our cohort study shows that the risk of cancer is substantially higher in women with a history of obstetric APS than in the general population, and in women with a similar initial clinical history but negative for antiphospholipid antibodies.

Published
2020
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5. A new bioabsorbable polymer film to prevent peritoneal adhesions validated in a post-surgical animal model.

Author

Lucie Allègre, Isabelle Le Teuff, Salomé Leprince, Sophie Warembourg, Hubert Taillades, Xavier Garric, Vincent Letouzey, and Stephanie Huberlant

Subjects
Medicine, Science
Abstract

BACKGROUND:Peritoneal adhesions are a serious surgical postoperative complication. The aim of this study is to investigate, in a rat model, the anti-adhesive effects of a bioabsorbable film of polymer combining polyethylene glycol and polylactic acid. MATERIALS AND METHODS:Sixty-three animals were randomized into five groups according to the anti-adhesion treatment: Hyalobarrier®, Seprafilm®, Polymer A (PA), Polymer B (PB), and control. The rats were euthanized on days 5 and 12 to evaluate the extent, severity and degree of adhesions and histopathological changes. Three animals were euthanized at day 2 in PA, PB and control groups to observe the in vivo elimination. RESULTS:Macroscopic adhesion formation was significantly lower in the PA group than in the control group at day 5 (median adhesion score 0±0 vs 9.6 ±0.5 p = 0.002) and at day 12 (0±0 vs 7.3±4 p = 0.02). Furthermore, median adhesion score at day 5 was significantly lower in the PA group than in the Seprafilm group (0±0 vs 4.2± 3.9 p = 0.03). Residence time of PA seems longer than PB. CONCLUSION:The PA bioabsorbable film seems efficient in preventing the formation of peritoneal adhesions.

Published
2018
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6. Obstetric antiphospholipid syndrome: early variations of angiogenic factors are associated with adverse outcomes

Author

Éva Cochery-Nouvellon, Érick Mercier, Sylvie Bouvier, Jean-Pierre Balducchi, Isabelle Quéré, Antonia Perez-Martin, Eve Mousty, Vincent Letouzey, and Jean-Christophe Gris

Subjects
Diseases of the blood and blood-forming organs, RC633-647.5
Abstract

The prognostic value of angiogenic factors in newly pregnant women with obstetric antiphospholipid syndrome (oAPS) has not been documented. We observed 513 oAPS who experienced three consecutive spontaneous abortions before the 10th week of gestation or one fetal loss at or beyond the 10th week. We assessed the plasma concentrations of the proangiogenic factor placenta growth factor (PIGF) and of the antiangiogenic factor soluble fms-like tyrosine kinase-1 on the eve and on the 4th day of the low-molecular weight heparin-low-dose aspirin treatment. Placenta growth factor and fms-like tyrosine kinase-1 plasma concentrations showed marked increases. Treatment-associated variations of PIGF and of soluble fms-like tyrosine kinase-1 were antagonist risk factors for placenta-mediated complications (PMC) and for severe PMC, for fetal death, stillbirth and neonatal death. The ratio between PIGF increase and soluble fms-like tyrosine kinase-1 was a summary variable whose best cut-off values (1.944.10−2) had high negative predictive values for PMC (0.918) and may be used to help rule out the development of PMC in evolutive pregnancies after 19 completed weeks. The early variations of PIGF and soluble fms-like tyrosine kinase-1 concentrations in newly pregnant oAPS may help to detect patients at low risk of PMC. (clinicaltrials.gov identifier: 02855047)

Published
2017
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7. A preclinical evaluation of polypropylene/polylacticacid hybrid meshes for fascial defect repair using a rat abdominal hernia model.

Author

Daniela Ulrich, Isabelle Le Teuff, Stephanie Huberlant, Patrick Carteron, Vincent Letouzey, and Renaud de Tayrac

Subjects
Medicine, Science
Abstract

Synthetic mesh surgery for both abdominal and urogenital hernia repair is often unsatisfactory in the long-term due to postoperative complications. We hypothesized that a semi-degradable mesh hybrid may provide more appropriate biocompatibility with comparable mechanical properties. The aim was to compare its in vivo biocompatibility with a commercial polypropylene (PP) mesh.72 rats were randomly allocated to either our new composite mesh (monofilament PP mesh knitted with polylactic-acid-fibers (PLA)) or to a commercially available PP mesh that was used as a control. 15, 90, and 180 days after implantation into the rat abdomen mesh tissue complexes were analysed for erosion, contraction, foreign body reaction, tissue integration and biomechanical properties.No differences were seen in regard to clinical parameters including erosion, contraction or infection rates between the two groups. Biomechanical properties including breaking load, stiffness and deformation did not show any significant differences between the different materials at any timepoint. Macrophage staining did not reveal any significant differences between the two groups or between timepoints either. In regard to collagen I there was significantly less collagen I in the PP group compared to the PP/ PLA group at day 180. Collagen III did not show any significant differences at any timepoint between the two groups.A PP/PLA hybrid mesh, leaving a low amount of PP after PLA degradation seems to have comparable biomechanical properties like PP at 180 days due to enhanced collagen production without significant differences in erosion, contraction, herniation or infection rates.

Published
2017
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8. Tolerance and long-term MRI imaging of gadolinium-modified meshes used in soft organ repair.

Author

Vincent Letouzey, Stéphanie Huberlant, Arnaud Cornille, Sébastien Blanquer, Olivier Guillaume, Laurent Lemaire, Xavier Garric, and Renaud de Tayrac

Subjects
Medicine, Science
Abstract

BackgroundSynthetic meshes are frequently used to reinforce soft tissues. The aim of this translational study is to evaluate tolerance and long-term MRI visibility of two recently developed Gadolinium-modified meshes in a rat animal model.Materials and methodsGadolinium-poly-ε-caprolactone (Gd-PCL) and Gadolinium-polymethylacrylate (Gd-PMA) modified meshes were implanted in Wistar rats and their tolerance was assessed daily. Inflammation and biocompatibility of the implants were assessed by histology and immunohistochemistry after 30 days post implantation. Implants were visualised by 7T and 3T MRI at day 30 and at day 90. Diffusion of Gadolinium in the tissues of the implanted animals was assessed by Inductively Coupled Plasma Mass Spectrometry.ResultsOverall Gd-PMA coated implants were better tolerated as compared to those coated with Gd-PCL. In fact, Gd-PMA implants were characterised by a high ratio collagen I/III and good vascularisation of the integration tissues. High resolution images of the coated mesh were obtained in vivo with experimental 7T as well as 3T clinical MRI. Mass spectrometry analyses showed that levels of Gadolinium in animals implanted with coated mesh were similar to those of the control group.ConclusionsMeshes coated with Gd-PMA are better tolerated as compared to those coated with Gd-PCL as no signs of erosion or significant inflammation were detected at 30 days post implantation. Also, Gd-PMA coated meshes were clearly visualised with both 7T and 3T MRI devices. This new technique of mesh optimisation may represent a valuable tool in soft tissue repair and management.

Published
2015
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9. Isolation and characterisation of mesenchymal stem/stromal cells in the ovine endometrium.

Author

Vincent Letouzey, Ker Sin Tan, James A Deane, Daniela Ulrich, Shanti Gurung, Y Rue Ong, and Caroline E Gargett

Subjects
Medicine, Science
Abstract

Mesenchymal stem/stromal cells (MSC) were recently discovered in the human endometrium. These cells possess key stem cell properties and show promising results in small animal models when used for preclinical tissue engineering studies. A small number of surface markers have been identified that enrich for MSC from bone marrow and human endometrium, including the Sushi Domain-containing 2 (SUSD2; W5C5) and CD271 markers. In preparation for developing a large animal preclinical model for urological and gynecological tissue engineering applications we aimed to identify and characterise MSC in ovine endometrium and determine surface markers to enable their prospective isolation.Ovine endometrium was obtained from hysterectomised ewes following progesterone synchronisation, dissociated into single cell suspensions and tested for MSC surface markers and key stem cell properties. Purified stromal cells were obtained by flow cytometry sorting with CD49f and CD45 to remove epithelial cells and leukocytes respectively, and MSC properties investigated.There was a small population CD271+ stromal cells (4.5 ± 2.3%) in the ovine endometrium. Double labelling with CD271 and CD49f showed that the sorted CD271+CD49f- stromal cell population possessed significantly higher cloning efficiency, serial cloning capacity and a qualitative increased ability to differentiate into 4 mesodermal lineages (adipocytic, smooth muscle, chondrocytic and osteoblastic) than CD271-CD49f- cells. Immunolabelling studies identified an adventitial perivascular location for ovine endometrial CD271+ cells.This is the first study to characterise MSC in the ovine endometrium and identify a surface marker profile identifying their location and enabling their prospective isolation. This knowledge will allow future preclinical studies with a large animal model that is well established for pelvic organ prolapse research.

Published
2015
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10. Impact of Bacterial Vaginosis on Perineal Tears during Delivery: A Prospective Cohort Study.

Author

Vincent Letouzey, Sophie Bastide, Daniela Ulrich, Laurie Beccera, Mariella Lomma, Renaud de Tayrac, and Jean Philippe Lavigne

Subjects
Medicine, Science
Abstract

Long term effects of perineal tears pose a major worldwide health issue for women during delivery. Since bacterial vaginosis is related to major obstacles in obstetrics the aim of this study was to determine the relationship between bacterial vaginosis and the occurrence of perineal tears during vaginal delivery.Between June 2013 and December 2013 pregnant women delivering after 37 weeks were recruited at one University hospital / tertiary care referral center in the course of this single-center, prospective cohort study. Bacterial vaginosis was assessed according to Nugent score method. Logistic-regression model was used to estimate odds ratios, adjusted for other risk factors to test the relationship between bacterial vaginosis and the occurrence of 1st to 4th degree perineal tears in women undergoing vaginal delivery.A total of 728 woman were included, 662 analyzed with a complete Nugent Score of the vaginal swab. The prevalence of 1st to 4th degree perineal tears was 35.8% (95% Confidence Interval (95%CI) = [32.2; 39.6]). The presence of BV was not significantly associated to the incidence of perineal tears neither in the univariate analysis (crude Odds Ratio = 1.43; 95%CI = [0.79; 2.60]; p = 0.235) nor in the multivariate analysis (adjusted Odds Ratio = 1.65; 95%CI = [0.81; 3.36]; p = 0.167). Instrumental delivery was the most important risk factor for perineal lacerations.There is no evidence that vaginosis is a risk factor for vaginal tears.ClinicalTrials.gov N° NCT01822782.

Published
2015
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11. Application of a hyaluronic acid gel after intrauterine surgery may improve spontaneous fertility: a randomized controlled trial in New Zealand White rabbits.

Author

Stephanie Huberlant, Herve Fernandez, Pierre Vieille, Mohamed Khrouf, Daniela Ulrich, Renaud deTayrac, and Vincent Letouzey

Subjects
Medicine, Science
Abstract

Intrauterine adhesions (IUAs) are the most common complication after hysteroscopy in patients of reproductive age. Intra-abdominal anti-adhesion gel reduces the incidence of adhesions, but effects on fertility after uterine surgery are not known. The objective of our work was to evaluate the effect of intrauterine anti-adhesion gel on spontaneous fertility after repeated intrauterine surgery with induced experimental synechiae in the rabbit model.Twenty New Zealand White rabbits underwent a double uterine curettage 10 days apart and were randomized into two groups. Each rabbit served as its own control: one uterine tube was the treatment group (A), the second uterine tube was the control group (B) to avoid bias through other causes of infertility. Group A received a post curettage intrauterine instillation of anti-adhesion gel whereas group B, the control group, underwent curettage without instillation of the gel. After a recovery period, the rabbits were mated. An abdominal ultrasound performed 21 days after mating allowed us to diagnose pregnancy and quantify the number of viable fetuses.There was a significant difference in total fetuses in favor of group A, with an average of 3.7 (range, 0-9) total fetuses per tube against 2.1 (0-7) in group B (p = .04). The number of viable fetuses shows a trend in favor of group A, with an average of 3.4 (0-7) viable fetuses per tube against 1.9 (0-6) viable fetuses per tube in group B (p = .05).The use of immediate postoperative anti-adhesion gel improved fertility in an animal model after intrauterine surgery likely to cause uterine synechiae. This experimental model will permit comparison of different anti-adhesion solutions, including assessment of their tolerance and potential mucosal toxicity on embryonic development.

Published
2015
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12. Regional variation in tissue composition and biomechanical properties of postmenopausal ovine and human vagina.

Author

Daniela Ulrich, Sharon L Edwards, Vincent Letouzey, Kai Su, Jacinta F White, Anna Rosamilia, Caroline E Gargett, and Jerome A Werkmeister

Subjects
Medicine, Science
Abstract

OBJECTIVE: There are increasing numbers of reports describing human vaginal tissue composition in women with and without pelvic organ prolapse with conflicting results. The aim of this study was to compare ovine and human posterior vaginal tissue in terms of histological and biochemical tissue composition and to assess passive biomechanical properties of ovine vagina to further characterise this animal model for pelvic organ prolapse research. STUDY DESIGN: Vaginal tissue was collected from ovariectomised sheep (n = 6) and from postmenopausal women (n = 7) from the proximal, middle and distal thirds. Tissue histology was analyzed using Masson's Trichrome staining; total collagen was quantified by hydroxyproline assays, collagen III/I+III ratios by delayed reduction SDS PAGE, glycosaminoglycans by dimethylmethylene blue assay, and elastic tissue associated proteins (ETAP) by amino acid analysis. Young's modulus, maximum stress/strain, and permanent strain following cyclic loading were determined in ovine vagina. RESULTS: Both sheep and human vaginal tissue showed comparable tissue composition. Ovine vaginal tissue showed significantly higher total collagen and glycosaminoglycan values (p

Published
2014
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13. Neonatal outcomes for women at risk of preterm delivery given half dose versus full dose of antenatal betamethasone: a randomised, multicentre, double-blind, placebo-controlled, non-inferiority trial

