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Hegde A, Huebner M, Ibrahim S, Mastrolia SA, David-Montefiore E, Weintraub AY. Impact of childbirth on pelvic floor dysfunction in women who have undergone previous pelvic floor reconstructive surgery: systematic review and meta-analysis. Int Urogynecol J 2024; 35:3-17. [PMID: 37796329 DOI: 10.1007/s00192-023-05630-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 07/27/2023] [Indexed: 10/06/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The aim of the study was to perform a systematic review and meta-analysis of the impact of pregnancy and childbirth (vaginal delivery [VD]) or cesarean section (CS) on the recurrence of pelvic floor disorders in women who had previously undergone pelvic floor reconstructive surgery for pelvic organ prolapse (POP) or stress urinary incontinence (SUI), to facilitate future evidence-based counseling. METHODS PubMed, Cochrane, Embase, BJOG, Scopus, etc. were screened, from 1990 to date. Inclusion criteria included cohort studies, case-control studies, case series, and case reports that reported on the primary outcome measure of the review. Exclusion criteria included studies on surgical procedures whose outcomes are unlikely to be impacted by pregnancy and childbirth or are obsolete. Meta-analysis was performed using Review Manager 5.3. RESULTS Seven papers on midurethral slings (MUS; 181 women in both VD and CS groups respectively) and three papers on different hysteropexy techniques (47 and 29 women in the VD and CS groups respectively), were included in the meta-analysis. No difference was seen between the two groups regarding the recurrence of SUI in women who had previously undergone MUS surgery (OR: 1.18 [0.66, 2.09]; Z = 0.56; p = 0.58) or the recurrence of POP following hysteropexy using various apical suspension procedures (OR: 1.81 [0.04, 80.65]; Z = 0.31; p = 0.76). There are insufficient data to support meta-analyses for individual MUS sub-types or hysteropexy procedures. CONCLUSION Current literature does not demonstrate a protective effect of CS in preventing recurrent SUI in women who had undergone MUS surgery for SUI. When hysteropexy is considered irrespective of the apical suspension procedure employed, the incidence of recurrent POP appears similar after CS and VD.
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Affiliation(s)
- Aparna Hegde
- Department of Urogynecology, Cama Hospital, Grant Medical College, Mumbai, India.
| | - Markus Huebner
- Department of Obstetrics and Gynecology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | | | | | | | - Adi Y Weintraub
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
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Taban F, Elia N, Rapiti E, Rageth C, Fioretta G, Benhamou S, Than Lam G, David-Montefiore E, Bouchardy C. Impact of experience in breast cancer surgery on survival: the role of quality of care in a registry-based cohort. Swiss Med Wkly 2019; 149:w14704. [PMID: 30685868 DOI: 10.4414/smw.2019.14704] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
AIMS OF THE STUDY Previous studies have suggested that the surgeon's experience in breast cancer surgery may affect patient survival. In this registry-based retrospective cohort study, we examined whether quality of care could partly explain this association. METHODS All invasive breast cancers operated on in the private sector between 2000 and 2009 were identified in the Geneva Cancer Registry and followed up for 5 years. Surgeons were classified according to their experience into three categories: ≤5, 6-10, >10 breast cancer operations performed per year. We extracted patient and tumour characteristics. Quality of care was scored as the proportion of 11 quality indicators correctly fulfilled for each patient. Breast cancer-specific mortality was examined with a Cox model adjusted for variables known to affect survival, surgeon experience, and quality of care. RESULTS A total of 1489 patients were operated on by 88 surgeons; 50 patients (3.4%) died from breast cancer during the 5 years of follow-up. Socioeconomic status and country of birth of the patients, as well as period of diagnosis, differed according to the surgeons' experience. Quality of care provided improved with surgeons' experience. Surgeons performing >10 operations/year more frequently assessed histology before surgery, excised sentinel lymph nodes, removed ≥10 lymph nodes, and prescribed adjuvant radiotherapy when indicated. Crude breast cancer-specific mortality was lower in patients treated by surgeons performing >10 compared with ≤5 operations/year (hazard ratio [HR] 0.34, 95% confidence interval [CI] 0.17-0.67; p = 0.002). The strength of the association decreased after adjustment for patient and tumour characteristics (HR 0.45, 95% CI 0.21-0.94; p = 0.034) and decreased further after adjustment for quality of care (HR 0.51, 95% CI 0.24-1.08, p = 0.078). CONCLUSIONS The association between surgeon's experience and 5-year breast cancer survival is at least partly explained by quality of care, patient and tumour characteristics. Further investigations on the impact of other quality indicators such as multidisciplinary networks are needed.
