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Fermaut M.,Service de Gynecologie obstetrique et de Medecine de la Reproduction | Nyangoh Timoh K.,University Paris - Sud | Lebacle C.,University Paris - Sud | Moszkowicz D.,University Paris - Sud | And 4 more authors.
Gynecologie Obstetrique Fertilite | Year: 2016

Objectives. - Deep pelvic endometriosis surgery may need substantial excisions, which in turn expose to risks of injury to the pelvic nerves. To limit functional complications, nerve-sparing surgical techniques have been developed but should be adapted to the specific multifocal character of endometriotic lesions. The objective was to identify the anatomical areas where the pelvic nerves are most at risk of injury during endometriotic excisions. Methods. - The Medline and Embase databases have been searched for available literature using the keywords hypogastric nerve or hypogastric plexus [Mesh] or autonomic pathway [Mesh], anatomy,endometriosis, surgery [Mesh]''. All relevant French and English publications, selected based on their available abstracts, have been reviewed. Five female adult fresh cadavers have been dissected to localize the key anatomical areas where the pelvic nerves are most at risk of injury. Results. - Six anatomical areas of high risk for pelvic nerves have been identified, analysed and described. Pelvic nerves can be damaged during the dissection of retrorectal space and the anterolateral rectal excision. Furthermore, before an uterosacral ligament excision, a parametrial excision, a colpectomy or a dissection of the vesico-uterine ligament, the hypogastric nerves, splanchnic nerves, inferior hypogastric plexus and its efferent pathways must be mapped out to avoid injury. The distance between the deep uterin vein and the pelvic splanchnic nerves were measured on four cadavers and varied from 2.5 cm to 4 cm. Conclusion. - Six key anatomical pitfalls must be known in order to limit the functional complications of the endometriotic surgical excision. Applying nerve-sparing surgical techniques for endometriosis would lead to less urinary functional complications and a better short-term postoperative satisfaction. © 2016 Elsevier Masson SAS. All rights reserved. Source


Fritel X.,Service de Gynecologie obstetrique et de Medecine de la Reproduction | Fauconnier A.,Service de gynecologie obstetrique | Bader G.,Service de gynecologie obstetrique | Cosson M.,Service de Gynecologie | And 16 more authors.
Pelvi-perineologie | Year: 2010

Urinary incontinence is a frequent affliction in women and may be disabling and costly (LE1). When consulting for urinary incontinence, it is recommended that circumstances, frequency and severity of leaks be specified (grade B). The cough test is recommended prior to surgery (grade C). Urodynamic investigations are not needed before lower urinary tract rehabilitation (grade B). A complete urodynamic investigation is recommended prior to surgery for urinary incontinence (grade C). In case of pure stress urinary incontinence, urodynamic investigations are not essential prior to surgery, provided the clinical assessment is fully comprehensive (standardised questionnaire, cough test, bladder diary, postvoid residual volume) with concordant results (PC). It is recommended to start treatment for stress incontinence with pelvic floor muscle training (grade C). Bladder training is recommended at first intention in cases with overactive bladder syndrome (grade C). For overweight patients, loss of weight improves stress incontinence (LE1). For surgery, suburethral tape (retropubic or transobturator route) is the first-line, recommended technique (grade B). Suburethral tape surgery involves intraoperative risks, postoperative risks and a risk of failure, which must be the subject of prior information (grade A). Elective caesarean section and systematic episiotomy are not recommended methods of prevention for urinary incontinence (grade B). Pelvic floor muscle training is the treatment of first intention for pre- and postnatal urinary incontinence (grade A). Prior to any treatment for an elderly woman, it is recommended to screen for urinary infection using a test strip, ask for a bladder diary and measure postvoid residual volume (grade C). It is recommended to carry out a cough test and look for occult incontinence prior to surgery for pelvic organ prolapse (grade C). It is recommended to carry out urodynamic investigations prior to pelvic organ prolapse surgery when there are urinary symptoms or occult urinary incontinence (grade C). © 2010 Springer Paris. Source


Fadhlaoui A.,Service de Gynecologie obstetrique et de Medecine de la Reproduction | Fadhlaoui A.,Tunis el Manar University | Khrouf M.,Service de Gynecologie obstetrique et de Medecine de la Reproduction | Khrouf M.,Tunis el Manar University | And 12 more authors.
Tunisie Medicale | Year: 2012