Author

Thomas Schmitz, Muriel Doret-Dion, Loic Sentilhes, Olivier Parant, Olivier Claris, Laurent Renesme, Julie Abbal, Aude Girault, Héloïse Torchin, Marie Houllier, Nolwenn Le Saché, Alexandre J Vivanti, Daniele De Luca, Norbert Winer, Cyril Flamant, Claire Thuillier, Pascal Boileau, Julie Blanc, Véronique Brevaut, Pierre-Emmanuel Bouet, Géraldine Gascoin, Gaël Beucher, Valérie Datin-Dorriere, Stéphane Bounan, Pascal Bolot, Christophe Poncelet, Corinne Alberti, Moreno Ursino, Camille Aupiais, Olivier Baud, Philippe Boize, Charles Garabédian, Florence Flamein, Maela Le Lous, Alain Beuchée, Jean Gondry, Pierre Tourneux, Perrine Coste-Mazeau, Antoine Bedu, Denis Gallot, Karen Coste, Céline Chauleur, Hugues Patural, Gilles Kayem, Delphine Mitanchez, Hélène Heckenroth, Farid Boubred, Jeanne Sibiude, Luc Desfrère, Caroline Bohec, Thierry Mansir, Antoine Koch, Pierre Kuhn, Nadia Tillouche, Fabrice Lapeyre, Franck Perrotin, Géraldine Favrais, Edouard Lecarpentier, Xaxier Durrmeyer, Véronique Equy, Thierry Debillon, Luc Rigonnot, Stéphanie Lefoulgoc, Claudia Brie, Anne-Sophie Pagès, Romy Rayssiguier, Gilles Cambonie, Corinne Cudeville, Doriane Madeleneau, Olivier Morel, Jean-Michel Hascoet, Vincent Letouzey, Massimo Di Maio, Laurent J. Salomon, Alexandre Lapillonne, Hôpital Robert Debré, Hôpital Femme Mère Enfant [CHU - HCL] (HFME), Hospices Civils de Lyon (HCL), CHU Bordeaux [Bordeaux], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Centre de recherche Cardio-Thoracique de Bordeaux [Bordeaux] (CRCTB), Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux]-Institut National de la Santé et de la Recherche Médicale (INSERM), Maternité Port-Royal [CHU Cochin], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), AP-HP - Hôpital Cochin Broca Hôtel Dieu [Paris], Equipe 1 : EPOPé - Épidémiologie Obstétricale, Périnatale et Pédiatrique (CRESS - U1153), Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS (U1153 / UMR_A_1125 / UMR_S_1153)), Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), AP-HP - Hôpital Antoine Béclère [Clamart], Service de Pédiatrie et Réanimations néonatales [Béclère], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Antoine Béclère [Clamart], Hypertension pulmonaire : physiopathologie et innovation thérapeutique (HPPIT), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, Physiopathologie des Adaptations Nutritionnelles (PhAN), Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Nantes Université - UFR de Médecine et des Techniques Médicales (Nantes Univ - UFR MEDECINE), Nantes Université - pôle Santé, Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ)-Nantes Université - pôle Santé, Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ), CHI Poissy-Saint-Germain, Physiologie et physiopathologie endocriniennes (PHYSENDO), École Nationale Supérieure de Formation de l'Enseignement Agricole de Toulouse-Auzeville (ENSFEA), Education, Formation, Travail, Savoirs (EFTS), Université Toulouse - Jean Jaurès (UT2J), Université de Toulouse (UT)-Université de Toulouse (UT)-École Nationale Supérieure de Formation de l'Enseignement Agricole de Toulouse-Auzeville (ENSFEA), Hôpital Nord [CHU - APHM], Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN), Centre Hospitalier de Saint-Denis [Ile-de-France], Centre Hospitalier René Dubos [Pontoise], Hôpital Robert Debré Paris, Centre de Recherche des Cordeliers (CRC (UMR_S_1138 / U1138)), École Pratique des Hautes Études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université Paris Cité (UPCité), Health data- and model- driven Knowledge Acquisition (HeKA), Inria de Paris, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)-Centre de Recherche des Cordeliers (CRC (UMR_S_1138 / U1138)), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université Paris Cité (UPCité)-École Pratique des Hautes Études (EPHE), Centre d'Investigation Clinique 1426 (CIC 1426), Institut National de la Santé et de la Recherche Médicale (INSERM)-AP-HP Hôpital universitaire Robert-Debré [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Epidémiologie Clinique et Evaluation Economique Appliquées aux Populations Vulnérables (ECEVE (U1123 / UMR_S_1123)), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Cité (UPCité), Maladies neurodéveloppementales et neurovasculaires (NeuroDiderot (UMR_S_1141 / U1141)), and Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)

Subjects
Respiratory Distress Syndrome, Newborn, Double-Blind Method, Pregnancy, [SDV]Life Sciences [q-bio], Infant, Newborn, Humans, Premature Birth, Female, Infant, Premature, Diseases, General Medicine, Betamethasone
Abstract

International audience; BackgroundAntenatal betamethasone is recommended before preterm delivery to accelerate fetal lung maturation. However, reports of growth and neurodevelopmental dose-related side-effects suggest that the current dose (12 mg plus 12 mg, 24 h apart) might be too high. We therefore investigated whether a half dose would be non-inferior to the current full dose for preventing respiratory distress syndrome.MethodsWe designed a randomised, multicentre, double-blind, placebo-controlled, non-inferiority trial in 37 level 3 referral perinatal centres in France. Eligible participants were pregnant women aged 18 years or older with a singleton fetus at risk of preterm delivery and already treated with the first injection of antenatal betamethasone (11·4 mg) before 32 weeks’ gestation. We used a computer-generated code producing permuted blocks of varying sizes to randomly assign (1:1) women to receive either a placebo (half-dose group) or a second 11·4 mg betamethasone injection (full-dose group) 24 h later. Randomisation was stratified by gestational age (before or after 28 weeks). Participants, clinicians, and study staff were masked to the treatment allocation. The primary outcome was the need for exogenous intratracheal surfactant within 48 h after birth. Non-inferiority would be shown if the higher limit of the 95% CI for the between-group difference between the half-dose and full-dose groups in the primary endpoint was less than 4 percentage points (corresponding to a maximum relative risk of 1·20). Four interim analyses monitoring the primary and the secondary safety outcomes were done during the study period, using a sequential data analysis method that provided futility and non-inferiority stopping rules and checked for type I and II errors. Interim analyses were done in the intention-to-treat population. This trial was registered with ClinicalTrials.gov, NCT02897076.FindingsBetween Jan 2, 2017, and Oct 9, 2019, 3244 women were randomly assigned to the half-dose (n=1620 [49·9%]) or the full-dose group (n=1624 [50·1%]); 48 women withdrew consent, 30 fetuses were stillborn, 16 neonates were lost to follow-up, and 9 neonates died before evaluation, so that 3141 neonates remained for analysis. In the intention-to-treat analysis, the primary outcome occurred in 313 (20·0%) of 1567 neonates in the half-dose group and 276 (17·5%) of 1574 neonates in the full-dose group (risk difference 2·4%, 95% CI –0·3 to 5·2); thus non-inferiority was not shown. The per-protocol analysis also did not show non-inferiority (risk difference 2·2%, 95% CI –0·6 to 5·1). No between-group differences appeared in the rates of neonatal death, grade 3–4 intraventricular haemorrhage, stage ≥2 necrotising enterocolitis, severe retinopathy of prematurity, or bronchopulmonary dysplasia.InterpretationBecause non-inferiority of the half-dose compared with the full-dose regimen was not shown, our results do not support practice changes towards antenatal betamethasone dose reduction.

Published
2022

14. Photobiomodulation et troubles vulvovaginaux après traitements anticancéreux

Author

Amaury Forret, Pierre Mares, Charlotte Delacroix, Thierry Chevallier, Hugo Potier, Brigitte Fatton, Florent Masia, Sylvie Ripart, Vincent Letouzey, Renaud de Tayrac, and Jennifer Salerno

Subjects
Cancer Research, Oncology, Radiology, Nuclear Medicine and imaging, Hematology, General Medicine
Published
2023

15. In Vivo Evaluation of the Efficacy and Safety of a Novel Degradable Polymeric Film for the Prevention of Intrauterine Adhesions

Author

S. Huberlant, Salome Leprince, Vincent Letouzey, Renaud de Tayrac, Sophie Warembourg, Isabelle Leteuff, Lucie Allegre, Xavier Garric, Hubert Taillades, Institut des Biomolécules Max Mousseron [Pôle Chimie Balard] (IBMM), Ecole Nationale Supérieure de Chimie de Montpellier (ENSCM)-Institut de Chimie du CNRS (INC)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Service de Gynécologie et Obstétrique [Hôpital de la Croix-Rousse - HCL], Hôpital de la Croix-Rousse [CHU - HCL], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), and Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)

Subjects
Male, medicine.medical_specialty, animal structures, Adhesions, medicine.medical_treatment, Rat model, Urology, Tissue Adhesions, [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, medicine.disease_cause, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Pregnancy, In vivo, Hyaluronic acid, medicine, Animals, Humans, Animal model, [SDV.BBM]Life Sciences [q-bio]/Biochemistry, Molecular Biology, Hyaluronic Acid, Rats, Wistar, Good practice, Intrauterine, Medical device, Uterine Diseases, 030219 obstetrics & reproductive medicine, Biologic response, business.industry, [SDV.BA]Life Sciences [q-bio]/Animal biology, Obstetrics and Gynecology, Curettage, Rats, 3. Good health, medicine.anatomical_structure, chemistry, Case-Control Studies, 030220 oncology & carcinogenesis, embryonic structures, Female, Uterine cavity, Irritation, business, Synechiae
Abstract

Study Objective To study the safety of a degradable polymeric film (DPF) and its efficacy on reducing the risk of intrauterine-adhesion (IUA) formation in a rat model. Design A series of case-control studies relying on random allocation, where feasible. Setting University and good practice animal laboratories. Animals The animal models comprised female and male Oncins France Strain A and female Wistar rats. Intervention(s) and Measurements The Oncins France Strain A rats were used for in vivo evaluation of the impact of the DPF on endometrial thickness and its effect on fertility. For in vivo evaluation of the biologic response, 40 Wistar rats were randomly allocated to intervention and control groups, with matched sampling time after surgery. Finally, for the in vivo evaluation of the DPF's efficacy on IUA prevention, a total of 24 Wistar rats were divided into 3 groups: 1 treated with the DPF, 1 treated with hyaluronic acid gel, and a sham group. Main Results The DPF did not have a significant impact on endometrial thickness, and there were no significant differences in the number of conceived or prematurely terminated pregnancies, confirming its noninferiority to no treatment. The DPF did not induce irritation at 5 days and 28 days. Finally, the DPF significantly reduced the likelihood of complete IUA formation compared with hyaluronic acid gel– and sham-implanted animals, where only 27% of the animals had their uterine cavity obliterated compared with 80% and 100%, respectively. Conclusion The DPF is a safe film that is effective in preventing IUA formation after intrauterine curettage in rats.

Published
2021

17. Clinical outcomes following surgical management of deep infiltrating endometriosis: a retrospective cohort study

Author

Perrine LEBORNE, Stephanie HUBERLANT, Florent MASIA, Renaud DE TAYRAC, Vincent LETOUZEY, and Lucie ALLEGRE

Abstract

Objectives: The main aim of the study was to evaluate severe post-operative complications following deep endometriosis surgery in a tertiary referral centre.Methods: This is a retrospective cohort study that included women who had surgery for deep infiltrating endometriosis between 1st January 2013 and 31st December 2019. Endometriosis was diagnosed based on clinical, imaging and histological parameters. We evaluated the rates of post-operative complications, potential risk factors for such complications and postoperative pregnancy rates.Results: A total of 165 patients were included in the final analysis. The median follow-up was 63 (25 - 106) months. Thirty-seven patients (22.42%) had hysterectomy, 60 (36.81%) had ureterolysis and 44 (26.67%) had colorectal surgery. The overall and severe rates of post-operative complications were 16.20% (n=23) and 2.42% (n=4) respectively. Of the variables assessed, operative time and age were the only statistically significant risk factor for complications on multivariate analysis. Among the women operated on for infertility, 34.5% (n=20/58) got pregnant following surgery with 30% of these spontaneously.Conclusions: This study demonstrates acceptable overall and severe post-operative complications and pregnancy rates after deep endometriosis surgery. This information should help clinicians when counselling women to enable them make an informed choice about their management.

Published
2022

18. NETosis Markers in Pregnancy: Effects Differ According to Histone Subtypes

Author

Christophe Demattei, E. Nouvellon, Marielle Herzog, Mathieu Fortier, E. Mousty, Vincent Letouzey, Laura Vincent, Eric Mercier, Guillaume Rommelaere, Jean-Christophe Gris, and Sylvie Bouvier

Subjects
Adult, Neutrophils, Placenta, Apoptosis, Pilot Projects, Inflammation, Extracellular Traps, Cell Line, Proinflammatory cytokine, Histones, Young Adult, Pre-Eclampsia, Cell Movement, Pregnancy, medicine, Extracellular, Humans, Prospective Studies, Enoxaparin, Innate immune system, Aspirin, biology, business.industry, Hematology, Heparin, Heparin, Low-Molecular-Weight, medicine.disease, Nucleosomes, Trophoblasts, Pregnancy Complications, Kinetics, Histone, biology.protein, Cancer research, Female, France, medicine.symptom, business, medicine.drug
Abstract

NETosis is an innate immune response occurring after infection or inflammation: activated neutrophils expel decondensed DNA in complex with histones into the extracellular environment in a controlled manner. It activates coagulation and fuels the risk of thrombosis. Human pregnancy is associated with a mild proinflammatory state characterized by circulatory neutrophil activation which is further increased in complicated pregnancies, placenta-mediated complications being associated with an increased thrombotic risk. This aberrant activation leads to an increased release of nucleosomes in the blood flow. The aim of our study was to initially quantify nucleosome-bound histones in normal pregnancy and in placenta-mediated complication counterpart. We analyzed the role of histones on extravillous trophoblast function. Circulating nucleosome-bound histones H3 (Nu.QH3.1, Nu.QH3PanCit, Nu.QH3K27me3) and H4 (Nu.QH4K16Ac) were increased in complicated pregnancies. In vitro using the extravillous cell line HTR-8/SVNeo, we observed that free recombinant H2B, H3, and H4 inhibited migration in wound healing assay, but only H3 also blocked invasion in Matrigel-coated Transwell experiments. H3 and H4 also induced apoptosis, whereas H2B did not. Finally, the negative effects of H3 on invasion and apoptosis could be restored with enoxaparin, a low-molecular-weight heparin (LMWH), but not with aspirin. Different circulating nucleosome-bound histones are increased in complicated pregnancy and this would affect migration, invasion, and induce apoptosis of extravillous trophoblasts. Histones might be part of the link between the risk of thrombosis and pregnancy complications, with an effect of LMWH on both.

Published
2021

19. Tranexamic acid for the prevention of blood loss after cesarean among women with twins: a secondary analysis of the TRAnexamic Acid for Preventing Postpartum Hemorrhage Following a Cesarean Delivery randomized clinical trial

Author

Loïc Sentilhes, Hugo Madar, Maëla Le Lous, Marie Victoire Sénat, Norbert Winer, Patrick Rozenberg, Gilles Kayem, Eric Verspyck, Florent Fuchs, Elie Azria, Denis Gallot, Diane Korb, Raoul Desbrière, Camille Le Ray, Céline Chauleur, Fanny de Marcillac, Franck Perrotin, Olivier Parant, Laurent J. Salomon, Emilie Gauchotte, Florence Bretelle, Nicolas Sananès, Caroline Bohec, Nicolas Mottet, Guillaume Legendre, Vincent Letouzey, Bassam Haddad, Delphine Vardon, Aurélien Mattuizzi, Alizée Froeliger, Hanane Bouchghoul, Valérie Daniel, Sophie Regueme, Caroline Roussillon, Aurore Georget, Astrid Darsonval, Antoine Benard, and Catherine Deneux-Tharaux

Subjects
Tranexamic Acid, Pregnancy, Cesarean Section, Postpartum Hemorrhage, Obstetrics and Gynecology, Humans, Female, Blood Transfusion, Antifibrinolytic Agents
Abstract

Although prophylactic tranexamic acid administration after cesarean delivery resulted in a lower incidence of calculated estimated blood loss of1000 mL or red cell transfusion by day 2, its failure to reduce the incidence of hemorrhage-related secondary clinical outcomes (TRAnexamic Acid for Preventing Postpartum Hemorrhage Following a Cesarean Delivery trial) makes its use questionable. The magnitude of its effect may differ in women at higher risk of blood loss, including those with multiple pregnancies.This study aimed to compare the effect of tranexamic acid vs placebo to prevent blood loss after cesarean delivery among women with multiple pregnancies.This was a secondary analysis of the TRAnexamic Acid for Preventing Postpartum Hemorrhage Following a Cesarean Delivery trial data, a double-blind, randomized controlled trial from March 2018 to January 2020 in 27 French maternity hospitals, that included 319 women with multiple pregnancies. Women with a cesarean delivery before or during labor at ≥34 weeks of gestation were randomized to receive intravenously 1 g of tranexamic acid (n=160) or placebo (n=159), both with prophylactic uterotonics. The primary outcome was a calculated estimated blood loss of1000 mL or a red blood cell transfusion by 2 days after delivery. The secondary outcomes included clinical and laboratory blood loss measurements.Of the 4551 women randomized in this trial, 319 had a multiple pregnancy and cesarean delivery, and 298 (93.4%) had primary outcome data available. This outcome occurred in 62 of 147 women (42.2%) in the tranexamic acid group and 67 of 152 (44.1%) receiving placebo (adjusted risk ratio, 0.97; 95% confidence interval, 0.68-1.38; P=.86). No significant between-group differences occurred for any hemorrhage-related clinical outcomes: gravimetrically estimated blood loss, provider-assessed clinically significant hemorrhage, additional uterotonics, postpartum blood transfusion, arterial embolization, and emergency surgery (P.05 for all comparisons).Among women with a multiple pregnancy and cesarean delivery, prophylactic tranexamic acid did not reduce the incidence of any blood loss-related outcomes.

