Abscess of the thigh and psoas muscle after transobturator suburethral sling procedure.
Explore the source record for details and available documents.
Abscess↗
Biomedical subjects
Valérie Roger
Publications and source records attributed to Valérie Roger.
Immediate complications of tension-free vaginal tape (TVT): results of a French survey.
BACKGROUND: The aim was to evaluate morbidity following operation using tension-free vaginal tape (TVT). METHODS: Between June 2002 and June 2003, a questionnaire was sent to French gynecologists and urologists. Participants reported the number of TVT procedures performed before January 2002, number of minor or major pre- and post-operative complications. RESULTS: The questionnaire was returned by 92 participants (21 urologists and 71 gynecologists) who reported 12,280 TVT procedures (median: 100, minimum: 5, maximum: 2100). Overall, 901 preoperative bladder injuries were reported (7.34%). For 809 patients (6.59%), complete post-operative urinary retention requiring catheterization was noted. There were 26 cases of vaginal defect healing (0.21%). Retropubic or vulvovaginal hematoma was reported for 39 patients (0.32%). Ten major organ injuries were reported (0.08%): one obturator nerve injury, three bowel perforations, four vessel injuries and two ureteral injuries. CONCLUSION: The risk of major complications following the use of tension-free vaginal tape is low. However, these potential complications require experienced surgeons for the practice of tension-free vaginal tape.
Female↗
Oxytocin during myomectomy: a randomized study.
OBJECTIVE: To evaluate the influence of oxytocin on peroperative blood loss during myomectomy. STUDY DESIGN: From October 1998 to May 2002, 94 patients requiring surgical myomectomy by laparotomy or by the vaginal approach were enrolled in a randomized double blind study. Patients were randomized to two groups. In the first group (47 patients) oxytocin was administered during myomectomy and in the second group (47 patients) a placebo was used. The main outcome measures were peroperative blood loss and rates of blood transfusion and autotransfusion. RESULTS: Peroperative blood loss was no different between the oxytocin group and the placebo group (508 +/- 558 ml versus 451 +/- 336 ml; P=0.55). Rates of autotransfusion and blood transfusion were also similar in both groups. CONCLUSION: Administration of oxytocin during myomectomy did not reduce peroperative blood loss in our study. The benefits of using oxytocin to prevent hemorrhage during myomectomy seem to be limited.
Adult↗
Uterus and bladder necrosis after uterine artery embolisation for postpartum haemorrhage.
Explore the source record for details and available documents.
Adult↗
Vaginal myomectomy using posterior colpotomy: feasibility in normal practice.
BACKGROUND: Myomectomy is classically performed via laparotomy. Endoscopic surgery is limited for some indications. Vaginal myomectomy is a surgical procedure that has recently been evaluated. The aim of this study was to evaluate the feasibility, reproducibility and complication rate of vaginal myomectomy via posterior colpotomy. METHODS: A retrospective study was performed from November 1998 to February 2001 in three departments of gynaecology. RESULTS: Forty-five patients were involved, 17 (37.8%) of whom underwent laparoscopy before vaginal myomectomy for evaluation or treatment of a second pelvic disorder. Myomectomy was performed vaginally in 40 (89%) of the 45 patients. Peroperative laparotomy was required in five patients (11%), either because vaginal myomectomy proved impossible (four cases) or because of rectal injury (one case). One patient needed supplementary laparotomy on day 8 for the treatment of a pelvic abscess. CONCLUSION: Posterior vaginal myomectomy seems to be a feasible and reproducible surgical procedure. The success rate of vaginal myomectomy in this study was over 80%. Further randomised studies are needed to compare this procedure with laparotomy and laparoscopy.
Adult↗
Risk of vasovagal syndrome during outpatient hysteroscopy.
STUDY OBJECTIVE: To evaluate influence of hysteroscope type and media used during outpatient hysteroscopy on vasovagal syndrome risk. STUDY DESIGN: Prospective observational study (Canadian Task Force classification II-1). SETTING: University hospital. PATIENTS: Two thousand seventy-nine women undergoing outpatient hysteroscopy without analgesia. INTERVENTION: Office hysteroscopy with a flexible or rigid hysteroscope and normal saline or CO(2). MEASUREMENTS AND MAIN RESULTS: Fifteen cases of vasovagal syndrome were reported. The rate of vasovagal syndrome was higher with use of a rigid hysteroscope (12/647 [1.85%]) vs. a flexible hysteroscope (3/1432 [0.21%]), p =.00013; p =.009 after adjustment for medium used; and with the use of CO2 (10/426 [2.34%]) vs. saline solution (5/1653 [0.30%]), p <.0001; p =.014 after adjustment for hysteroscope type. CONCLUSION: Risk of vasovagal syndrome is higher with the use of a rigid hysteroscope and CO2, regardless of the indication for hysteroscopy or the parity and menopausal status of the patient.