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Affiliation(s)
- François Taban
- SONGe (Réseau de Sénologie et ONco-gynécologie Genevois), Breast Network of Geneva Private Practitioners, Geneva, Switzerland
| | - Nadia Elia
- Geneva Cancer Registry, Institute of Global Health, University of Geneva, Switzerland
| | - Elisabetta Rapiti
- Geneva Cancer Registry, Institute of Global Health, University of Geneva, Switzerland
| | - Christoph Rageth
- Breast Centre, Department of Gynaecology and Obstetrics, University Hospitals of Geneva, Switzerland
| | - Gérald Fioretta
- Geneva Cancer Registry, Institute of Global Health, University of Geneva, Switzerland
| | - Simone Benhamou
- Geneva Cancer Registry, Institute of Global Health, University of Geneva, Switzerland / INSERM U946, Genetic Variability and Human Diseases, Fondation Jean Dausset/CEPH, Paris, France
| | - Giang Than Lam
- Breast Centre, Department of Gynaecology and Obstetrics, University Hospitals of Geneva, Switzerland
| | - Emmanuel David-Montefiore
- Breast Centre, Department of Gynaecology and Obstetrics, University Hospitals of Geneva, Switzerland
| | - Chirstine Bouchardy
- Geneva Cancer Registry, Institute of Global Health, University of Geneva, Switzerland
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Lambat Emery S, Kalovidouri A, David-Montefiore E. Recurrent Mondor's breast disease -- Hormonal contraceptive involvement. Breast Dis 2019; 38:31-33. [PMID: 30530952 DOI: 10.3233/bd-180346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Mondor's disease can be a challenging diagnosis. The case we present is of a 29 year-old Brazilian woman, under combined hormonal contraception, who consulted for a painful lump on her right breast. She presented a complete resolution after a local treatment of heparinoid cream and a non-steroidal anti-inflammatory oral treatment, but relapsed 18 months later. Oral combined hormonal contraception was the only "risk factor" found, in this case, and the modification of the latter helped resolve the relapse clinical symptoms.
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Affiliation(s)
- S Lambat Emery
- Department of Gynecology, Geneva University hospitals (HUG), Switzerland
| | - A Kalovidouri
- Department of Radiology, Geneva University hospitals (HUG), Switzerland
| | - E David-Montefiore
- Department of Gynecology, Geneva University hospitals (HUG), Switzerland
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Garbin O, Helmlinger C, Meyer N, David-Montefiore E, Vayssiere C. [Can medical treatment be the first-line treatment for most ectopic pregnancies? A series of 202 patients]. ACTA ACUST UNITED AC 2009; 39:30-6. [PMID: 20005640 DOI: 10.1016/j.jgyn.2009.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2009] [Revised: 11/07/2009] [Accepted: 11/12/2009] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess the efficacy and safety of a liberal policy of medical treatment for ectopic pregnancies (EUP). MATERIAL AND METHODS Retrospective study of EUP that received active management between January 1999 and December 2003. Patients with rupture or near-rupture and those who refused medical treatment received surgical treatment. Other patients were treated by methotrexate. RESULTS Two hundred and two EUP were managed; 26 % were treated surgically, 74 % medically. The success rate of medical treatment was 83 %. A ss-hCG threshold of 2526 IU/l was selected. Under this level, the success rate was 90.7 % compared with 68 % when it was higher (p=0.001). Cardiac activity tripled the failure rate. Morbidity with medical treatment consisted of an augmentation in transaminases in 18.8 % and one case of severe dermatosis (0.7 %). Almost half of the patients treated medically required hospitalizations. CONCLUSION The extension of medical treatment in our population to 74 % of all EUP yielded a high success rate, 83 %.
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Affiliation(s)
- O Garbin
- Service de gynécologie-obstétrique, pôle de gynécologie-obstétrique, hôpitaux universitaires de Strasbourg, SIHCUS-CMCO, 19, rue Louis-Pasteur, 67300 Schiltigheim, France.