Published
2022

20. Prospective ultrasonographic follow-up of transvaginal lightweight meshes: a 1-year multicenter study

Author

Geertje Callewaert, C. Carlier-Guérin, Lucie Allegre, L. Panel, Renaud de Tayrac, Brigitte Fatton, Christophe Demattei, Charles Coudray, and Vincent Letouzey

Subjects
medicine.medical_specialty, Urology, 030232 urology & nephrology, Pelvic Organ Prolapse, 03 medical and health sciences, 0302 clinical medicine, Transvaginal surgery, medicine, Humans, Prospective Studies, Stage (cooking), Aged, Pelvic organ, 030219 obstetrics & reproductive medicine, business.industry, Ultrasound, Significant difference, Obstetrics and Gynecology, Surgical Mesh, Surgery, Neck of urinary bladder, Treatment Outcome, Multicenter study, Female, Ultrasonography, business, Cystocele, Follow-Up Studies
Abstract

The use of new lightweight meshes in pelvic organ prolapse (POP) surgery may reduce complications related to mesh retraction (chronic pain, dyspareunia, and mesh exposure). The aim of this study was to investigate changes in the area and position of Uphold Lite™ mesh 6 weeks and 12 months after anterior and/or apical prolapse repair. This observational prospective multicenter study included patients who had undergone transvaginal surgery for symptomatic POP-Q stage ≥ II anterior and/or apical compartment prolapse with placement of Uphold Lite mesh. The dimensions and position of the mesh were evaluated at 6 weeks and 12 months by ultrasonography. Correlations between ultrasonographic mesh characteristics and POP recurrence were analyzed. Fifty evaluable women with an average age of 66.8 years were included. No statistically significant difference in mesh area was found between week 6 and month 12 postoperatively, either at rest (1746.92 vs. 1574.48 mm2; p = 0.15) or on Valsalva (1568.81 vs. 1542.98 mm2; p = 0.65). The ROC-AUC of the distance between the mesh and the bladder neck (M-BN) at 6 weeks for predicting cystocele recurrence at 12 months was 0.764 (95% CI 0.573–0.955) at rest and 0.724 (95% CI 0.533–0.916) on Valsalva. An M-BN distance > 12.5 mm could predict cystocele recurrence at month 12 with a sensitivity of 80% and a specificity of 69%. Ultrasonographic measurements of the Uphold Lite™ mesh appear to remain stable between 6 weeks and 12 months postoperatively. M-BN distance correlates with cystocele recurrence. These results appear to confirm the value of ultrasound in mesh evaluation.

Published
2020

21. Reoperation rate and outcomes following the placement of polypropylene mesh by the vaginal route for cystocele: very long-term follow-up

Author

Xavier Deffieux, Vincent Letouzey, Marie Vinchant, Iris Bitumba, Renaud de Tayrac, and Hervé Fernandez

Subjects
Reoperation, medicine.medical_specialty, Long term follow up, Urology, 030232 urology & nephrology, Physical examination, Polypropylenes, Pelvic Organ Prolapse, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, Retrospective Studies, 030219 obstetrics & reproductive medicine, Vaginal route, medicine.diagnostic_test, business.industry, Mortality rate, Obstetrics and Gynecology, Retrospective cohort study, Surgical Mesh, Surgery, Polypropylene mesh, Treatment Outcome, Satisfaction rate, Improvement rate, Vagina, Female, business, Cystocele, Follow-Up Studies
Abstract

The aim was to evaluate the reoperation rate and outcomes in women who underwent transvaginal non-absorbable monofilament polypropylene mesh placement for the treatment of cystocele. The retrospective cohort study included 63 patients who underwent transvaginal surgery using a synthetic polypropylene mesh (Gynemesh™) for cystocele. Patients were evaluated using a clinical examination (POP-Q) and validated questionnaires (PGI-I, PFDI-20, PFIQ-7) at 18 years of follow-up (median 18 years [IQR 16–19]). Cumulative death rate was 13 out of 63 (20%) and rate of total loss to follow-up was 21 out of 50 (42%). Finally, among the 63 women who underwent surgery, 29 completed maximum follow-up and 21 underwent a clinical examination. The cumulative reoperation rate was 35% (22 out of 63). Three patients were reoperated on because of recurrence of pelvic organ prolapse. Among the 63 patients initially operated, vaginal mesh exposure occurred in 16 (25%) during follow-up and 11 women (17%) needed a reintervention for vaginal mesh exposure. One patient was reoperated on for bladder mesh exposure. Among the 29 women who completed follow-up, the overall postoperative improvement rate was 93% after 18 years (PGI-I: 1–3). Mean overall satisfaction rate was 80 out of 100. Functional success rate was 76% (22 out of 29) and anatomical success rate was 62% (13 out of 21). The median score of the POP-DI-6 was 4.1 (IQR: 0–11) and the median score of the PFDI-20 was 30.7 (IQR: 13–60) in the 29 women who completed maximum follow-up. At very long-term follow-up, the recurrence rate of cystocele following polypropylene mesh placement by the vaginal route remained low and the satisfaction rate was high. However, we found high cumulative reoperation and mesh exposure rates.

Published
2020

22. Hemoperitoneum complicating an oocyte puncture in a chronic hemodialysis patient

Author

Celine Schultz, Stéphanie Huberlant, Vincent Letouzey, and Olivier Moranne

Subjects
Nephrology, Heparin, Renal Dialysis, Hemoperitoneum, Oocytes, Humans, Female, Punctures
Abstract

We report the case of a 31-year-old patient on chronic hemodialysis for 17 years, after two failed kidney grafts, presently on daily home hemodialysis. She underwent follicle puncture for oocyte retrieval in the context of an in vitro fertilization program. This procedure was complicated by hemoperitoneum, requiring transfusion of 2 units of packed red blood cells and 2 units of fresh-frozen plasma, as well as an emergency laparoscopy to drain the hemoperitoneum and perform local hemostasis of the ovarian bleeding. This complication occurred following the patient's routine hemodialysis session, performed with the usual systemic anticoagulation with unfractionated heparin. The evolution was favorable and there was no recurrence of bleeding or sequelae. A later hematology workup did not reveal any pathology of hemostasis that might have favored bleeding. This case may underline how, even though assisted reproductive procedures are increasingly performed in patients on dialysis, special care should be taken when these procedures are performed in this fragile population.

Published
2021

23. Increased incidence of cancer in the follow-up of obstetric antiphospholipid syndrome within the NOH-APS cohort

Author

Sylvie Ripart, Sylvie Bouvier, Jean-Christophe Gris, Pascale Fabbro-Peray, Antonia Perez-Martin, E. Mousty, Vincent Letouzey, Eva Cochery-Nouvellon, Jonathan Broner, Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Caractéristiques féminines des dysfonctions des interfaces cardio-vasculaires (EA 2992), Université Montpellier 1 (UM1)-Université de Montpellier (UM), Sechenov First Moscow State Medical University, Laboratoire de Biostatistique, Epidémiologie clinique, Santé Publique Innovation et Méthodologie [CHU Nîmes] (BESPIM), Hôpital Universitaire Carémeau [Nîmes] (CHU Nîmes), and Centre Hospitalier Universitaire de Nîmes (CHU Nîmes)-Centre Hospitalier Universitaire de Nîmes (CHU Nîmes)

Subjects
medicine.medical_specialty, Population, [SDV.CAN]Life Sciences [q-bio]/Cancer, [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, Article, Cohort Studies, 03 medical and health sciences, MESH: Pregnancy, 0302 clinical medicine, Pregnancy, Antiphospholipid syndrome, Neoplasms, MESH: Antiphospholipid Syndrome, medicine, Humans, MESH: Neoplasms, MESH: Incidence, education, MESH: Cohort Studies, Hemostasis, Lupus anticoagulant, education.field_of_study, MESH: Humans, Obstetrics, business.industry, Incidence, Incidence (epidemiology), Hazard ratio, [SDV.MHEP.HEM]Life Sciences [q-bio]/Human health and pathology/Hematology, MESH: Follow-Up Studies, Hematology, Antiphospholipid Syndrome, medicine.disease, 3. Good health, Standardized mortality ratio, Cohort, Female, business, MESH: Female, Follow-Up Studies, 030215 immunology, Cohort study
Abstract

International audience; Malignancies can be associated with positive antiphospholipid antibodies but the incidence of cancer among women with the purely obstetric form of antiphospholipid syndrome (APS) is currently unknown. Our aim was to investigate the comparative incidence of cancers in women with a history of obstetric APS within a referral university hospital-based cohort (NOH-APS cohort). We performed a 17-year observational study of 1,592 non-thrombotic women with three consecutive spontaneous abortions before the 10th week of gestation or one fetal death at or beyond the 10th week of gestation. We compared the incidence of cancer diagnosis during follow-up among the cohort of women positive for antiphospholipid antibodies (n=517), the cohort of women carrying the F5 rs6025 or F2 rs1799963 polymorphism (n=279) and a cohort of women with negative thrombophilia screening results (n=796). The annualized rate of cancer was 0.300% (0.20%-0.44%) for women with obstetric APS and their cancer risk was substantially higher than that of women with negative thrombophilia screening [adjusted hazard ratio (aHR) 2.483; 95% confidence interval (CI) 1.27-4.85]. The computed standardized incidence ratio for women with obstetric APS was 2.89; 95% CI: 1.89-4.23. Among antiphospholipid antibodies, lupus anticoagulant was associated with incident cancers (aHR 2.608; 95% CI: 1.091-6.236). Our cohort study shows that the risk of cancer is substantially higher in women with a history of obstetric APS than in the general population, and in women with a similar initial clinical history but negative for antiphospholipid antibodies.

Published
2019

24. Pelvic organ prolapse and sexual function

Author

Vincent Letouzey, Renaud de Tayrac, Stéphanie Huberlant, Brigitte Fatton, and Centre Hospitalier Universitaire de Nîmes (CHU Nîmes)

Subjects
0301 basic medicine, Attractiveness, Pessary, medicine.medical_specialty, genetic structures, Urology, Pelvic organ prolapse (POP), [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, Pelvic Organ Prolapse, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, Pelvic organ, Pelvic floor, business.industry, Obstetrics, Patient counselling, 3. Good health, body regions, Sexual Dysfunction, Physiological, 030104 developmental biology, Sexual dysfunction, medicine.anatomical_structure, Increased risk, Treatment Outcome, 030220 oncology & carcinogenesis, Female, medicine.symptom, business, Sexual function
Abstract

International audience; Sexual dysfunction is one of the symptoms associated with pelvic organ prolapse (POP) that motivates women to seek medical help. Women with POP are likely to restrict sexual activity owing to a perceived of loss of attractiveness and fear of incontinence. Conservative (pelvic floor muscles training or pessary) or surgical management (transabdominally or transvaginally) can be offered to treat POP but questions remain regarding sexual outcome. Despite the usual improvement in sexual function after surgery, a risk of de novo dyspareunia exists irrespective of the procedure used with slightly increased risk after transvaginal repair. Preoperative patient counselling, ideally with a cross-disciplinary approach is an important part of management of POP.

Published
2020

25. Fertility and obstetrical outcomes after robot-assisted laparoscopic myomectomy

Author

Noemie Ranisavljevic, F. Masia, Renaud de Tayrac, Stéphanie Huberlant, Juliette Lenot, Sophie Warembourg, Mathias Neron, Vincent Letouzey, Hôpital Universitaire Carémeau [Nîmes] (CHU Nîmes), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Hôpital Arnaud de Villeneuve [CHRU Montpellier], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Service de Gynécologie et Obstétrique [Hôpital de la Croix-Rousse - HCL], Hôpital de la Croix-Rousse [CHU - HCL], and Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL)

Subjects
Pregnancy Rate, medicine.medical_treatment, Miscarriage, [INFO.INFO-AI]Computer Science [cs]/Artificial Intelligence [cs.AI], 0302 clinical medicine, MESH: Pregnancy, Robotic Surgical Procedures, Pregnancy, Robot-assisted myomectomy, MESH: Uterine Myomectomy, MESH: Pregnancy Rate, 030219 obstetrics & reproductive medicine, MESH: Middle Aged, medicine.diagnostic_test, Obstetrics, Middle Aged, 3. Good health, Computer Science Applications, Uterine rupture, Hysteroscopy, MESH: Pregnancy Complications, 030220 oncology & carcinogenesis, Female, Live birth, Synechiae, Adult, medicine.medical_specialty, Biophysics, [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, 03 medical and health sciences, Uterine Myomectomy, medicine, Humans, Caesarean section, Retrospective Studies, MESH: Humans, business.industry, MESH: Fertility, Retrospective cohort study, Myoma, MESH: Adult, MESH: Retrospective Studies, medicine.disease, MESH: Robotic Surgical Procedures, Pregnancy Complications, Fertility, Infertility, Surgery, business, MESH: Female
Abstract

International audience; To evaluate fertility after robot-assisted laparoscopic myomectomy (RALM) in terms of pregnancy rates, and obstetrical outcomes.Patients: This is a retrospective cohort of RALM performed for symptomatic leiomyomas among women who want to conceive. Medical data were retrospectively reviewed. An office hysteroscopy was prescribed 3 months after the surgery.Results: Fifty-three patients were included. The mean number of myomas was 2 ± 1.5 with a mean size of 69 ± 17.7 mm. A breach of the cavity was noticed in 15.1% of the cases. Two cases of intrauterine adhesions were diagnosed and treated during the post-operative office hysteroscopy (5.7%). Clinical pregnancy rates were 52.8% with a live birth rate of 41.5% in patients desiring pregnancy. A caesarean section was performed in 17 cases (70.8%). No case of uterine rupture was reported.Conclusion: More than half of the patients became pregnant after RALM. A low rate of obstetrical complications was reported, with no uterine ruptures, highlighting the promise of this technique for infertile patients.