Background: Menstruations, by their abundance and their duration, can be a source of impaired quality of life. Women with inherited bleeding disorders appear to be, specially at risk. Aim: Assess the impact of menstrual blood loss on the quality of life for women with inherited bleeding disorders. Methods: 31 women with various inherited bleeding disorders were interviewed. They completed a quality of life questionnaire. Results: Von Willebrand disease was the most frequent inherited bleeding disorder in our population (38.7%). 54.8% of patients had a menstrual period more than 6 days 61.3% of them consider their menstrual flow to be normal. The general condition apart of the menstrual period was considered medium to poor in 35.5% of patients. The average score assessing the impact of menstruation on daily life was of 5.00 ± 3.47. Only 19.35% of patients felt that dysmenorrhea significantly affect their quality of life. Impaired quality of life was seen in 64.5% of patients according to score A and in 41.9% of them according to score B. During menstruation 22.6% of the patients didn't do to work or to school because of the menstrual flow. On the other hand, 48.4% of patients were hospitalized at least once for a heavy menstrual flow. Conclusion: The quality of life during menstruation, in women with an inherited bleeding disorder, according to the different scores appear altered. Although because of the small size of our study population, we could not prove correlation between the importance of menstrual blood loss and the impairment of quality of life. Source


Hamidouche A.,Service de Gynecologie obstetrique et de Medecine de la Reproduction | Vincienne M.,Service de Gynecologie obstetrique et de Medecine de la Reproduction | Thubert T.,Service de Gynecologie obstetrique et de Medecine de la Reproduction | Thubert T.,University Paris - Sud | And 5 more authors.
Gynecologie Obstetrique Fertilite | Year: 2015

Objective. - The treatment of endometrial polyps is based on hysteroscopic resection. The aim of the current study was to compare the results associated with hysteroscopic morcellation and those observed with bipolar loop resection. Patients and methods. - A single-center observational retrospective comparative study was performed, including 25 patients who underwent hysteroscopic resection of endometrial polyps from January 2012 to December 2013. The mean size of polyp was 9.2 mm in the group compared to 12.5 mm in the resection group loop (P = 0.06). Results. - Twelve patients underwent resection of the polyp morcellation with MyoSure1 and 13 with bipolar resection loop Versapoint1 24F. The mean operative time was 16 minutes in morcellation group and 17 minutes in the bipolar resection group (P = 0.76). Complete removal was achieved in 100% of cases in morcellation group and in bipolar loop resection. Regarding intraoperative and postoperative complications, no complication was observed in the two groups. Discussion and Conclusion. - Results associated with hysteroscopic morcellation and bipolar loop resection seen to be comparable. © 2014 Elsevier Masson SAS. All rights reserved. Source


Fadhlaoui A.,Service de Gynecologie obstetrique et de Medecine de la Reproduction | Khediri Z.,Service de Gynecologie obstetrique et de Medecine de la Reproduction | Khrouf M.,Service de Gynecologie obstetrique et de Medecine de la Reproduction | Chaker A.,Service de Gynecologie obstetrique et de Medecine de la Reproduction | Zhioua F.,Service de Gynecologie obstetrique et de Medecine de la Reproduction
Imagerie de la Femme | Year: 2012

Introduction: Inclusion in an IVF program requires several additional morphological examinations such as pelvic ultrasound, hysterosalpingography (HSG) and hysteroscopy. The exploration of the uterine cavity is an essential step and the contribution of each of these morphological examinations is variably appreciated. Aim: To evaluate the contribution of hysteroscopy prior to the first IVF/ICSI attempt when compared to the couple pelvic ultrasound and hysterosalpingography and to estimate the correlation between these three exams. Material and patients: This is a retrospective study including 94 patients, included in an IVF program, in the assisted reproductive techniques center of Aziza Othmana hospital of Tunis, during a period of one year, from January 1 to December 31 2009. Results: The hysterography has a specificity of 85.71% and overall sensitivity of 39.47%, with a strong correlation with hysteroscopy. Ultrasound has, in turn, an overall specificity of 82.35% and a sensitivity of 35.29%, with a moderate correlation with hysteroscopy. Combining the results of ultrasound and hysteroscopy, this couple has a sensitivity of 72.97% if at least one of them is pathological. The pair (echo/HSG) has a specificity of 92.68% if both tests are concordant. Conclusion: The couple pelvic ultrasound and hysterosalpingography could avoid the use of hysteroscopy prior to an IVF program, provided they are concordant. © 2012 Elsevier Masson SAS. Tous droits réservés. Source

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