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Apfelbaum D, David-Montefiore E, Daraï E. [Mid-term results of the grade 3-4 genital prolapse cure by vaginal route using a total hammock of porcine skin implant associated with bilateral sacro-spinofixation]. ACTA ACUST UNITED AC 2009; 38:125-32. [PMID: 19251381 DOI: 10.1016/j.jgyn.2008.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2008] [Revised: 10/27/2008] [Accepted: 11/04/2008] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the feasibility, morbidity and mid-term results of genital prolapse cure by vaginal route using a total hammock of porcine skin implant (Pelvicol) and bilateral sacro-spinofixation. PATIENTS AND METHODS From May 2001 to June 2006, 101 patients with grade 3-4 genital prolapse, using the POPQ classification, were treated by vaginal route. One patient refused the use of porcine skin implant for religious reasons. Anterior fixation of the total hammock was performed by transobturator route and the posterior fixation was done on sacrospinous ligaments associated with a bilateral Richter operation. Intra- and postoperative complications, anatomical results, as well as global satisfaction, have been evaluated. RESULTS The technique was always feasible. With a mean follow-up of 29 months, anatomical results were optimal in 73.3% while 16.8% of recurrences were observed. Mean operating time was 112+/-39 min (range: 40-310). Intraoperative complication rate was 4.9% (three bladder injuries, one rectal injury, one unfundibulo pelvic ligament injury during hysterectomy). Postoperative complication rate was 11.9% (four cases of urinary retention, one urethral plication and five pararectal haematomas including two cases requiring a second surgery complicated by an urethrovaginal fistula in one case and one urinary infection). With a mean follow-up of 29+/-12 months (74-12), optimal anatomical results and recurrence rate were 73.3 and 16.8%, respectively. Global satisfaction rate was 87.7%. This rate decreased to 60% for patients with a 4- to 6-year follow-up. CONCLUSION Our results confirmed the feasibility of genital prolapse cure using a total hammock of porcine skin and bilateral sacro-spinofixation with a similar rate of complications to vaginal surgery without implant. However, anatomical results at mid-term raise the issue on the permanence of biological meshes.
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Affiliation(s)
- D Apfelbaum
- Service de gynécologie-obstétrique, hôpital Tenon, Assistance publique des Hôpitaux de Paris, 4, rue de la Chine, 75020 Paris, France
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Daraï E, Coutant C, Rouzier R, Ballester M, David-Montefiore E, Apfelbaum D. Genital Prolapse Repair Using Porcine Skin Implant and Bilateral Sacrospinous Fixation: Midterm Functional Outcome and Quality-of-Life Assessment. Urology 2009; 73:245-50. [DOI: 10.1016/j.urology.2008.09.044] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Revised: 09/12/2008] [Accepted: 09/16/2008] [Indexed: 01/12/2023]
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Deffieux X, Salet-Lizee D, Herry M, David-Montefiore E, Bader G, Ansquer Y, Dhainaut C, Foulot H, Gadonneix P, Friederich L, Fauconnier A, Chapron C, Panel P, Darai E, Villet R, Fernandez H. Serious Adverse Events Following Pelvic Organ Prolapse Surgery. A Study from a French Registers. J Minim Invasive Gynecol 2008. [DOI: 10.1016/j.jmig.2008.09.495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Dubernard G, Rouzier R, David-Montefiore E, Bazot M, Daraï E. Urinary Complications After Surgery for Posterior Deep Infiltrating Endometriosis are Related to the Extent of Dissection and to Uterosacral Ligaments Resection. J Minim Invasive Gynecol 2008; 15:235-40. [DOI: 10.1016/j.jmig.2007.10.009] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2007] [Revised: 10/16/2007] [Accepted: 10/29/2007] [Indexed: 11/26/2022]
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Dubernard G, Rouzier R, David-Montefiore E, Bazot M, Darai E. Use of the SF-36 questionnaire to predict quality-of-life improvement after laparoscopic colorectal resection for endometriosis. Hum Reprod 2008; 23:846-51. [PMID: 18281681 DOI: 10.1093/humrep/den026] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Laparoscopic colorectal resection for endometriosis can improve quality of life (QOL), but the results vary widely from one woman to another. The aim of this study was to determine whether the preoperative results on the Physical Component Summary (PCS) and Mental Component Summary (MCS) subscales of the SF-36 questionnaire could predict the improvement in QOL after surgery. METHODS The predictive value of the subscales was first evaluated on a training set of 57 patients. A mathematical model, quantified with respect to discrimination and calibration was then applied to the validation set of 36 patients. RESULTS Women with preoperative PCS and MCS scores below 37.5 and 44.5, respectively, had 80.7% and 84.2% probabilities of seeing their scores improve after surgery, whereas women with preoperative scores above 46.5 and 47.5, respectively, had probabilities of 0% and 10.7% to improve their scores. CONCLUSIONS With our mathematical model, the postoperative improvement in QOL can be reliably predicted. This model should help to identify those women who are most likely to benefit from this major surgery.