Adult↗
The role of frozen section examination of conisations in the management of women with cervical intraepithelial neoplasia.
OBJECTIVE: To determine whether frozen section in conisation improves the management of cervical intraepithelial neoplasia. DESIGN: Randomised trial. SETTING: Department of Obstetrics and Gynaecology, Conception Hospital, Marseille, France. POPULATION: Patients referred for treatment or diagnosis of cervical intraepithelial neoplasia. METHODS: Two hundred and three patients requiring conisation for diagnosis or treatment of cervical pathology were randomly assigned to have (n = 102) or not (n = 101) a frozen section of the endocervical margin of the cone specimen. MAIN OUTCOME MEASURES: The principal criterion was the 12 month residual or recurrent high grade disease rate. RESULTS: At 12 months, the residual or recurrent disease rate of high grade lesions was 12.6% in the group that did not have frozen sections and 1% in the group that did (relative risk, RR, 11.9, 95% CI 1.6-89.5, P = 0.0025). The corresponding rates of margin involvement were 18.9% and 1%, respectively (RR 15.13, 95% CI 2.06-111.27, P = 0.0002). The groups did not differ as to the height of the cone (13.6 [5.6] mm vs 13.7 [4.7] mm, P = 0.75) or post-operative morbidity (6% vs 7%, RR 1.01, 95% CI 0.94-1.09, P = 0.8). The rate of patients lost to follow up was similar in both groups 17% vs 12% (RR 1.42, 95% CI 0.71-2.81, P = 0.31). CONCLUSION: Frozen section is effective in conisation and significantly reduces residual or recurrent high grade disease. This finding improves the management of cervical pathology achieving immediate clear margins in most of conisations. This is of great interest because high rates of patients are lost to follow up as we and others authors have found.
Adult↗
Vaginal hysterectomy in nulliparous women without prolapse: a prospective comparative study.
OBJECTIVE: To compare vaginal hysterectomy success and complication rates in nulliparous and primiparous or multiparous women. DESIGN: A comparative prospective study. SETTING: Department of Gynaecology, La Conception Hospital, Marseille, France. POPULATION: Three hundred and forty-five consecutive patients without genital prolapse requiring hysterectomy for benign conditions and without previous pelvic surgery or caesareans were treated prospectively by vaginal hysterectomy. Fifty-two patients were nulliparous and 293 were primiparous or multiparous. METHODS: Data of patients were collected prospectively. MAIN OUTCOME MEASURES: Operative time, length of hospital stay, oophorectomy, conversion to laparotomy, intra- and post-operative complications. RESULTS: The mean operative time was significantly longer in nulliparous patients [95 (55.2) vs 79.9 (34.9) minutes, P < 0.01]. The overall complication rate was significantly higher [7/52 (13.46%) vs 13/293 (4.44%), P = 0.02, RR = 3.03 (1.27-7.23)] as was the haemorrhage rate in nulliparous compared with the primiparous and multiparous women [4/52 (7.69%) vs 5/293 (1.7%), P = 0.03, RR = 4.51 (1.25-16.23)]. Vaginal hysterectomy was successfully performed in 96.2% (50/52) of the nulliparous and 99.7% (292/293) of the parous patients [P = 0.06, RR = 1.04 (0.98-1.09)]. CONCLUSION: The success rate of vaginal hysterectomy in nulliparous women is high. However, the risk of complications seems higher than in the parous women. Laparoscopy assisted vaginal hysterectomy in nulliparous women needs further investigations.
Body Mass Index↗
Acceptance of outpatient flexible hysteroscopy by premenopausal and postmenopausal women.
OBJECTIVE: To compare tolerance for and feasibility of outpatient flexible hysteroscopy in premenopausal and postmenopausal women. STUDY DESIGN: A comparative, prospective study including 475 premenopausal and 216 postmenopausal women who underwent outpatient hysteroscopy without analgesia. RESULTS: Mean pain score was higher in postmenopausal patients (1.55 +/- 0.56 vs. 1.27 +/- 0.38 [P < .0001]). Outpatient flexible hysteroscopy was feasible without analgesia in 471/475 premenopausal (99.2%) and 210/216 postmenopausal women (97.2%) (P = .07). CONCLUSION: Outpatient flexible hysteroscopy was feasible and well tolerated; local anesthesia should be reserved for postmenopausal women.
Adult↗
Risk of finding an endometrial cancer when atypical hyperplasia was incidentally diagnosed on hysteroscopic resection products.