Published
2020

26. Are we performing episiotomies correctly? A study to evaluate French technique in a high-risk maternity unit

Author

Fanny Béchard, Pierre Vieille, Renaud de Tayrac, Julia Geronimi, Vincent Letouzey, Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Centre d'études et de recherche en informatique et communications (CEDRIC), Ecole Nationale Supérieure d'Informatique pour l'Industrie et l'Entreprise (ENSIIE)-Conservatoire National des Arts et Métiers [CNAM] (CNAM), Institut des Biomolécules Max Mousseron [Pôle Chimie Balard] (IBMM), and Ecole Nationale Supérieure de Chimie de Montpellier (ENSCM)-Institut de Chimie du CNRS (INC)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)

Subjects
Adult, Risk, Episiotomy, medicine.medical_specialty, medicine.medical_treatment, Anal Canal, [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, Midwifery, Perineum, 03 medical and health sciences, 0302 clinical medicine, Suture (anatomy), Pregnancy, Physicians, Perineal tear, medicine, Humans, 030212 general & internal medicine, Obstetrics and Gynecology Department, Hospital, 030219 obstetrics & reproductive medicine, Doctor, OASIS, business.industry, Suture Techniques, Midwife, Obstetrics and Gynecology, Anus, Surgery, medicine.anatomical_structure, Reproductive Medicine, Sphincter, Female, France, Severe perineal tears, business, Angle
Abstract

International audience; INTRODUCTION:The aim of this study was to evaluate episiotomy technique, in particular suture angles, and any correlation between suture angle and severe perineal tears.MATERIAL AND METHODS:An observational questionnaire-based study was conducted between 01 August 2015 and 30 April 2016 among accoucheurs performing episiotomies in a French maternity unit with facilities for high-risk pregnancies. For each patient included, accoucheurs were asked to measure the episiotomy suture angle, and to record the angle at which they thought they had cut, the length of the episiotomy, its distance from the anus, and whether the woman sustained a sphincter injury.RESULTS:The centre's episiotomy rate during the study period was 15%. We analyzed the characteristics of episiotomies performed on 89 women (68 by doctors and 21 by midwives). Only 43% of suture angles were between 45° and 60° (45.6% of those performed by doctors vs 38.1% by midwives, p=0.8623), whereas 91% of accoucheurs thought they had cut within the correct range. Doctors made longer incisions than midwives (4 [4.2-5.0] vs 3 [2.5-3.5] cm, p=0.0006). Only 40.5% of accoucheurs correctly estimated the incision angle. Twelve (13.64%) of the 88 women sustained a third-degree perineal tear. The risk of sphincter injury was higher with suture angles

Published
2018

27. Preliminary design of a new degradable medical device to prevent the formation and recurrence of intrauterine adhesions

Author

Sophie Warembourg, Xavier Garric, Isabelle Leteuff, Renaud de Tayrac, Hubert Taillades, Cédric Paniagua, Vincent Letouzey, S. Huberlant, Audrey Bethry, Salome Leprince, Lucie Allegre, Jean Coudane, Institut des Biomolécules Max Mousseron [Pôle Chimie Balard] (IBMM), Ecole Nationale Supérieure de Chimie de Montpellier (ENSCM)-Institut de Chimie du CNRS (INC)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Laboratoire de Chirurgie Experimentale, and Université Montpellier 1 (UM1)

Subjects
Magnetic Resonance Spectroscopy, medicine.medical_treatment, Medicine (miscellaneous), Adhesion (medicine), Tissue Adhesions, 02 engineering and technology, Endometrium, Polyethylene Glycols, Random Allocation, 0302 clinical medicine, Recurrence, lcsh:QH301-705.5, Gynecological surgery, Uterine Diseases, 030219 obstetrics & reproductive medicine, Viscosity, Equipment Design, 021001 nanoscience & nanotechnology, 3. Good health, Uterine walls, Experimental models of disease, medicine.anatomical_structure, Female, Uterine cavity, Collagen, 0210 nano-technology, General Agricultural and Biological Sciences, Adult, medicine.medical_specialty, Medical device, Polyesters, Optimal deployment, In Vitro Techniques, Intrauterine device, General Biochemistry, Genetics and Molecular Biology, Article, 03 medical and health sciences, medicine, Cell Adhesion, Animals, Humans, Rats, Wistar, business.industry, Uterus, Translational research, medicine.disease, Surgery, Rats, lcsh:Biology (General), business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

Intrauterine adhesions lead to partial or complete obliteration of the uterine cavity and have life-changing consequences for women. The leading cause of adhesions is believed to be loss of stroma resulting from trauma to the endometrium after surgery. Adhesions are formed when lost stroma is replaced by fibrous tissue that join the uterine walls. Few effective intrauterine anti-adhesion barriers for gynecological surgery exist. We designed a degradable anti-adhesion medical device prototype to prevent adhesion formation and recurrence and restore uterine morphology. We focused on ideal degradation time for complete uterine re-epithelialization for optimal anti-adhesion effect and clinical usability. We developed a triblock copolymer prototype [poly(lactide) combined with high molecular mass poly(ethylene oxide)]. Comparative pre-clinical studies demonstrated in vivo anti-adhesion efficacy. Ease of introduction and optimal deployment in a human uterus confirmed clinical usability. This article provides preliminary data to develop an intrauterine medical device and conduct a clinical trial., Salome Leprince, Stephanie Huberlant et al. report the design of a degradable anti-adhesion intrauterine device that prevents formation of intrauterine adhesions following trauma or surgery. They show its efficacy in rats and its usability in the human uterus.

Published
2019

28. Liste des collaborateurs

Author

Gérard, Amarenco, primary, Christophe, Courtieu, additional, Phillipe, Debodinance, additional, Xavier, Deffieux, additional, Pierre, Denys, additional, Renaud, De Tayrac, additional, Brigitte, Fatton, additional, Arnaud, Fauconnier, additional, Hervé, Fernandez, additional, Xavier, Fritel, additional, Jacques, Kerdraon, additional, Jacques, Labat Jean, additional, Vincent, Letouzey, additional, Nathalie, Michel-Laaengh, additional, Anne, Pizzoferrato, additional, Gilberte, Robain, additional, and Laurent, Siproudhis, additional

Published
2011
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29. Quelles mesures de protection périnéale à l’accouchement sont consensuelles en France ? Résultats d’une enquête Delphi

Author

S. Huberlant, R. de Tayrac, Vincent Letouzey, L. Carligny, and R. Zimmerman

Subjects
03 medical and health sciences, 030219 obstetrics & reproductive medicine, 0302 clinical medicine, business.industry, Urology, Medicine, 030212 general & internal medicine, business, Humanities
Abstract

Resume Objectif Evaluer l’opinion d’un panel d’experts et obtenir un consensus sur les differentes mesures de protection perineale au moment de l’accouchement par voie vaginale. Methodes Une enquete selon la methode Delphi a ete realisee aupres d’un panel d’experts francais obstetriciens, urogynecologues et sages-femmes. Le questionnaire comprenait 22 questions regroupees en quatre groupes : efforts expulsifs, indications de l’episiotomie, realisation de l’episiotomie et autres modalites de protection perineale. Les experts devaient repondre sur une echelle en 9 points, tant sur la validite que sur la clarte de chaque proposition. Apres analyse des reponses du 1 er tour, un 2 e tour a ete envoye aux meme experts pour certaines propositions. Chaque tour a fait l’objet de deux relances. Pour etre validee, chaque proposition devait obtenir une mediane superieure ou egale a 7/9 et un accord entre les experts superieur a 65 % au 1 er tour, et 75 % au 2 e tour. Resultats L’etude s’est deroulee entre mars et octobre 2016. Sur 300 professionnels initialement selectionnes, 93 (31 %) ont repondu au 1 er tour, dont 63 obstetriciens (67,7 %), 12 urogynecologues (12,9 %) et 18 sages-femmes (19,4 %). Au 2 e tour, 72 experts ont repondu, soit 77,4 % des experts ayant egalement repondus au 1 er tour. A l’issue des deux tours, 11 propositions ont ete validees et 11 rejetees. Les recommandations suivantes ont ete validees : l’expression uterine doit etre proscrite ; les deux modes de poussee (bloquee en Valsalva et en expiration) peuvent etre indifferemment proposees, en cas de progression du mobile fœtal et en l’absence d’anomalie du RCF ; l’episiotomie mediane doit etre proscrite ; la realisation d’une episiotomie medio-laterale (ou laterale) doit etre laissee a l’appreciation de l’accoucheur ; le maintien de la tete fœtale avec une main doit etre systematique a l’expulsion pour proteger le perinee ; la reparation de l’episiotomie doit etre faite (sauf exception) avec un fil a resorption rapide ; la prescription d’AINS et/ou d’antalgiques de palier 2 doit etre privilegiee pour reduire les douleurs des cicatrices perineales post-natales. Conclusion Certaines mesures de protection perineale au moment de l’accouchement par voie vaginale sont consensuelles en France. D’autres mesures doivent faire l’objet d’etudes complementaires. Niveau de preuve 4.

Published
2017

30. Cranberry capsules to prevent nosocomial urinary tract bacteriuria after pelvic surgery: a randomised controlled trial

Author

Stéphanie Huberlant, Sandrine Alonso, Christophe Demattei, Jean-Philippe Lavigne, Daniela Ulrich, R. de Tayrac, Vincent Letouzey, Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Institut des Biomolécules Max Mousseron [Pôle Chimie Balard] (IBMM), Centre National de la Recherche Scientifique (CNRS)-Institut de Chimie du CNRS (INC)-Université de Montpellier (UM)-Ecole Nationale Supérieure de Chimie de Montpellier (ENSCM), BESPIM, Aide à la Décision pour une Médecine Personnalisé - Laboratoire de Biostatistique, Epidémiologie et Recherche Clinique - EA 2415 (AIDMP), Université Montpellier 1 (UM1)-Université de Montpellier (UM), Virulence bactérienne et maladies infectieuses (VBMI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), and Université de Montpellier (UM)

Subjects
medicine.medical_specialty, Bacteriuria, Urinary system, Population, Urine, [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, Placebo, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Medicine, pelvic surgery, 030212 general & internal medicine, education, Pelvic surgery, education.field_of_study, 030219 obstetrics & reproductive medicine, business.industry, Obstetrics and Gynecology, catheterisation, medicine.disease, 3. Good health, Surgery, Relative risk, cranberry capsules, urinary tract infections, business
Abstract

OBJECTIVE: To evaluate whether cranberries are able to prevent postoperative urinary bacteriuria in patients undergoing pelvic surgery and receiving transurethral catheterisation. DESIGN: Randomised, double-blind, placebo-controlled trial. SETTINGS: French tertiary Care centre, University Hospital. POPULATION: A total of 272 women undergoing pelvic surgery aged 18 or older. METHODS: Participants undergoing pelvic surgery were randomised to 36 mg cranberry (proanthocyanidins, PAC) or placebo once daily for 10 days. Statistical analysis was performed by a chi-square test. MAIN OUTCOME MEASURES: The primary and secondary outcomes were postoperative bacteriuria, defined by a positive urine culture, within the first 15 and 40 days, respectively. RESULTS: Two hundred and fifty-five participants received the intended treatment: 132 (51.8%) received PAC and 123 (48.2%) received placebo. There were no significant differences in baseline demographics, intra-operative characteristics or duration and type of catheterisation between the two groups. PAC prophylaxis did not reduce the risk of bacteriuria treatment within 15 days of surgery [27% bacteriuria with PAC compared with 25% bacteriuria with placebo: relative risk 1.05, 95% CI 0.78-1.4, P = 0.763). The same result was observed on day 40. Bacteriuria occurred more often in older women with increased length of catheterisation. CONCLUSION: Immediate postoperative prophylaxis with PAC does not reduce the risk of postoperative bacteriuria in patients receiving short-term transurethral catheterisation after pelvic surgery. TWEETABLE ABSTRACT: PAC prophylaxis does not reduce the risk of postoperative bacteriuria in patients undergoing pelvic surgery.

Published
2017

31. Risk of new-onset urinary incontinence 3 and 12 months after vaginal or cesarean delivery of twins: Part I

Author

Fanny Béchard, Thomas Schmitz, Sandrine Alonso, E. Vintejoux, Vincent Letouzey, Christel Castelli, Renaud de Tayrac, François Goffinet, Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Laboratoire de Biostatistique, Epidémiologie clinique, Santé Publique Innovation et Méthodologie [CHU Nîmes] (BESPIM), Hôpital Universitaire Carémeau [Nîmes] (CHU Nîmes), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes)-Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Service de gynécologie-obstétrique et médecine de la reproduction, Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Arnaud de Villeneuve, Equipe 1 : EPOPé - Épidémiologie Obstétricale, Périnatale et Pédiatrique (CRESS - U1153), Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS (U1153 / UMR_A_1125 / UMR_S_1153)), Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de la Recherche Agronomique (INRA)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de la Recherche Agronomique (INRA), Institut des Biomolécules Max Mousseron [Pôle Chimie Balard] (IBMM), Ecole Nationale Supérieure de Chimie de Montpellier (ENSCM)-Institut de Chimie du CNRS (INC)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), and Hôpital Robert Debré

Subjects
Adult, medicine.medical_specialty, Time Factors, Twin pregnancy, Urinary Incontinence, Stress, Urology, Urinary incontinence, [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Pregnancy, Postpartum, Surveys and Questionnaires, Prevalence, medicine, Humans, Prospective Studies, 030212 general & internal medicine, Risk factor, Prospective cohort study, Twin Pregnancy, Vaginal delivery, 2. Zero hunger, 030219 obstetrics & reproductive medicine, Pelvic floor, Cesarean Section, Obstetrics, business.industry, Parturition, Obstetrics and Gynecology, Urinary Incontinence, Urge, 3. Good health, Distress, medicine.anatomical_structure, Risk factors, Pregnancy, Twin, Quality of Life, Gestation, Female, France, medicine.symptom, business
Abstract

International audience; ntroduction and hypothesis: Our purpose was to compare the prevalence of urinary incontinence (UI) 3 and 12 months after vaginal vs cesarean delivery of twins after 34 weeks of gestation.Methods: This was a multicenter prospective cohort study conducted at 172 French maternity units and included 2812 primiparous women with twins with no prior history of UI. Participants were enrolled at the time of delivery and followed up to 12 months postpartum. The primary outcome was the prevalence of UI, both stress and urge, 3 months postpartum, based on the patient reporting any frequency of urine leakage to the first question of the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF). The Pelvic Floor Distress Inventory - Short Form 20 (PFDI-20), Pelvic Floor Impact Questionnaire - Short Form 7 (PFIQ-7), Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12), and Medical Outcome Study Short Form-12 (SF-12) were also used.Results: The ICIQ-SF was completed by 1155 (39.8%) and 800 (27.5%) women, respectively, at 3 and 12 months postpartum; 556 (48%) had delivered vaginally and 599 (52%) by cesarean section. The prevalence of UI at 3 months was 26% overall and was significantly higher in the vaginal delivery group at both 3 months (35% vs 17% in the cesarean group, p < 0.0001) and 12 months postpartum (38% vs 24%, p < 0.0001). UI was predominantly stress or mixed. The risk factors for UI at 3 months, determined by multivariate modeling, were vaginal delivery [odds ratio (OR) 3.073, 95% confidence interval (CI) 2.3-4.105, p < 0.0001) and body mass index >25 in early pregnancy (OR 1.620, 95% CI 1.188-2.209, p = 0.0023).Conclusions: Vaginal delivery is a risk factor for UI at 3 months after twin birth.