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Affiliation(s)
- G Dubernard
- Department of Obstetrics and Gynecology, Hôpital Tenon, AP-HP, Université Pierre et Marie Curie Paris VI, 4 rue de Chine, 75020 Paris, France
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Mergui JL, Polena V, David-Montefiore E, Uzan S. Recommandations pour la surveillance des patientes traitées pour des lésions de haut grade du col utérin. ACTA ACUST UNITED AC 2008; 37 Suppl 1:S121-30. [DOI: 10.1016/j.jgyn.2007.11.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Daraï E, David-Montefiore E. Reply. Am J Obstet Gynecol 2007. [DOI: 10.1016/j.ajog.2006.07.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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David-Montefiore E, Rouzier R, Chapron C, Daraï E. Surgical routes and complications of hysterectomy for benign disorders: a prospective observational study in French university hospitals. Hum Reprod 2007; 22:260-5. [PMID: 16950826 DOI: 10.1093/humrep/del336] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Despite the advantages of the vaginal and laparoscopic approaches, most hysterectomies carried out involve laparotomy. The objective of this prospective observational multicentre study was to examine the routes and complications of hysterectomy for benign disorders. METHODS Of the 15 university hospitals belonging to Collégiale de Gynécologie-Obstétrique de Paris-Ile de France, 12 participated in this study that took place between June and December 2004. We analysed the characteristics of the patients, the indications for hysterectomy and intra- and post-operative complications (and their determinants) according to the surgical approach. RESULTS In total, 634 women underwent hysterectomy for benign disorders during the study period. The patients' mean age (+/-SD), BMI, parity and previous Caesarean sections were 51.4 +/- 10.3 years, 25 +/- 5.7 kg/m(2), 2 +/- 1.6 children and 0.2 +/- 0.6, respectively. Hysterectomy was performed by the laparoscopic, laparoscopically assisted vaginal hysterectomy (LAVH), laparotomic and vaginal routes in 19.1, 8.2, 24.4 and 48.3% of cases, respectively. The operating time was shorter with the vaginal route than with laparoscopy, laparotomy and LAVH (P < 0.0001). Intra- and post-operative complications were significantly more frequent in the laparotomic group (18%) compared with the vaginal group (8.2%), the laparoscopic group (5.8%) and the LAVH group (8.2%) (P < 0.0001). In a multivariate logistic regression model, obesity [odds ratio (OR): 2.84, 95% confidence interval (CI): 1.53-5.27, P = 0.001], history of pelvic surgery (OR: 2.47, 95% CI: 1.39-4.39, P = 0.002) and history of Caesarean section (OR: 2.04, 95% CI: 1.01-4.1, P = 0.046) were significantly associated with intra- and post-operative complications. Laparoconversion was necessary in 36 cases (7.5%) overall and was more frequent with laparoscopy and LAVH than with the vaginal route (P < 0.0001). CONCLUSIONS This study confirms that the vaginal route is increasingly used for hysterectomy in France and that it is the route of choice for benign disorders.