OBJECTIVE: To evaluate the risk of discovering an endometrial cancer when atypical hyperplasia was diagnosed by histologic examination of hysteroscopic resection products. STUDY DESIGN: A retrospective monocentric study from January 1994 to January 2001. Seventeen patients with atypical hyperplasia were included. Initial endometrial status was provided by operative hysteroscopy resection products. For all patients, there was no hysteroscopical aspect evocative of adenocarcinoma. Histopathological analysis of the hysterectomy pieces precised the final diagnosis. RESULTS: Among the 17 hysterectomy pieces, one adenocarcinoma was diagnosed. Risk for discovering adenocarcinoma when atypical hyperplasia was diagnosed by operative hysteroscopy resection products was 5.9% (1/17). CONCLUSION: Risk of omitting adenocarcinoma when atypical hyperplasia is discovered by hysteroscopy resection pieces is low.
Adenocarcinoma↗
Postoperative infection and surgical hysteroscopy.
OBJECTIVE: To evaluate the risk of infection after surgical hysteroscopy. DESIGN: Prospective observational study. SETTING: University hospital. PATIENT(S): One thousand nine hundred fifty-two patients requiring operative hysteroscopy during a 10-year period from January 1990 to January 2000. INTERVENTION(S): Two thousand one hundred sixteen operative hysteroscopies were performed: 782 fibroma resections, 422 polyp resections, 623 endometrectomies, 90 uterine septa sections, and 199 lyses of synechiae. MAIN OUTCOME MEASURE(S): Postoperative infectious complications. RESULT(S): Thirty (1.42%) infections occurred. There were 18 (0.85%) cases of endometritis and 12 urinary tract infections. No other severe infectious complications were reported. The risk for early-onset endometritis was higher after lysis of synechiae compared with endometrectomy, fibroma, or polyp resections. However, the risk for early-onset endometritis was similar for endometrectomy, septa, fibroma, or polyp resections. CONCLUSION(S): Infectious risk following surgical hysteroscopy is low. No major infectious complications occurred. Risk for early-onset endometritis was higher after lysis of synechiae compared with other procedures.
Endometritis↗
Risk of uterine perforation during hysteroscopic surgery.
STUDY OBJECTIVE: To evaluate the rate of uterine perforation during different operative hysteroscopy procedures. DESIGN: Observational study (Canadian Task Force classification II-2). SETTING: Department of Obstetrics and Gynecology, La Conception Hospital, Marseille, France. PATIENTS: One thousand nine hundred fifty-two women. INTERVENTION: Of 2116 operative hysteroscopies performed, there were 623 endometrectomies, 782 myoma resections, 422 polyp resections, 199 adhesiolyses, and 90 uterine septa sections. MEASUREMENTS AND MAIN RESULTS: Risk of perforation was evaluated according to hysteroscopic procedure. Severity of complications were also noted. In case of perforation, a management protocol was applied to prevent metabolic disorders and pelvic infections. Thirty-four perforations (1.61%) were reported. In 33 cases (97%) it was realized during the procedure and no complications occurred during follow-up. One perforation with hemorrhage was misdiagnosed during the intervention and required laparotomy. Perforation risk was higher during hysteroscopic adhesiolysis than during other procedures [endometrial ablation RR 9.39 (3.46-25.52), p <0.0001; uterine septa section RR 6.78 (0.91-50.6), p = 0.026; polyp RR 8.52 (2.60-30.80), p <0.0001 or myoma resection RR 7 (2.83-17.62), p <0.0001]. Perforation risk was comparable during endometrial ablation, uterine septa section, and polyp or myoma resection (p = 0.93). CONCLUSION: Perforation risk is higher during synechiolysis than in other indications for hysteroscopy. Severe complications are rare but may be avoided if precautions are taken.
Endometrial Neoplasms↗
Hemorrhage risk during operative hysteroscopy.
BACKGROUND: To evaluate the risk of hemorrhage during hysteroscopic surgery. METHODS: Cases of hemorrhage during hysteroscopic surgery were assessed in a single center, observational, prospective study conducted from 1990 to 2000, including 2116 surgical hysteroscopies. Risk of hemorrhage was evaluated according to the hysteroscopic procedure. The management of this complication was also noted. RESULTS: Thirteen cases (0.61%) were reported. In six cases, hemorrhage stopped spontaneously. For six patients, a Foley (no. 10) probe was introduced into the uterine cavity and inflated for 24 h to stop hemorrhage. For one patient, immediately from the start of the procedure, the uterine arteries were ligatured through the vaginal route in order to stop bleeding. Haemorrhage risk was higher during hysteroscopic adhesiolysis compared with endometrial ablation (Relative risk [RR] 5.22 (1.26-21.64); p = 0.02), polyp [RR 5.3 (1.04-27.09); p = 0.04], and fibroid resections [RR 6.55 (1.58-27.17); p = 0.01]. Haemorrhage risk was however, comparable for endometrial ablation, uterus septa section, polyp, and fibroid resections (p = 0.92). CONCLUSIONS: Hemorrhage risk is higher during synechiolysis compared with other procedures. An inflated Foley probe may be an efficient means of stopping hemorrhage.
Female↗