Published
2019

32. Impact of mode of delivery of twins on the pelvic floor 3 and 12 months post-partum—part II

Author

Christel Castelli, Renaud de Tayrac, Sandrine Alonso, Thomas Schmitz, Vincent Letouzey, François Goffinet, E. Vintejoux, Fanny Béchard, Hôpital Universitaire Carémeau [Nîmes] (CHU Nîmes), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Laboratoire de Biostatistique, Epidémiologie clinique, Santé Publique Innovation et Méthodologie [CHU Nîmes] (BESPIM), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes)-Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Service de gynécologie-obstétrique et médecine de la reproduction, Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Arnaud de Villeneuve, Equipe 1 : EPOPé - Épidémiologie Obstétricale, Périnatale et Pédiatrique (CRESS - U1153), Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS (U1153 / UMR_A_1125 / UMR_S_1153)), Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de la Recherche Agronomique (INRA)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de la Recherche Agronomique (INRA), Institut des Biomolécules Max Mousseron [Pôle Chimie Balard] (IBMM), Ecole Nationale Supérieure de Chimie de Montpellier (ENSCM)-Institut de Chimie du CNRS (INC)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), and Hôpital Robert Debré

Subjects
Time Factors, 030232 urology & nephrology, Urinary incontinence, 0302 clinical medicine, Quality of life, Pregnancy, Surveys and Questionnaires, Medicine, Prospective Studies, Prospective cohort study, Twin Pregnancy, reproductive and urinary physiology, Vaginal delivery, 030219 obstetrics & reproductive medicine, Pelvic floor, Obstetrics, Postpartum Period, Obstetrics and Gynecology, Middle Aged, 3. Good health, [SDV.BBM.BP]Life Sciences [q-bio]/Biochemistry, Molecular Biology/Biophysics, medicine.anatomical_structure, Gestation, Female, France, medicine.symptom, Symptom Assessment, Adult, medicine.medical_specialty, Adolescent, Twin pregnancy, Urology, Pelvic Floor Disorders, Pelvic floor dysfunction, 03 medical and health sciences, Young Adult, Postpartum, Humans, business.industry, Cesarean Section, Parturition, medicine.disease, Urination Disorders, Pelvic organ prolapse, body regions, Sexual Dysfunction, Physiological, Risk factors, Pregnancy, Twin, Quality of Life, business
Abstract

To compare the impact of vaginal delivery (VD) versus cesarean section (CS) on the pelvic floor in twin primiparae at 3 and 12 months postpartum.This comparative multicenter prospective cohort from a large French national cohort study consisted of primiparas who gave birth to live twins after 34 weeks of gestation. The primary end point was the postnatal urinary incontinence rate 3 months postpartum. The secondary end points were the pelvic floor dysfunction (PFD) at 3 and 12 months based on PFDI-20, PFIQ-7, PISQ-12, and SF-12 responses.A total of 2812 patients in 172 French maternity units were recruited between February 2014 and March 2015: 1076 (38%) responded at 3 and 12 months (61% at 3 months); 1155 were analyzed at 3 months (556 VD and 599 CS) and 800 at 12 months (394 VD and 406 CS). VD was associated with more symptoms at 3 months [median PFDI-20 score 25/300 (8-50) vs. 17/300 (4-36) after CS; p 0.0001]. Vaginal bulge was more frequently reported after VD (9 vs. 4%; p = 0.0015). Abdnormal PFD-related quality-of-life scores (scores0) were more frequent after VD at 3 months (58 vs. 42%; p 0.0001) and 12 months (57 vs. 43%; p = 0.0020), indicating greater discomfort. However, SF-12 scores were higher after VD [56 (53-59) vs. 55 (51-58)] at 12 months, indicating better general quality of life.Mode of delivery is significantly associated with pelvic organ prolapse symptoms 3 months postpartum, which regress by 12 months, probably because of the known spontaneous postnatal improvement of PFDs.

Published
2019

33. Perioperative morbi-mortality after pelvic organ prolapse surgery in a large French national database from gynecologist surgeons

Author

Renaud de Tayrac, Majd Labaki, Isabelle Le Teuff, Bernard Jacquetin, Pascale Fabbro-Peray, Georges Eglin, Philippe Debodinance, Jean Marty, Vincent Letouzey, Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Institut des Biomolécules Max Mousseron [Pôle Chimie Balard] (IBMM), Ecole Nationale Supérieure de Chimie de Montpellier (ENSCM)-Institut de Chimie du CNRS (INC)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Université de Montpellier (UM), and BESPIM

Subjects
Adult, Male, Reoperation, medicine.medical_specialty, Constipation, Databases, Factual, [SDV]Life Sciences [q-bio], 030232 urology & nephrology, Urinary incontinence, 03 medical and health sciences, 0302 clinical medicine, Hematoma, Gynecologic Surgical Procedures, Postoperative Complications, Vaginal surgery, medicine, Humans, Mortality, Perioperative Period, Aged, Retrospective Studies, Aged, 80 and over, Surgeons, Sacrocolpopexy, 030219 obstetrics & reproductive medicine, Urinary retention, business.industry, Chronic pain, Obstetrics and Gynecology, Retrospective cohort study, Perioperative, Prostheses and Implants, Middle Aged, Surgical Mesh, medicine.disease, 3. Good health, Surgery, Pelvic organ prolapse, Reproductive Medicine, Gynecology, Female, Clinical Competence, France, medicine.symptom, Morbidity, business, Abdominal surgery
Abstract

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.

Published
2019

34. A new bioabsorbable polymer film to prevent peritoneal adhesions validated in a post-surgical animal model

Author

S. Huberlant, Salome Leprince, Xavier Garric, Sophie Warembourg, Lucie Allegre, Vincent Letouzey, Isabelle Le Teuff, Hubert Taillades, Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Institut des Biomolécules Max Mousseron [Pôle Chimie Balard] (IBMM), Ecole Nationale Supérieure de Chimie de Montpellier (ENSCM)-Institut de Chimie du CNRS (INC)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Université de Montpellier (UM), Laboratoire de Chirurgie Experimentale, and Université Montpellier 1 (UM1)

Subjects
Post surgical, Polymers, [SDV]Life Sciences [q-bio], Adhesion (medicine), lcsh:Medicine, Tissue Adhesions, Pathology and Laboratory Medicine, Bioabsorbable polymer, Biochemistry, Polyethylene Glycols, 0302 clinical medicine, Abdomen, Medicine and Health Sciences, Hyalobarrier, lcsh:Science, Materials, Cecum, Immune Response, 030219 obstetrics & reproductive medicine, Multidisciplinary, Gynecologic Surgery, 3. Good health, Chemistry, medicine.anatomical_structure, Macromolecules, 030220 oncology & carcinogenesis, Physical Sciences, Artificial, Female, Anatomy, Peritoneum, Research Article, medicine.medical_specialty, Polyesters, Materials Science, Immunology, Urology, Surgical and Invasive Medical Procedures, Biodegradable Plastics, Peritoneal adhesions, 03 medical and health sciences, Signs and Symptoms, Diagnostic Medicine, In vivo, medicine, Animals, Inflammation, Fibrin, Membranes, Euthanasia, business.industry, Animal, lcsh:R, Biology and Life Sciences, Proteins, Postoperative complication, Membranes, Artificial, Polymer Chemistry, medicine.disease, Rats, Gastrointestinal Tract, Disease Models, Animal, Disease Models, lcsh:Q, business, Digestive System
Abstract

International audience; BACKGROUND: Peritoneal adhesions are a serious surgical postoperative complication. The aim of this study is to investigate, in a rat model, the anti-adhesive effects of a bioabsorbable film of polymer combining polyethylene glycol and polylactic acid. MATERIALS AND METHODS: Sixty-three animals were randomized into five groups according to the anti-adhesion treatment: Hyalobarrier\textregistered, Seprafilm\textregistered, Polymer A (PA), Polymer B (PB), and control. The rats were euthanized on days 5 and 12 to evaluate the extent, severity and degree of adhesions and histopathological changes. Three animals were euthanized at day 2 in PA, PB and control groups to observe the in vivo elimination. RESULTS: Macroscopic adhesion formation was significantly lower in the PA group than in the control group at day 5 (median adhesion score 0\textpm0 vs 9.6 \textpm0.5 p = 0.002) and at day 12 (0\textpm0 vs 7.3\textpm4 p = 0.02). Furthermore, median adhesion score at day 5 was significantly lower in the PA group than in the Seprafilm group (0\textpm0 vs 4.2\textpm 3.9 p = 0.03). Residence time of PA seems longer than PB. CONCLUSION: The PA bioabsorbable film seems efficient in preventing the formation of peritoneal adhesions.

Published
2018

35. Tranexamic Acid for the Prevention of Blood Loss after Vaginal Delivery

Author

Groupe de Recherche en Obstétrique et Gynécologie, Raoul Desbriere, Nicolas Mottet, Delphine Vardon, Marie V. Sénat, Patrick Rozenberg, Hugo Madar, Antoine Bénard, L. Sentilhes, Norbert Winer, Caroline Bohec, Maela Le Lous, Elie Azria, Caroline Roussillon, Valérie Daniel, Gilles Kayem, Diane Korb, Eric Verspyck, Bassam Haddad, Florent Fuchs, Aurore Georget, Vincent Letouzey, Franck Perrotin, Céline Chauleur, Emilie Gauchotte, Fanny De Marcillac, Aurélien Mattuizzi, Sophie Regueme, Camille Le Ray, Catherine Deneux-Tharaux, Denis Gallot, Guillaume Legendre, Florence Bretelle, Olivier Parant, Laurent Salomon, Astrid Darsonval, Nicolas Sananès, Université de Bordeaux (UB), Physiopathologie des Adaptations Nutritionnelles (PhAN), Université de Nantes (UN)-Institut National de la Recherche Agronomique (INRA), Hôpital Saint Joseph, Service de biostatistique et information médicale de l’hôpital Saint Louis (Equipe ECSTRA) (SBIM), Hopital Saint-Louis [AP-HP] (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut national du cancer [Boulogne] (INCA)-Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université de Caen Normandie (UNICAEN), Normandie Université (NU), Centre Hospitalier Régional Universitaire de Tours (CHRU de Tours), Centre Hospitalier Universitaire de Montpellier (CHU Montpellier ), Centre Hospitalier Départemental Vendée, Université Claude Bernard Lyon 1 (UCBL), Université de Lyon, Hôpital de la Croix-Rousse [CHU - HCL], Hospices Civils de Lyon (HCL), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Hôpital Jeanne de Flandre [Lille], Université d'Angers (UA), Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon (CHD Vendée), and ProdInra, Migration

Subjects
macromolecular substances, 030204 cardiovascular system & hematology, law.invention, 03 medical and health sciences, 0302 clinical medicine, Pharmacotherapy, Randomized controlled trial, Blood loss, law, medicine, reproductive and urinary physiology, Pregnancy, 030219 obstetrics & reproductive medicine, Intention-to-treat analysis, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, business.industry, Vaginal delivery, General Medicine, medicine.disease, 3. Good health, Oxytocin, Anesthesia, business, Tranexamic acid, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, medicine.drug
Abstract

International audience; Among women with vaginal delivery who received prophylactic oxytocin, the use of tranexamic acid did not result in a rate of postpartum hemorrhage of at least 500 ml that was significantly lower than the rate with placebo. (Funded by the French Ministry of Health; TRAAP ClinicalTrials.gov number, NCT02302456 .).

Published
2018

36. Impact of systematic urinary catheterization protocol in delivery room on covert postpartum urinary retention: a before-after study

Author

Mathias Neron, Vincent Letouzey, Stéphanie Huberlant, Lucie Allegre, Renaud de Tayrac, Brigitte Fatton, Eve Mousty, Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Institut des Biomolécules Max Mousseron [Pôle Chimie Balard] (IBMM), Centre National de la Recherche Scientifique (CNRS)-Institut de Chimie du CNRS (INC)-Université de Montpellier (UM)-Ecole Nationale Supérieure de Chimie de Montpellier (ENSCM), and Université de Montpellier (UM)

Subjects
Adult, medicine.medical_specialty, medicine.medical_treatment, Urinary Bladder, 030232 urology & nephrology, lcsh:Medicine, Urinary catheterization, Article, 03 medical and health sciences, 0302 clinical medicine, Catheterization procedure, Pregnancy, medicine, Humans, Prospective Studies, lcsh:Science, Prospective cohort study, 030219 obstetrics & reproductive medicine, Multidisciplinary, Urinary retention, Obstetrics, business.industry, Delivery Rooms, lcsh:R, Postpartum Period, Urinary Retention, medicine.disease, Delivery, Obstetric, Confidence interval, 3. Good health, Controlled Before-After Studies, lcsh:Q, Observational study, Female, France, medicine.symptom, business, Urinary Catheterization, Postpartum period, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

We investigated whether implementation of a routine catheterization procedure in labor improves covert postpartum urinary retention (cPUR) rates. We conducted a prospective before-after study. 121 women admitted to delivery room in the observational group, and 82 in the intervention group, in a tertiary university hospital in Southern France were included. All patients in the intervention group were systematically catheterized 2 hours after delivery. cPUR was screened for in both groups. The primary end-point was cPUR (post-void residual bladder volume >150 ml when voided volume is >150 mL). The rate of cPUR decreased from 50% (60 out of 121 patients) in the observational group to 17% (14/82) in the intervention group (OR = 0.21; 95% Confidence Interval [0.13;0.58]; p

Published
2017

37. Prévention et traitement des synéchies endo-utérines : revue de la littérature

Author

Sophie Warembourg, R. de Tayrac, Salome Leprince, Vincent Letouzey, S. Huberlant, and Xavier Garric

Subjects
medicine.medical_specialty, 030219 obstetrics & reproductive medicine, Web of science, medicine.diagnostic_test, Pelvic adhesions, business.industry, General surgery, MEDLINE, Obstetrics and Gynecology, Asherman's syndrome, General Medicine, Cochrane Library, medicine.disease, Secondary infertility, 3. Good health, 03 medical and health sciences, 0302 clinical medicine, Reproductive Medicine, Hysteroscopy, 030220 oncology & carcinogenesis, medicine, Adhesion prevention, business
Abstract

Intra-uterine adhesions are a major cause of secondary infertility. The prevalence of adhesions is probably underestimated due to the heterogeneity of the symptoms. An exhaustive literature search using search engines MEDLINE, Pubmed, Cochrane library and Web of Science was performed to make a focus on the origins, consequences and methods of prevention of intra-uterine adhesions. Intra-uterine adhesions are likely to occur after any endo-uterine surgery via dysregulated activation of coagulation chain linked to the inflammatory process. Early and late obstetric complications are also recognized as caused by adhesions. The diagnosis is currently performed by hysteroscopy but it remains an invasive procedure even if it can be done with an ambulatory management. Several research approaches inspired by intra-abdominal surgery for the prevention of pelvic adhesions have been developed. However, no current method of prevention has proven its effectiveness in terms of improving spontaneous fertility. The improvement in surgical practices, the design of new intra-uterine medical devices and new research especially in the field of endometrial stem cells can maybe reduce the rate of adhesions end their complications after intra-uterine surgery.