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Affiliation(s)
- E David-Montefiore
- Service de Gynécologie-Obstétrique, Hôpital Tenon, Université Pierre et Marie Curie-Paris VI, France
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Daraï E, Frobert JL, Grisard-Anaf M, Lienhart J, Fernandez H, Dubernard G, David-Montefiore E. Functional results after the suburethral sling procedure for urinary stress incontinence: a prospective randomized multicentre study comparing the retropubic and transobturator routes. Eur Urol 2006; 51:795-801; discussion 801-2. [PMID: 17010507 DOI: 10.1016/j.eururo.2006.08.046] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2006] [Accepted: 08/25/2006] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To compare short-term functional outcomes, urodynamic parameters, and quality of life of transobturator and retropubic routes in the cure of urinary stress incontinence. POPULATION AND METHODS This prospective, multicentre study involved 88 women undergoing suburethral sling procedure for stress urinary incontinence (SUI). The retropubic route (RPR) and the transobturator route (TOR) were used in 42 and 46 women, respectively. No difference in epidemiologic and preoperative urinary functional status (SUI stage, and pollakiuria, nocturia, and urgency rates) was found between the groups. Functional results and quality of life were evaluated before surgery and at 1, 3, 6, and 12 mo postoperatively. Urodynamic examinations were performed before and 3 mo after surgery. RESULTS The mean follow-up was 10 mo. No difference in the rate of de novo urge incontinence and immediate and late voiding dysfunction was noted between the groups. No difference in the cure rate was observed between the groups (89.3% in the RPR group and 88.6% in the TOR group). RPR was associated with a significant decrease in maximum urinary flow and an increase in residual urine volume. Quality of life was significantly improved after surgery without difference between the groups. CONCLUSIONS Retropubic and transobturator routes for treatment of female SUI have similar high cure rates and quality of life improvement. Because of advantages in the rate of complications and postoperative pain previously demonstrated on the same population, the transobturator route appears to be the best option for the treatment of urinary incontinence.
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Affiliation(s)
- Emile Daraï
- Service de Gynécologie-Obstétrique, Hôpital Tenon, Université Saint-Antoine Paris IV, Assistance Publique des Hôpitaux de Paris, Paris, France
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Daraï E, David-Montefiore E. Re: Emmanuel David-Montefiore, Jean-Louis Frobert, Marielle Grisard-Anaf, Jean Lienhart, Karine Bonnet, Christophe Poncelet and Emile Daraï. Peri-Operative Complications and Pain After the Suburethral Sling Procedure for Urinary Stress Incontinence: A French Prospective Randomised Multicentre Study Comparing the Retropubic and Transobturator Routes. Eur Urol 2006;49:133–8. Eur Urol 2006. [DOI: 10.1016/j.eururo.2006.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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David-Montefiore E, Barranger E, Dubernard G, Nizard V, Antoine JM, Daraï E. Functional results and quality-of-life after bilateral sacrospinous ligament fixation for genital prolapse. Eur J Obstet Gynecol Reprod Biol 2006; 132:209-13. [PMID: 16730875 DOI: 10.1016/j.ejogrb.2006.04.031] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2005] [Revised: 01/30/2006] [Accepted: 04/20/2006] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To evaluate intra- and post-operative complications, anatomical results, quality-of-life and sexuality after bilateral sacrospinous ligament fixation (SSLF). STUDY DESIGN Retrospective longitudinal study. Between March 2001 and September 2003, 51 women with stage III or IV genital prolapse underwent bilateral SSLF at the gynecology and obstetrics university department of Tenon Hospital, Paris, France. The population characteristics were as follows: mean age (+/-S.D.) was 64+/-10 years. Mean+/-SD BMI was 25+/-4 and median (range) parity was (0-12). Forty-eight (94%) women were post-menopausal, and one-third had previously undergone hysterectomy. Intra- and post-operative complications and anatomical results were recorded. Quality-of-life questionnaires (IIQ-7 and PISQ-12) and numerical analog scales were administered as well as nine questions on digestive symptoms. RESULTS The overall complication rate was 17.3%, with rectal injury in one (1.9%) women. One pararectal hematoma necessitated repeat surgery. Anterior vaginal wall prolapse (Ba=-1) occurred in three women, at 10, 16 and 19 months, but did not necessitate further surgery. The global patient satisfaction rate after bilateral SSLF was 93% (47 women). Digestive symptoms were improved after bilateral SSLF. The mean pre- and post-operative scores on the IIQ-7 and PISQ-12 questionnaires were 41+/-27 and 10+/-18 (p<0.0001), and 62+/-14 and 72+/-11 (p<0.0001), respectively. Posterior perineorrhaphy was associated with significantly altered sexuality. CONCLUSION These results support the feasibility of bilateral SSLF: intra- and post-operative complication rates are acceptable, quality-of-life and sexuality are improved, and bowel function is unaffected.