Published
2015

38. Obstetric antiphospholipid syndrome: early variations of angiogenic factors are associated with adverse outcomes

Author

Erick Mercier, Antonia Perez-Martin, Sylvie Bouvier, Ève Mousty, Isabelle Quéré, Eva Cochery-Nouvellon, Vincent Letouzey, Jean-Pierre Balducchi, Jean-Christophe Gris, Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Caractéristiques féminines des dysfonctions des interfaces cardio-vasculaires (EA 2992), Université Montpellier 1 (UM1)-Université de Montpellier (UM), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Institut des Biomolécules Max Mousseron [Pôle Chimie Balard] (IBMM), and Centre National de la Recherche Scientifique (CNRS)-Institut de Chimie du CNRS (INC)-Université de Montpellier (UM)-Ecole Nationale Supérieure de Chimie de Montpellier (ENSCM)

Subjects
Adult, medicine.medical_specialty, Adolescent, Placenta, 030204 cardiovascular system & hematology, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Fibrinolytic Agents, Antiphospholipid syndrome, Pregnancy, medicine, Humans, Young adult, Tyrosine, reproductive and urinary physiology, Aspirin, Hemostasis, 030219 obstetrics & reproductive medicine, Vascular Endothelial Growth Factor Receptor-1, Obstetrics, business.industry, Pregnancy Outcome, Membrane Proteins, [SDV.MHEP.HEM]Life Sciences [q-bio]/Human health and pathology/Hematology, Hematology, Heparin, Articles, Heparin, Low-Molecular-Weight, medicine.disease, Antiphospholipid Syndrome, 3. Good health, Pregnancy Complications, Pregnancy Trimester, First, PIGF, embryonic structures, Gestation, Female, business, medicine.drug
Abstract

International audience; The prognostic value of angiogenic factors in newly pregnant women with obstetric antiphospholipid syndrome (oAPS) has not been documented. We observed 513 oAPS who experienced three consecutive spontaneous abortions before the 10th week of gestation or one fetal loss at or beyond the 10th week. We assessed the plasma concentrations of the proangiogenic factor placenta growth factor (PIGF) and of the antiangiogenic factor soluble fms-like tyrosine kinase-1 on the eve and on the 4th day of the low-molecular weight heparin-low-dose aspirin treatment. Placenta growth factor and fms-like tyrosine kinase-1 plasma concentrations showed marked increases. Treatment-associated variations of PIGF and of soluble fms-like tyrosine kinase-1 were antagonist risk factors for placenta-mediated complications (PMC) and for severe PMC, for fetal death, stillbirth and neonatal death. The ratio between PIGF increase and soluble fms-like tyrosine kinase-1 was a summary variable whose best cut-off values (1.944.10-2) had high negative predictive values for PMC (0.918) and may be used to help rule out the development of PMC in evolutive pregnancies after 19 completed weeks. The early variations of PIGF and soluble fms-like tyrosine kinase-1 concentrations in newly pregnant oAPS may help to detect patients at low risk of PMC. (clinicaltrials.gov identifier: 02855047).

Published
2017

39. Treatment of neovaginal prolapse: case report and systematic review of the literature

Author

Mathias Neron, Vincent Letouzey, Gwenaël Ferron, Brigitte Fatton, Renaud de Tayrac, Pierre Vieille, Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Institut Claudius Regaud, Université de Montpellier (UM), Institut des Biomolécules Max Mousseron [Pôle Chimie Balard] (IBMM), and Centre National de la Recherche Scientifique (CNRS)-Institut de Chimie du CNRS (INC)-Université de Montpellier (UM)-Ecole Nationale Supérieure de Chimie de Montpellier (ENSCM)

Subjects
medicine.medical_specialty, Sacrum, Urology, medicine.medical_treatment, 030232 urology & nephrology, Uterine Cervical Neoplasms, [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, 03 medical and health sciences, 0302 clinical medicine, Postoperative Complications, Uterine Prolapse, Neovagina, medicine.ligament, Prolapse, medicine, Humans, Omentoplasty, Sacrospinous ligament, Aged, 030219 obstetrics & reproductive medicine, Pelvic exenteration, business.industry, Carcinoma, Obstetrics and Gynecology, Uterine prolapse, Plastic Surgery Procedures, Surgical Mesh, Recurrent Cervical Carcinoma, medicine.disease, 3. Good health, Surgery, Pelvic Exenteration, medicine.anatomical_structure, Surgical mesh, Treatment Outcome, Vagina, Vaginoplasty, Female, Neoplasm Recurrence, Local, business, Uphold
Abstract

International audience; INTRODUCTION AND HYPOTHESIS:Neovaginal prolapse (NP) is a rare event as few cases have been reported in the literature. Its management is complex and depends on the initial pathology, the vaginoplasty technique and the patient's history. We present a review the literature on this rare event.METHODS:We describe the case of a 72-year-old woman who presented with NP 1 year after pelvic exenteration and radiotherapy for recurrent cervical carcinoma associated with vaginal reconstruction by shaped-tube omentoplasty. She had undergone two previous surgical procedures (posterior sacrospinous ligament suspension and partial colpocleisis), but NP recurred each time within a few months. We performed an anterior approach to the sacrospinous ligament and inserted a mesh under the anterior wall of the neovagina, with the two mesh arms driven through the sacrospinous ligament in a tension-free manner (Uphold Lite® system). The MEDLINE, Cochrane Library, ClinicalTrials and OpenGrey databases were systematically searched for literature on the management of NP following bowel vaginoplasty, mechanical dilatation, graciloplasty, omentoplasty, rectus abdominis myocutaneous flap and the Davydov procedure.RESULTS:The postoperative course in the patient whose case is described was uneventful and after 1 year of follow-up, the anatomical results and patient satisfaction were good. The systematic search of the databases revealed several studies on the treatment of NP using abdominal and vaginal approaches, and these are reviewed.CONCLUSIONS:Overall, sacrocolpopexy would appear to be a good option for the treatment of prolapse after bowel vaginoplasty, but too few cases have been reported to establish this technique as the standard management of NP.

Published
2017

40. Methods of pushing during vaginal delivery and pelvic floor and perineal outcomes: a review

Author

Vincent Letouzey, Renaud de Tayrac, Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Institut des Biomolécules Max Mousseron [Pôle Chimie Balard] (IBMM), and Centre National de la Recherche Scientifique (CNRS)-Institut de Chimie du CNRS (INC)-Université de Montpellier (UM)-Ecole Nationale Supérieure de Chimie de Montpellier (ENSCM)

Subjects
Episiotomy, medicine.medical_specialty, Valsalva Maneuver, medicine.medical_treatment, Prenatal care, [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, Oxytocin, Perineum, Lacerations, law.invention, 03 medical and health sciences, 0302 clinical medicine, Patient satisfaction, Randomized controlled trial, law, Labor Stage, Second, Pregnancy, medicine, Valsalva maneuver, Humans, 030212 general & internal medicine, Randomized Controlled Trials as Topic, Gynecology, 030219 obstetrics & reproductive medicine, Pelvic floor, Labor, Obstetric, Vaginal delivery, Obstetrics, business.industry, Cesarean Section, Pregnancy Outcome, Obstetrics and Gynecology, Prenatal Care, Pelvic Floor, Heart Rate, Fetal, medicine.disease, Delivery, Obstetric, 3. Good health, medicine.anatomical_structure, Patient Satisfaction, Female, business
Abstract

International audience; PURPOSE OF REVIEW:Over the past 20 years, several randomized studies have compared Valsalva and spontaneous pushing techniques during vaginal delivery. This review summarizes current medical knowledge concerning their maternal and fetal consequences, focusing on pelvic and perineal outcomes.RECENT FINDINGS:We selected nine randomized controlled trials comparing Valsalva and spontaneous pushing, and a secondary analysis of a randomized controlled trial comparing different methods of perineal protection. Two trials showed that spontaneous pushing reduces the risk of perineal tears, but no firm conclusions can be drawn given the heterogeneity and inconsistent results of these studies. Conflicting results have been reported regarding the duration of the second stage of labor. Pushing technique does not seem to affect episiotomy, instrumental delivery or cesarean rates. Maternal satisfaction seems to be better after spontaneous pushing. Spontaneous pushing appears to have no adverse effects on neonatal well being, and one study showed a significant improvement in prenatal fetal parameters during the expulsive phase.SUMMARY:Valsalva and spontaneous pushing techniques currently appear comparable in terms of duration, pelvic floor, perineal, and neonatal outcomes. In the absence of strong evidence in favor of either technique, the decision should be guided by patient preference and the clinical situation. Additional, well-designed randomized controlled trials are required.

Published
2016

42. Evaluation Objective Des Symptomes : Et Information Des Patientes

Author

Pierre Mares, Vincent Letouzey, and Renaud de Tayrac

Subjects
medicine.medical_specialty, Pelvic floor, business.industry, Urinary system, General Medicine, Objective assessment, Distress, medicine.anatomical_structure, Multidisciplinary approach, medicine, Ovarian conservation, Sex organ, Stage (cooking), Intensive care medicine, business
Abstract

Genital prolapse is a functional pathology presenting with numerous urinary, genito-sexual, and anorectal symptoms. These symptoms are responsible for an alteration of the quality of life, sometimes associated to a real anxiety-depressive syndrome. Because of these complex intricacies, the management of these disorders became multidisciplinary. Tools to measure the impact of prolapse symptoms on the quality of life became a necessity. Such instruments should allow a correlation of the functional symptomatology at the anatomic stage, raise a surgical indication based on the functional disturbance and evaluate the effectiveness and tolerance of the various therapeutic procedures. Two validated self-questionnaires in French (short versions of the Pelvic Floor Distress Inventory [PFDI-20] and the Pelvic Floor Impact Questionnaire [PFIQ-7]) are presently available. Moreover, the physician has the legal obligation to provide detailed presurgical information on frequent and severe hazards, expected benefits, functional consequences, therapeutic alternatives and the consequences of nonintervention. Before surgery takes place, the surgical approach, the benefit of using synthetic prostheses, the possibility of uterine and/or ovarian conservation, and some risky conditions such as smoking, obesity and estrogen deficiency should be discussed.

Published
2013

43. Prevention of complications related to the use of prosthetic meshes in prolapse surgery: guidelines for clinical practice

Author

Vincent Letouzey, Aubert Agostini, Pierre Mares, Fabrice Pierre, Denis Savary, Xavier Deffieux, and Loïc Sentilhes

Subjects
Adult, medicine.medical_specialty, medicine.medical_treatment, MEDLINE, Polypropylenes, Pelvic Organ Prolapse, Postoperative Complications, Obstetrics and gynaecology, Uterine Prolapse, Fascia lata, medicine, Humans, Antibiotic prophylaxis, Cross Infection, Hysterectomy, business.industry, Obstetrics and Gynecology, Uterine prolapse, Prostheses and Implants, Perioperative, Guideline, Antibiotic Prophylaxis, Surgical Mesh, medicine.disease, Surgery, medicine.anatomical_structure, Reproductive Medicine, Surgical Procedures, Operative, Female, business
Abstract

The objective of the study was to provide guidelines for clinical practice from the French College of Obstetrics and Gynecology (CNGOF), based on the best evidence available, concerning adverse events related to surgical procedures involving the use of prosthetic meshes. French and English-language articles from Medline, PubMed, and the Cochrane Database were searched, using key words (mesh; pelvic organ prolapse; cystocele; rectocele; uterine prolapse; complications; adverse event; sacral colpopexy; extrusion; infection). As with any surgery, recommendations include perioperative smoking cessation (Expert opinion) and compliance with the prevention of nosocomial infections (regulatory recommendation). There is no evidence to recommend routine local or systemic estrogen therapy before or after prolapse surgery using mesh, regardless of the surgical approach (Grade C). Antibiotic prophylaxis is recommended, regardless of the approach (Expert opinion). It is recommended to check for pre-operative urinary tract infection and treat it (Expert opinion). The first procedure should be undertaken under the guidance of a surgeon experienced in the relevant technique (Grade C). It is recommended not to place a non-absorbable synthetic mesh into the rectovaginal septum when a rectal injury occurs (Expert opinion). Placement of a non-absorbable synthetic mesh into the vesicovaginal septum may be considered after suturing of a bladder injury if the suture is considered to be satisfactory (Expert opinion). If a synthetic mesh is placed by vaginal route, it is recommended to use a macroporous polypropylene monofilament mesh (Grade B). It is recommended not to use polyester mesh for vaginal surgery (Grade B). It is permissible to perform hysterectomy associated with the placement of a non-absorbable synthetic mesh placed by the vaginal route but this is not routinely recommended (Expert opinion). It is recommended to minimize the extent of the colpectomy (Expert opinion). The laparoscopic approach is recommended for sacral colpopexy (Expert opinion). It is recommended not to place and suture meshes by the vaginal route when a sacral colpopexy is performed (Grade B). It is recommended not to use silicone-coated polyester, porcine dermis, fascia lata, and polytetrafluoroethylene meshes (Grade B). It is recommended to use polyester (without silicone coating) or polypropylene meshes (Grade C). Suture of the meshes to the promontory can be performed using thread/needle or tacks (Grade C). Peritonization is recommended to cover the meshes (Grade C). If hysterectomy is required, it is recommended to perform a subtotal hysterectomy (Expert opinion). Implementation of this guideline should decrease the prevalence of complications related to surgical procedures involving the use of prosthetic meshes.