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Affiliation(s)
- Emmanuel David-Montefiore
- Service de Gynécologie, Obstétrique et Médecine de la Reproduction, Hôpital Tenon, Université Saint-Antoine Paris IV, Assistance Publique des Hôpitaux de Paris, 4 rue de la Chine, 75020 Paris Cedex 20, France
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David-Montefiore E, Barranger E, Dubernard G, Detchev R, Nizard V, Daraï E. Treatment of genital prolapse by hammock using porcine skin collagen implant (Pelvicol). Urology 2005; 66:1314-8. [PMID: 16360466 DOI: 10.1016/j.urology.2005.06.091] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2005] [Revised: 05/12/2005] [Accepted: 06/15/2005] [Indexed: 11/30/2022]
Abstract
INTRODUCTION To assess the feasibility and efficacy of the hammock using a porcine skin collagen (Pelvicol) implant for the treatment of genital prolapse by the vaginal route. A total of 47 women with Stage III or IV genital prolapse underwent surgical treatment with porcine skin collagen implantation using anterior transobturator and posterior bilateral sacrospinous fixations. Genital prolapse treatment was combined with hysterectomy in 34 patients (72%). TECHNICAL CONSIDERATIONS Porcine skin collagen implantation was feasible in every case. The surgical procedure lasted a median of 90 minutes (range 80 to 150). No vessel injuries, one bladder injury, and one rectal injury not requiring additional surgery occurred. One pararectal hematoma required a second procedure. The median follow-up was 24.6 +/- 8.5 months (range 6 to 42). No rejection of the porcine grafts occurred. Of the 47 women, 39 (83%) had optimal anatomic results, 5 had asymptomatic Stage I prolapse, and 2 had Stage II prolapse. The subjective cure rate was 93.6% (44 of 47 patients). The postoperative scores for lifestyle and urinary discomfort improved significantly after the procedure (P < 0.0001 and P < 0.0002, respectively). Of the 18 patients who were sexually active, an improvement in sexual discomfort occurred (P = 0.04). CONCLUSIONS These short-term results suggest that hammock using porcine skin collagen implantation by the transobturator route and bilateral sacrospinous fixation is a safe and effective treatment for genital prolapse.
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Affiliation(s)
- Emmanuel David-Montefiore
- Service de Gynécologie, Obstétrique et Médecine de la Reproduction, Hôpital Tenon, Université Saint-Antoine, Assistance Publique des Hôpitaux de Paris, Paris, France
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17
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David-Montefiore E, Frobert JL, Grisard-Anaf M, Lienhart J, Bonnet K, Poncelet C, Daraï E. Peri-operative complications and pain after the suburethral sling procedure for urinary stress incontinence: a French prospective randomised multicentre study comparing the retropubic and transobturator routes. Eur Urol 2005; 49:133-8. [PMID: 16310932 DOI: 10.1016/j.eururo.2005.09.019] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2005] [Accepted: 09/30/2005] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To compare peri-operative complications, pain, and the immediate functional results of the sub-urethral sling procedure for urinary stress incontinence by the retropublic and transobturator routes, using a non-elastic polypropylene sub-urethral sling. PATIENTS AND METHODS This prospective, multicentre study involved 88 women undergoing the sub-urethral sling procedure for stress urinary incontinence (SUI). The retropubic route (RPR) and the transobturator route (TOR) were used in respectively 42 and 46 cases. The characteristics of the women in the RPR and TOR groups were as follows: mean age (+/-standard deviation) 56.8+/-12 years and 53.4+/-10 years, respectively; mean BMI: 25+/-4 and 26+/-4; mean parity: 2.1+/-0.9 and 2+/-1 children; post-menopausal status: 66.7% and 58.7%; prior surgery for SUI: 7.1% and 6.5%; and prior hysterectomy: 21.4% and 26.1%. None of these characteristics differed significantly between the groups. Likewise, pre-operative urinary functional status (SUI stage, and pollakiuria, nocturia and urgency rates) was similar in the two groups. RESULTS Mean hospital stay and overall morbidity rate were not significantly different between the RPR and TOR groups. Mean operating time was longer in the RPR group. Bladder injury was significantly more frequent in the RPR group and vaginal injury was significantly more frequent in the TOR group. Pain scores were significantly lower in the TOR group. The objective functional results at one month did not differ between the groups. Quality of life, evaluated with questionnaires and numerical rating scales, was similarly improved in the two groups. DISCUSSION The suburethral sling procedure was less painful by the TOR route than by the RPR route. Bladder injury, haematomas and abscesses were only observed in the RPR group, while vaginal injury only occurred in the TOR group. The immediate functional results of the two approaches were similar.