Published
2012

44. Clinical features and prognostic factors of listeriosis: the MONALISA national prospective cohort study

Author

Odile Fremin-Batteux, Juliette Clarissou-Philippe, Benoît Jauhlac, Severine Guyetand, Jacques Gasnault, Corinne Haioun, Liamine Aissaoui, Marie-Christine Pages, Marie-Pierre Fos, Christian Rose, Didier Hubert, Marie-Rose Rothe, N. Bouziges, Benoît Huc, François Devianne, Sabine Bidart, Anne Forest, Kevin Bertrand, Mohamed Eldeghedy, Annick Verhaeghe, Caroline Malderet, Anne Bertrou, Bernard Guerquin, Catherine Duche, Muriel Archambaud, Rabea Cotteret, Olivier Toullalan, Yves Devaux, Smail Bergheul, Valérie Sivadon-Tardy, Pierre-Gilles Merville, Geneviève Blanchard-Marche, Didier Raoult, Bernard Hory, Florence Richardin, Evelyne Belle, Mohamed Menouar, K Guitteaud, Mohamad Mohty, Ambroise Montcriol, Max Laurin, Aurélia Picard, Jean-Paul Mira, Marie-Charlotte Chopin, Richard Bonnet, Michel Wolff, Sébastien Maillez, Jeanne Maugein, Véronique Leblond, Nicola Walid, Bernard Gauche, Mathieu Evillard, Hassen Jeddi, Anne Bourlet, Isabelle Grawey, Thierry Jault, Sandrine Hiret, Valerie Gaborieau, Véronique Boin-Gay, An Kim, Thierry Constans, Jean-François Gaide, Martine Giraud, Eric Meaudre Desgouttes, Alain Fur, Abdallah Maakaroun, Olivier Matray, Bertrand Maubert, Frédérique Péchinot, Aurelie Garbi, Claire Delbrouck, Benoît Grandclerc, Vincent Cadiergue, Hervé Lécuyer, Bernadette Grignon, Thierry Bensaid, Nicole Constantin, Yannick Chevalier, Hassène Rahmani, Thierry Levent, Joelle Desliers, Florence Van de Velde, Xavier Adhoute, Clara Andriau, Christophe Charasse, Rémi Vatan, Benoît Martha, Alain Lecis, Didier Albert, Romain Jacobs, Hélène Lefranc, Christian Martin, Nasseur Rezgui, Bertrand Pigeon, Catherine Le Henaff, Dominique Cassignard, Françoise Cotes, Eric Pujade Lauraine, Jean-François Gattault, Nicole Ferreira-Maident, Noémie Jourde-Chiche, Hélène Garrec, Olivier Darchen, Carole Schwebel, Marie-Christine Bezian, Patrick Daoud, Tsouria Becaid, Simone Laluque, David Broche, Christine Boisselier, Pascale Martres, Sarah Hammami, Brigitte Olivier, Jean-Marie Nkunzimana, Eric Monlun, Isabelle Marterl-Lafay, Marion Carboni, Marie-Françoise Mattei, Sandrine Castelin, Isabelle Barillot, Marie-Noelle Cufi, Thomas Kaiser, Catherine Herry, Pascal Hutin, Jean-Pierre Bronowicki, Bernard Branger, Pierre Thomas, Elie Zagdoun, Anne Goquelin, Ziad Assaf, Ingrid Croquet, Bruno Pozzetto, Thomas Similowski, Anne-Isabelle Briere, Marie-Thérèse Albertini, Mariam Blaka, Christelle Tassot, Anne Gaschet, Jean-Philippe Lavigne, Antoine Pujol, Philippe Colombat, Edouard Devaud, Hana Talabani-Boizot, François Barière, Anne-Marie Cordier, Philippe Gueudet, Georges Simon, Anne-Sophie Lipovac, Françoise Bandaly, Anne Beauplet-Lepage, Sylvie Prince, Charlotte Jouzel, Jean-Luc Deboutin, Patrick Zavadil, Louis Puybasset, Marie-Cécile Petit, Loïc Guillevin, Kamel Touati, Christophe Ntalu Nkato, Sylvie Carette, Jacques Vaucel, Chantal Delasalle, Marine Gross Goupil, Laurent Gutmann, Christiane Payen, Annick Barboteau, Firouzé Bani-Sadr, Christophe Legendre, Philippe Roulier, Elie Azria, Ibrahim Farah, Isabelle Rouquette-Vincent, Anne-Sophie Erena-Penet, Philippe Labadie, Eric Josien, Aicha Derragui, Mathieu Legrand, Odile Beyne-Rauzy, Jean-Marc Nabholtz, Marie-Joelle Demarcq, Olivier Garosi, Michel Deiber, Fabrice Chaix, Bertrand Souweine, Anne Collignon, Gisèle Renard, Mickael Jego, Gilles Bernardin, Anne Allart, Jocelyn Barrier, Marc Vasse, Philippe Ménager, Marc Wurmser, Abderkader Ouazir, Olivier Gontieron, Yvon Berland, Sébastien Trouiller, David Leysenne, Christophe Ozanon, Fanny Autret, Tahar Saghi, Loïc Dopeux, Sophie Benoit-Coustou, T. Fraisse, Christine Maillard, Karine Nikodijevic, Georges Kaltenbach, Angéline Jamet, Philippe Aucher, Julie Bottero, Marie-Claude Piffaut, Marianne Besnard, Florence Courillon, Marie Bonfils, Christine Ghevaert, Marie Destors, Eliette Jeanmaire, Franck Zerbib, Manuel-Luis Gameiro, T Prazuck, Laurent Mandin, Olivier Guisset, Marguerite Fines, Toufik Feddal, Agnès Jouffret, Louis Mesnard, Thomas Bourrée, Hasinrina Razafimahefa, Sylvestre Tigaud, Vincent Estève, Philippe Malherbe, Jean-Michel Salord, Pascal Adam, Bertrand Rozec, Michel Fuillet, Olivier Lemenand, Denis Quinsat, Ana Danalaché, Véronique Vialette, François Brosset, Patrick Messner Pellenc, Nicolas Heisel, Edouard Girard, Régine Martin, Olivier Garesslin, Catherine Mille, Alexandre Gascon, Marc Nicolino, Laurence Mouly, Claire Fabre, Bénédicte Ponceau, Marie-Etiennette Emeriau, Pascal Cathebras, Bérangère Bernardaud, Michèle Pérouse de Montclos, O. Arsene, Karine Grenet, Yazdan Yazdanpanah, Sten De Witte, Anne Scemla, Laurence Bouillet, Christophe Burucoa, Vincent Loffeier, Séverine Visentin, Luc Desfrere, Miloud Arabi, Frédérique Costa, Sylvie Lechat, Ali Chekroun, Raymond Ruimy, Marie, Jérôme Bizet, Xavier Nassif, Baihas Dib, Patrick Bert-Marcaz, Laurent Martin Lefèvre, Nicholas Sedillot, Blandine Cattier, Emilie Boidin, Daniel Sondag, Aude Bourrouillou, Alain Noirot, Franck Desemerie, Fréderic Heluwaert, Catherine Tamalet, Marc G. Berger, Jean-Daniel Lelièvre, Dominique Perotin, Abdelkader Bemrah, Alain Lozniewski, Bernard Borstein, Hanna Eid, Diana Suatean, Virginie Mignaut, Jean-Claude N'guyen, Valérie Le Goff, Laurent Teillet, Christophe Rolland, Gwenaël Alfonsi, Florence Lachenal, Philippe Bossi, Yves Botreau, Florence Doucet Populaire, Henry Jardel, Nicolas Gallo, Elias Jabre-Sikias, Michel Dupon, Hélène Brihier, Isabelle Patry, Alexandre Leclercq, Bernadette Tourrand, Christophe Roussel, Jean-Emmanuel Kurtz, Bénédicte Paindaveine, Simon Elhadad, Richard Sanchez, Eric Sgro, Pierre Berger, Valérie Murbach, Anne Holstein, Florence Martin, Taoufik Merabet, Amélie Benbara, Milagros Ferreyra, Laure Esposito, Pierre Delobel, Antoine Andremont, Marc Bourlière, Carole-Anne Boudy, Jean-Baptiste Gaulthier, Laurent Tacchini, Olivier Marpeau, Sonia Tesseydre, Marie-Pierre Coulhon, Nathalie Hodee, Marie-Chrsitine Conroy, Pierre Weinbreck, Roland Leclercq, Laurent Souply, Christian Bidault, Annie Elbez, Marie-Annick Lebreton, Patrick Brisou, Agnès Ferroni, Jean-Louis Pourriat, Nadia Anguel, Christian Noel, Philippe Jouvencel, Eric Pichard, Xavier Martin, Mathieu Coste, Pierre Zuber, Catherine Neuwirth, Jean-Pierre Hacot, Paul Aye, Jérôme Guinard, Yves Pean, Jean-Christophe Dengo, Fabrice Petassou, Didier Viole, Thierry Messiaen, Jean Beytout, Philippe Petitjean, Ferdinand Savare, Patrice Cuvillier, Sophie Coignard, Hélène Anglaret, Nassim Kamar, Elisabeth Chachaty, Karine Guimard, Louis Braem, Hacene Fezoui, Pierre Martin, Jean-Paul Viard, Claire Larroche, Nicolai Claudiu-Plesa, Thierry Benoit-Cattin, Olivier Moquet, Thierry Pasdeloup, David Rosay, Rodolphe Jean, Jean-Bernard Mariette, Marc Debouverie, Hervé Peltier, Mustapha Terki, Jacques Daleas, Valérie Dattin-Dorrière, Michel Vergnaud, Emmanuel Grimprel, Sylvène Rosselli, Jean-Marc Didier, Pierre Faurie, Luc Frimat, Aziza Mandjee, Sabine Etchemendy, Pierre Tissières, Jean Nakhleh, Sylvie Mariette, Christian Perronne, Bruno Carbonne, Nathalie Houssiaux-Maisonneuve, Tristan Ferry, S Beague, Anthony Sebban, Marie-Thérèse Hili, Jean-Michel De Kermadec, Lucien Brasme, Gilles Blaison, Caroline Garandeau, Jean-Pierre Sollet, Laurent Tronchon, Thierry Samson, Julien Gesquière, Nicolas Ettahar, Alain Créange, Etienne Laurens, Véronique Equy, Fréderic Bart, Bernard Bouffandeau, Christine Vaillant, Valerie Pesque, Jean-Marc Lalot, Marc Levy, Michel Kaidomar, Mihaela Saplacan, Sterenn Yvenou, Marie-Isabelle Steibach, Emmanuelle Cambau, Agnès Riche, François Fourrier, François Raffi, Mélissa Lalu, Henri Bérard, Danielle Clave, Jean-Claude Mouries, Martine Porcheron, Jean Cabalion, Richard Lamarca, Nathalie Canu, Jean-Baptiste Roseau, Annabelle Stoclin, Luca Luminitan Elena Lupean, Rémi Gebeile, Celia Salanoubat, Carole Marmouset, Pierre Bigot, Anne-Laure Breton, Pierre Kalfon, Colette Vincent, Sophie Marty, Olivier Tandonnet, Alexis Redor, Xavier Valette, Ourida Aoudia, Jacques-Arnaud Seyrig, Bertrand Beaune, Hugues Aumaitre, Georges Pinon, Yann Leveneur, Sylvie Charachon, Raoul Herbrecht, Henriette de Valk, Gary David, Julien Pouyanne, Marc Dommergues, Majed Al Chaar, Véronique Blanc-Amrane, Pascale Guillarmé Grossmann, Bruno Abraham, Yves Morel, Philippe Suel, Denis Sautereau, Olivier Guilloy, Tu Anh Tran, Frédéric Laurent, Zahir Amoura, Jacques-Olivier Bay, Zoubida Elharie-Heraux, Joyce Sibony-Prat, Bernard Guillois, Dominique Rohmer-Heitz, Audrey Barrelet, Jérémie Courouble, Jean-Paul Herry, Daniel Vittecoq, Annie Vermesch-Langlin, Jean Auroux, Claude Aubert, Thierry Harvey, Ghislaine Lamoine-Gimet, J. Riahi, Florence Soraudeau, Bachar Al-Jalaby, Caroline Périsson, Khélifa Ayouz, Florence Cardot, François Maillet, Alain Goux, Théophile Magna, Bertille de Barbeyrac, Adrien May, Dominique Andreotti, Olivier Jonquet, Hélène Dumouchel, Didier Thibaud, Philippe Morlat, Pascal Chevalet, Pascal Ancelin, Guy Chambreuil, Cécile Le Boterff, Anne Ceriez, Olivier Detante, B Pangon, Claude C.A. Bernard, Vincent Cailleaux Pierre-Etienne Cailleux, Jordi Miatello, Pierre-Yves le Berruyer, Sylvain Kouaho, Michel Briaud, Hélène Delaby, Patrick Herbecq, Christine Segonds, Véronique Jault, Pascale Brunel, Christine Dussopt, Jean Thore, Jean-Marc Thouret, Jean-Marc Kerleau, François Le Baron, Slavius Matica, Sophie Leautez-Nainville, Matthieu Pecquet, Laurent Bret, Yacine Sedjelmaci, Pierre Metton, Habiboulaye Diallo, Jany Rey Zermati, Arnaud Delahaye, Hélène Chaussade, Laurent Mandelbrot, Emilie Bessede, Olivier Casanovas, Paul Pierrot, Annick Legras, Dominique Lauque, Hélène Gatti, Jean Catineau, Ebutu Likose, Gilles Capellier, Eric Kibbrecht, Freddy Thibaut, Patrick Valadier, Chantal Lemble, Joël Gaudelus, Joelle Mellier, Joëlle Brochen, Emmanuel Gascou, Stéphane Bonacorsi, Stéphanie Bannier, Bruno Fantin, Didier Raffenot, Valérie Revel, Hakim Amroun, Huguette Negrery, Anne-Laure Fauchais, Paul Mercury, Michel Chuzeville, Christian Zumbo, Nicolas Després, Pascal Roblot, Jérôme Pasche, Jean Claude Boufetteau, Jocelyne Caillon, Julien Boileau, V. Rabier, Benjamin Manéglier, Emilie Jourdes, Franck Ceppa, Christine Recule, Nicolas Degand, Benoît Henry, Thierry Baranger, Dominique Pateron, Agnès Pélaquier, Gérard Bouchet, Hélène Fiette, Ozel Guiden, Dana Ranta, Etienne Ruppé, Nabil Chiouk, Jacques Breuil, Dominique Leduc, Véronique Loustaud, Hervé Métenier, Michel Durand, Isabelle Mahé, Leila Karaoui, Marie-José Collus, Mehran Monchi, Olivier Belmonte, Romain Blondet, Jacques Thierry, Karine Humbert, Gilles Salama, Marie-Noelle Heurtaux, Cécile Goujard, Bruno Sivery, Martial Boisseau, Redouane Dahoumane, Pierre Delour, Christian Niels Meyer, Anne Faudon-Gibelin, Gérard Poulain, Roger-Charles Luciani, J.-C. Souquet, Olivier Grossi, François Vandenesch, Sylvain Mermont, Jacques Bronner, Sonia Dahan, Paul Marzouk, Pascal Pouedras, Noureddine Djafari, François-Xavier Caroli-Bosc, Jean-François Dessin, Brigitte Gruffat, Armelle Morin-Fatome, Sylvie Thoinet, Bano Konate, Jean-Winoc Decousser, Claire Poyart, Patrick Plessis, Olivier Millet, Vincent Cattoir, Françoise Geffroy, Manica Vasseur, Pierre Carli, Isabelle Citony, Christian Richard, Nicolas Sigur, Patrick Marthelet, Luwawu Mbimba, Pierre Feugier, Philippe Sauder, Hama Djerad, Evelyne Bourgerette, Hanen Chahtour, Adrien Lemaignen, Dominique Bechade, Patrick Ochocki, Antoine Vieillard Baron, Dominique Astruc, Marie-Pierre Moiton, Nicolas Dubois, Sylvie Ledru, Corinne Seknazi, Hélène Poupet, Jean-Philippe Brieux, Gérard Barthélémy, Aihem Yehia, Louis-Jean Couderc, Ahmed, Françoise Rigaux, Yohann N'guyen, Philippe Bethery, Damien Corberand, Etienne Auvray, Paul-Louis Woerther, Christian Combe, Sophie Delesalle, Jean-Marie Piala, Faraj Al Freijat, Philippe Juvin, Malcolm Lemyze, Hyacine Rey, Claire Larible, Noel Milpied, Lémia Zgarni, Julia Gaillard, Agnès Juven, Paola Otean, Adrien Melis, André Pechinot, Olivier Bouchaud, Olivier Chassin, Pierre Hausfater, Asma Trabelsi-Jnifen, Vincent Grobost, Didier Lemery, Pierre Soury, Françoise Brevet, Jacques Tankovic, Dominique Sansot, Jean Louis Salomon, Charlotte Cordonnier, Brigitte Lamy, Antoine Maisonneuve, Dominique Pressac, Claude Rémy, Rodolphe Sobesky, Stéphanie Cognet, Pierre Cougoul, Didier Jan, Dominique Perrotin, Cécile Hombrouk-Alet, Thierry André, Gilbert Pochmalicki, Serge Girard, Vincent Zerr, Guillaume Cadiot, Claudine Lasbasses, Michel Slama, Abderrazak El Yamani, Sophie Brovedani, Jean Armengaud, Romain Hernu, Géraldine Mascade, Aurélien Lorléa'ch, Ali Akkari, Mathieu Tourdjman, Christopher Payan, Eric Jullian, Nathalie Fonsale, Frédéric Riehl, Paul Strock, Geneviève Grise, Philippe Mottaz, Christian Floriot, Marie-Noëlle Ungeheuer, Denis Caillot, Arnaud 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Lafforgue, Anne Le Du, C. Beuscart, Pierre Guillet, Fabrice Larrazet, Marie-Hélène Hausermann, Henri Robert, Nicolas Fanjaud, François Goehringer, Thomas Bachelot Philippe Badia, Jean-Michel Coulaud, Cristel Fissore Magdelein, Renaud Defebvre, Anne-Sohie Moreau, Johan Courjon, Gilles Salles, Michel Mialon, Silvia Iacobelli, Emmanuelle Bille, Marie-Christine Barbier, Yves Aubard, Patrice Badila, Jean-Philippe Rasigade, Alban Deroux, Evelyne Lecaillon-Thibon, Michel Godin, Abdelmajid Djeffal, Viorica Badurescu, Meriem Canitrot, Pierre Blanchard, Antoine Legros, Laurence Got, Françoise Duluc, Mylène M. Maury, Gilles Dassieu, Nordine Khodeir, Jean-Marie Duez, Mathieu Morincomme, Jérôme Lacroix, Mathieu Revest, Koffi Blewoussi, Isabelle Barazer, Françoise Poitevin, Camille Seignovert, Stéphanie Honore Bouakline, Anne Heidt, Brigitte Malbruny, Julien Desblache, Christian Cattoen, Eric Jaunait, Bruno Chaminade, Claude Bazin, Jonathan Chelly, Anne Pottier, Alain Schmitt, Alain Tissot, Karim Dadoun, P. 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(AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre National de Référence Listeria - National Reference Center Listeria (CNRL), Institut Pasteur [Paris] (IP)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre collaborateur de l'OMS Listeria / WHO Collaborating Centre Listeria (CC-OMS / WHO-CC), Institut Pasteur [Paris] (IP)-Organisation Mondiale de la Santé / World Health Organization Office (OMS / WHO), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université Pierre et Marie Curie - Paris 6 - UFR de Médecine Pierre et Marie Curie (UPMC), Université Pierre et Marie Curie - Paris 6 (UPMC), Département de Médecine interne [Lariboisière], Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), Biologie des Infections - Biology of Infection, Service de Gynécologie et Obstétrique [Cochin], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Investigation Clinique et d’Accès aux Ressources Biologiques (Plate-forme) - Clinical Investigation and Access to BioResources (ICAReB), Institut Pasteur [Paris] (IP), Infectious Disease Department [Saint Maurice], Agence Nationale de la Santé Publique [Saint-Maurice] (ANSP), Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS (U1153 / UMR_A_1125 / UMR_S_1153)), Institut National de la Recherche Agronomique (INRA)-Université Paris Diderot - Paris 7 (UPD7)-Université Paris Descartes - Paris 5 (UPD5)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris Descartes - Paris 5 (UPD5), CHU Amiens-Picardie, Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517 (MP3CV), Université de Picardie Jules Verne (UPJV)-CHU Amiens-Picardie, MONALISA study group, Programme Hospitalier Recherche Clinique, Institut Pasteur, Inserm, French Public Health Agency., ROZIER, marie-Claire, CHU Necker - Enfants Malades [AP-HP], Centre National de Référence Listeria - Biologie des Infections (CNRL), Institut Pasteur [Paris]-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre collaborateur de l'OMS Listeria - Biologie des Infections (CCOMS), CHU Pitié-Salpêtrière [APHP], Hôpital Lariboisière-Université Paris Diderot - Paris 7 (UPD7), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Cochin [AP-HP], Institut Pasteur [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Necker - Enfants Malades [AP-HP], Centre National de Référence Listeria - Biologie des Infections ( CNRL ), Institut Pasteur [Paris]-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Centre collaborateur de l'OMS (CCOMS) des Listeria ( CCOMS ), Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité ( CRESS (U1153 / UMR_A 1125) ), Institut National de la Recherche Agronomique ( INRA ) -Université Sorbonne Paris Cité ( USPC ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Université Pierre et Marie Curie - Paris 6 - UFR de Médecine Pierre et Marie Curie ( UPMC ), Université Pierre et Marie Curie - Paris 6 ( UPMC ), Université Paris Diderot - Paris 7 ( UPD7 ) -Hôpital Lariboisière, Biologie des Infections, Institut Pasteur [Paris]-Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Investigation Clinique et d’Accès aux Ressources Biologiques (Plate-forme) - Clinical Investigation and Access to BioResources ( ICAReB ), Agence Nationale de la Santé Publique [Saint-Maurice] ( ANSP ), Assistance Publique - Hôpitaux de Paris, Assistance publique - Hôpitaux de Paris (AP-HP), Université Paris Descartes - Paris 5 ( UPD5 ), Institut Pasteur [Paris]-CHU Necker - Enfants Malades [AP-HP], Institut Pasteur [Paris]-Organisation Mondiale de la Santé / World Health Organization Office (OMS / WHO), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), and Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de la Recherche Agronomique (INRA)

Subjects
Bacteremia/epidemiology/mortality, 0301 basic medicine, Male, Pediatrics, bacteraemia, Infectious Disease Transmission, [SDV]Life Sciences [q-bio], Bacteremia, France/epidemiology, Infant, Newborn, Diseases, Foodborne Diseases, Meningoencephalitis, Pregnancy, Risk Factors, Vertical, Medicine, Listeriosis, Prospective Studies, Pregnancy Complications, Infectious, Prospective cohort study, ddc:618, diabetes, alcoholism, Hazard ratio, Foodborne Diseases/microbiology, immuno suppressive therapies, Prognosis, 3. Good health, [SDV] Life Sciences [q-bio], Hospitalization, Infectious Diseases, isolates, Population Surveillance, Female, France, Listeria monocytogenes/classification/isolation & purification, Cohort study, Adult, medicine.medical_specialty, 030106 microbiology, Notifiable disease, Listeriosis/diagnosis/epidemiology/microbiology, Context (language use), macromolecular substances, 03 medical and health sciences, Humans, study, Aged, [ SDV ] Life Sciences [q-bio], business.industry, Public health, cirrhosis, Infant, Newborn, Infant, Diseases/epidemiology/microbiology, HIV, Mandatory Reporting, Newborn, medicine.disease, Listeria monocytogenes, infection, Infectious Disease Transmission, Vertical, Pregnancy Complications, Infectious/epidemiology/microbiology, Meningoencephalitis/epidemiology/microbiology/mortality, Observational study, business, prognostic, mellitus
Abstract

International audience; Evidence before this study We searched PubMed on June 30, 2016, for English-language cohort studies published since Jan 1, 1980, of patients with invasive listeriosis worldwide with the keywords " listeria " , " listeriosis " , " maternal " , and " neurolisteriosis ". Studies had to include epidemiological or clinical data on listeriosis. All clinical forms of infection were included (bacteraemia, neurolisteriosis, and maternal–neonatal infection). Host risk factors for listeriosis have been well identified, but the clinical features and prognostic factors of the disease are based on retrospective studies compiling heterogeneous data or random collected cases. Furthermore, no clinical trial has ever been done and medical management is not evidence based. Added value of the study Our study is the first prospective clinical study focusing on all forms of invasive listeriosis. The study is based on a national mandatory system that allowed the nearly complete capture of microbiologically proven cases. The study shows a higher burden of listeriosis than reported before: more than 80% of infected mothers experienced major fetal or neonatal complications (fetal loss, very high prematurity, early or late onset disease); only 39% of patients with neurolisteriosis survived and fully recovered. The study provides important new data to improve management and predict outcome in listeriosis, such as determination of the time window for fetal losses (

Published
2016

45. Highlights of the 40th IUGA meeting in Nice, June 2015

Author

Anna Rosamilia, Daniela Ulrich, Vincent Letouzey, Brigitte Fatton, Renaud de Tayrac, Medical University Graz, Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Monash Medical Centre [Clayton, Australia], Université de Montpellier (UM), Institut des Biomolécules Max Mousseron [Pôle Chimie Balard] (IBMM), and Centre National de la Recherche Scientifique (CNRS)-Institut de Chimie du CNRS (INC)-Université de Montpellier (UM)-Ecole Nationale Supérieure de Chimie de Montpellier (ENSCM)

Subjects
medicine.medical_specialty, 030219 obstetrics & reproductive medicine, business.industry, Urology, General surgery, Pelvic pain, 030232 urology & nephrology, MEDLINE, Obstetrics and Gynecology, Nice, Urinary incontinence, Anal canal, [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, Pelvic Floor Disorders, 03 medical and health sciences, 0302 clinical medicine, medicine.anatomical_structure, Medicine, medicine.symptom, business, computer, ComputingMilieux_MISCELLANEOUS, computer.programming_language
Abstract

International audience

Published
2016

46. The Role of Imaging in Assessing Perineal Trauma

Author

Katharina Jundt, Vincent Letouzey, Guillaume Legendre, Arnaud Fauconnier, Anne-Cécile Pizzoferrato, Renaud de Tayrac, and Xavier Fritel

Subjects
body regions, medicine.medical_specialty, Pelvic floor, medicine.anatomical_structure, business.industry, Intervention (counseling), General surgery, medicine, business, Pelvic Floor Disorders
Abstract

Pelvic floor disorders in women are highly prevalent affecting about a quarter of women with 10–20 % likely to have a surgical intervention for this pathology. A large proportion of pelvic floor disorders are related to perineal or pelvic floor trauma.

Published
2016

47. Anatomy and Physiology of the Pelvic Floor

Author

Vincent Letouzey, Xavier Fritel, Brigitte Fatton, Eve Mousty, M. Cayrac, F. Masia, Katharina Jundt, Pierre Mares, Michel Prudhomme, and Renaud de Tayrac

Subjects
Pelvic floor, business.industry, Urethral sphincter, Urinary incontinence, Fascia, Anatomy, body regions, Levator ani, medicine.anatomical_structure, Functional anatomy, Medicine, Obstetric trauma, Fecal incontinence, medicine.symptom, business
Abstract

The functional anatomy of the pelvic floor is based on a triple system of suspensor ligaments, cohesive fascia and muscle support. The integrity of these systems is essential if a normal anatomic and functional pelvi-perineal equilibrium is to be maintained. The levator ani is the principal muscle of the pelvic floor. It is made up mainly of the ileococcygeus muscle, that forms the levator plate, and the pubovisceral (or pubococcygeus) muscle which shares connective tract with adjacent organs and is divided into 2 bundles, the pubovaginal bundle and the puborectal bundle that is key to maintaining the pelvi-perineal functional equilibrium.

Published
2016

48. Permanent Polymer Coating for in vivo MRI Visualization of Tissue Reinforcement Prostheses

Author

Arnaud Cornille, S. Huberlant, Renaud de Tayrac, Olivier Guillaume, Florence Franconi, Xavier Garric, Jean Coudane, Sébastien Blanquer, Laurent Lemaire, and Vincent Letouzey

Subjects
chemistry.chemical_classification, Materials science, Polymers and Plastics, Soft tissue, Bioengineering, 02 engineering and technology, Polymer, 021001 nanoscience & nanotechnology, Mr imaging, 030218 nuclear medicine & medical imaging, Biomaterials, 03 medical and health sciences, 0302 clinical medicine, chemistry, In vivo, Long period, Materials Chemistry, Polymer coating, 0210 nano-technology, Biotechnology, Biomedical engineering
Abstract

The clinical advantage of MRI visualization of prostheses in soft tissue prolapses is very appealing as over 1,000000 MRI-transparent synthetic meshes are implanted annually, and postoperative complications such as mesh shrinkage and migration are frequent. Here, the synthesis of a new material composed of a DTPA-Gd complex grafted onto a backbone of PMA via a covalent bond is described (DTPA-Gd-PMA). This new polymer is sprayed onto meshes and gives an MR signal for a long period without any significant release of Gd. In vitro cytocompatibility tests on fibroblasts show limited cytotoxicity. Microscopic investigations indicate that vital cells rapidly colonize the material. Finally, coated meshes implanted in rats are easily recognizable using an MR imaging system.

Published
2012

49. Obésité et urogynécologie : revue de la littérature

Author

Thibault Thubert, Xavier Deffieux, Vincent Letouzey, and J.-F. Hermieu

Subjects
Gynecology, medicine.medical_specialty, business.industry, Urology, Suburethral Sling, Medicine, Prolapsus genital, business, Gynecologic surgical procedures
Abstract

Resume But Determiner les particularites de la prise en charge des pathologies urogynecologiques de la femme obese. Patients et methodes Revue de la litterature avec les mots cles : obesity , genital prolapse , pelvic organ prolapse , urinary incontinence , anal incontinence . Resultats Le risque relatif d’incontinence urinaire (IU) pour une patiente obese majeure (IMC > 40 kg/m 2 ) est superieur a 5 par rapport a une femme de poids normal. Une perte de poids de 10 % reduit de 50 % la frequence des fuites urinaires. Au-dela d’un IMC a 35 kg/m 2 , le taux de succes des bandelettes sous-uretrales (BSU) chute a environ 50 % avec un risque accru d’urgenturies de novo. Dans cette population de femmes tres obeses, la reduction de l’obesite par la chirurgie fait aussi bien, voire mieux que la chirurgie de l’incontinence. La prevalence de l’incontinence anale chez les patientes presentant une obesite morbide est multipliee par trois avec une prevalence atteignant 32 %. Le traitement de l’incontinence anale chez l’obese n’est pas clairement codifie. L’association entre obesite et prolapsus reste actuellement tres controversee selon la methodologie utilisee dans les etudes. Le traitement du prolapsus genital chez la femme obese est peu etudie dans la litterature. Seule la promontofixation par laparotomie a ete etudiee. Il ne semble pas exister plus de complications dans cette sous-population. Conclusion Cette etude a fait le point sur les particularites de la prise en charge urogynecologique de la femme obese. Il manque toutefois des etudes de bon niveau de preuve avant d’en tirer des conclusions probantes.

Published
2012

50. Conception d’un treillis anti-infectieux et visible en IRM pour la prise en charge chirurgicale des prolapsus génitaux et des hernies abdominales

Author

Olivier Guillaume, P. Gravagna, Jean Coudane, Marie de Tayrac, Cédric Paniagua, Sébastien Blanquer, Laurent Lemaire, Florence Franconi, Jean-Philippe Lavigne, Vincent Letouzey, Olivier Lefranc, and Xavier Garric

Subjects
medicine.medical_specialty, Pelvic organ, business.industry, Abdominal Hernia, Biomedical Engineering, Biophysics, 02 engineering and technology, 030230 surgery, 021001 nanoscience & nanotechnology, Surgery, 03 medical and health sciences, 0302 clinical medicine, medicine, 0210 nano-technology, business
Published
2012

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