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Affiliation(s)
- Emmanuel David-Montefiore
- Service de Gynécologie-Obstétrique, Hôpital Tenon, Université Saint-Antoine Paris IV, 4 rue de la Chine, 75020 Paris Cedex 20, France
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Dubernard G, Bazot M, Barranger E, Detchev R, David-Montefiore E, Uzan S, Daraï E. Intérêt de l'IRM associée à l'échographie pour la caractérisation des masses annexielles persistantes au cours de la grossesse : à propos de neuf cas. ACTA ACUST UNITED AC 2005; 33:293-8. [PMID: 15893499 DOI: 10.1016/j.gyobfe.2005.03.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2004] [Accepted: 03/21/2005] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the accuracy of MR imaging combined with sonography for the diagnosis of persistent adnexal masses during pregnancy. PATIENTS AND METHODS From January 1999 to November 2003, nine patients with a persistent adnexal masse were included in this retrospective study. All patients underwent both transvaginal and transabdominal sonography combined with MR imaging. Accuracy of imaging techniques was evaluated by comparison with histology. RESULTS Adnexal masse was detected by systematic sonography in six women whereas three patients were symptomatic. Mean gestational age at the diagnosis was 17 weeks of amenorrhea (range 5-36). Mean tumor size was 96 mm (range 2-15). Two patients underwent a surgery during pregnancy; one for acute abdominal pain related to an adnexal torsion and the second for suspicion of malignancy. One patient underwent a caesarean delivery for obstetrical reasons. In all patients, benign ovarian tumours were found. For eight patients the diagnosis suspected by imaging techniques was confirmed by histology. DISCUSSION AND CONCLUSION The combination of sonography and MR imaging allows diagnosing accurately adnexal masses during pregnancy.
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Affiliation(s)
- G Dubernard
- Service de gynécologie-obstétrique, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France.
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Barranger E, Kerrou K, Petegnief Y, David-Montefiore E, Cortez A, Daraï E. Laparoscopic resection of occult metastasis using the combination of FDG-positron emission tomography/computed tomography image fusion with intraoperative probe guidance in a woman with recurrent ovarian cancer. Gynecol Oncol 2005; 96:241-4. [PMID: 15589609 DOI: 10.1016/j.ygyno.2004.09.030] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2004] [Indexed: 11/29/2022]
Abstract
BACKGROUND Positron emission tomography and computed tomography (PET/CT) have a potential role in detecting and locating recurrent ovarian cancer. Precise tumor location during surgical treatment is often difficult, owing to limited tumor size and post-surgical anatomic modifications. The surgical gamma probe, which has become increasing popular in recent years with the development of sentinel node mapping, may improve tumor detection and facilitate resection of occult metastases. CASE REPORT We describe the first case of laparoscopic resection of occult metastasis using the combination of FDG-PET/CT image fusion with intraoperative FDG-sensitive probing in a patient with recurrent ovarian cancer. CONCLUSION FDG-sensitive probe combined with preoperative PET/CT image fusion can help to detect occult metastasis and guide laparoscopic excision.
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Affiliation(s)
- Emmanuel Barranger
- Department of Gynecology and Obstetrics, Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France.
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David-Montefiore E, Garbin O, Hummel M, Nisand I. Sacro-spinous ligament fixation peri-operative complications in 195 cases: visual approach versus digital approach of the sacro-spinous ligament. Eur J Obstet Gynecol Reprod Biol 2004; 116:71-8. [PMID: 15294372 DOI: 10.1016/j.ejogrb.2003.12.020] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2003] [Revised: 10/01/2003] [Accepted: 12/05/2003] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate sacro-spinous ligament fixation (SLF) peri-operative complications. STUDY DESIGN Monocentric, retrospective study. Department of Gynecology, SIHCUS-CMCO, University Hospital, Strasbourg, France. Between January 1990 and December 2000, 195 women, mean age 63.2 years old (40-90), underwent a vaginal SLF. Ninety point eight percent of women were post-menopaused and 27.9% of these had a hormonal substitution. About 24% of patients had prior hysterectomy, 20% vaginal prolapse repair and 22% urinary stress incontinence repair. SLF was performed in 1.5% of cases without any other procedures and it was combined with the following: rectocele and elytrocele repair in 89.2%, hysterectomy in 72.3%, cystocele repair in 52.8% and stress incontinence repair in 15.3% of cases. In 107 cases, the SLF attachment was placed under digital control and in 88 cases under visual control. RESULTS The mean hospitalisation stay was of 8.5 +/- 2.6 days (4-26). About 41% of women presented a complication. Major complications were represented by 3.6% of bladder injury, 0.5% of uretero-vaginal fistula, 0.5% of vascular injuries, 0.5% of thromboembolic events. In 38% of cases patients had minor complications: urinary tract infections (29%), temporary urinary retention (5.6%), local complications (4.5%), and other complications (3%). The only specific SLF complication in this data was a vascular injury and in this case the SLF was performed under digital control. CONCLUSIONS The global peri-operative complication frequency of SLF is high. It is mainly represented by non-specific complications, secondary to the combined procedures and not to the SLF itself. The specific complications due to SLF, all of which are major ones, can be avoided or diagnosed earlier, by using the visual approach technique.
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Affiliation(s)
- Emmanuel David-Montefiore
- Department of Gynecology and Obstetrics, 19 rue L. Pasteur, SIHCUS-CMCO, University Hospital, 67303 Schiltigheim-Strasbourg, France.
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Fauvet R, Boccara J, Dufournet C, David-Montefiore E, Poncelet C, Daraï E. Restaging surgery for women with borderline ovarian tumors: results of a French multicenter study. Cancer 2004; 100:1145-51. [PMID: 15022280 DOI: 10.1002/cncr.20098] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND The purpose of the current study was to examine the surgical management of women with borderline ovarian tumors and the adequacy of initial staging according to the guidelines of the International Federation of Gynecology and Obstetrics; to evaluate the impact of restaging operations; and to identify risk factors for initial understaging. METHODS In a retrospective French multicenter study, 54 of 360 women with borderline ovarian tumors underwent a restaging operation. After excluding women with initial complete staging (n = 62), epidemiologic, surgical, and histologic parameters and risk of recurrence were compared between women who underwent restaging (n = 54) and those who did not (n = 244). RESULTS One hundred fifty (41.6%) of 360 women underwent intraoperative histologic examination, which led to the diagnosis of a borderline tumor in 97 cases (64.7%). Thirty-seven (38.1%) of these 97 women had undergone complete initial staging procedures. A restaging operation was performed for 54 women. A lower median age and a higher rate of conservative treatment were noted in the group that underwent restaging. Eight (14.8%) of the 54 women who underwent restaging had their tumors upstaged: 7 of the 41 cases initially diagnosed as Stage IA tumors were upstaged to Stage IB (n = 3) or to Stage IIA, IIB, IIIA, or IIIC (n = 1 for each); in the eighth case, a Stage IC tumor was upstaged to Stage IIIA. Upstaging tended to be more common in women with serous borderline tumors (P = 0.06) and in women who underwent cystectomy (P = 0.08). There was no difference in recurrence rates according to whether a restaging operation was performed. The recurrence rates after conservative and radical treatment were 15.6% (25 of 160) and 4.5% (9 of 200), respectively (P < 0.001). CONCLUSIONS Women who initially were diagnosed with Stage IA disease and who had serous borderline tumors or underwent cystectomy appeared to derive the most benefit from restaging surgery. Nonetheless, the indications for restaging surgery remain controversial, as no difference in recurrence rate was observed between women who underwent restaging and those who did not.
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Affiliation(s)
- Raffaèle Fauvet
- Service de Gynécologie, Hôpital Tenon, Assistance Publique Hôpitaux de Paris, Paris, France
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Tissier I, Langer B, Sebahoune V, David-Montefiore E, Baldauf J, Boudier E, Treisser A, Ritter J. Management of hellp syndrome before delivery. Int J Gynaecol Obstet 2000. [DOI: 10.1016/s0020-7292(00)86251-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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