Renaud De Tayrac

To study the ongoing results of the repair of anterior vaginal wall prolapse reinforced with tension-free polypropylene mesh (GyneMesh, Gynecare, Ethicon, Issy-Les-Moulineaux, France). A case series of 87 consecutive women with anterior vaginal wall prolapse who underwent a transvaginal procedure using polypropylene mesh between October 1999 and August 2002. The mean age (+/-SD) was 62.4+/-13.4 years. Before the operation, patients underwent physical examination staging of the prolapse with the International Pelvic Organ Prolapse staging system. Thirteen women had stage 2 anterior vaginal wall prolapse (14.9%), 59 had stage 3 (67.9%), and 15 had stage 4 (17.3%). The polypropylene mesh was placed from the retropubic space to the inferior part of the bladder in a tension-freefashion. Patients were followed for 9-43 months, with a median follow-up (+/-SD) of 24+/-9.6 months. We defined "cure" as satisfactory (stage 1) or optimal (stage 0) outcome for point Ba in the staging system. Eighty-four patients returned for follow-up (96.6%). At follow-up, 77 women were cured (91.6%), 5 women had asymptomatic stage 2 anterior vaginal wall prolapse, and 2 had a recurrent stage 3 (2.4%). There were no postoperative infections. There were a total of 7 vaginal erosions of the mesh (8.3%); 4 necessitated a second procedure for partial excision of the mesh. Vaginal repair of anterior vaginal wall prolapse reinforced with tension-free polypropylene mesh is effective and relatively safe. Vaginal erosion occurred in 8.3% of the study population but was easily manageable, with no sequelae.

Background.  To evaluate the tension‐free vaginal tape (TVT) in both stress urinary incontinence (SUI) and occult SUI as an associated procedure at the time of tension‐free polypropylene mesh repair for the treatment of genitourinary prolapse.Methods.  Forty‐eight consecutive women undergoing surgery for genital prolapse and concurrent SUI from November 1999 to September 2002. Preoperatively, SUI was symptomatic in 29 women and occult in 19, with a positive stress test during repositioning of the prolapse. All patients had urethral hypermobility and none had intrinsic sphincter deficiency. The cystocele repair was performed in all patients according to the technique of tension‐free polypropylene mesh. Twenty‐six women had an associated TVT and 22 had no associated procedure for SUI (control group). The main outcome measures were postoperative SUI, voiding dysfunction, and recurrence of prolapse.Results.  The median follow‐up was 20 ± 10.1 months (range 7–41). Patient characteristics and preoperative urodynamic evaluation were similar in the two groups. In patients with preoperative SUI, postoperative SUI occurred in 1/15 of the TVT group (6.7%) vs. 5/14 (35.7%) in the control group (p < 0.05), and voiding dysfunction occurred in 2/15 patients of the TVT group (13.3%) vs. 0/14 in the control group (p > 0.05). In patients with preoperative occult SUI, postoperative SUI occurred in 0/11 of the TVT group vs. 1/8 (12.5%) in the control group (p > 0.05), and voiding dysfunction occurred in 3/11 patients of the TVT group (27.3%) vs. 0/8 in the control group (p < 0.05). Anatomic success on prolapse was 88.5% (23/26) and 86.4% (19/22) in the TVT and the control group, respectively (p > 0.05).Conclusion.  In patients with preoperative SUI, TVT is more efficient than prosthetic cystocele repair alone to prevent postoperative SUI, without differences in voiding dysfunction. In patients with preoperative occult SUI, prosthetic cystocele repair is as efficient as TVT, with a decreased risk of voiding dysfunction.

To determine the surgical practices for the treatment of female stress urinary incontinence (SUI) in Parisian public hospitals (AP-HP) over a 12-month period. 25 gynaecology (n=16) and urology (n=9) departments in Parisian teaching hospitals were surveyed by postal questionnaire concerning their surgical practice for female SUI. The survey concerned all operations performed between 1st' September 2002 and 31st August 2003 inclusive. The questionnaire concerned the number of operations, the type of operation, the type of suburethral tape and the incision used for placement of these tapes. The participation rate in the survey was 88% (22 out of 25 departments). The total number of surgical operations for SUI was 1,224: 586 in gynaecology (47.9%) and 638 in urology (52.1%). The distribution of techniques was as follows: 1,028 suburethral slings by prosthetic tape (83.9%), 106 retropubic colposuspensions (8.7%), 70 artificial sphincters (5.7%), 13 subcervical slings (1.1%) and 7 transurethral injections (0.6%). The distribution of tapes was as follows: 614 TVT (59.7%), 217 T.O.T. (21.1%), 111 SPARC, (10.8%) 40 PROLENE (3.9%), 27 URETEX (2.6%), 7 PELVICOL (0.7%), 6 SIS (0.6%) and 6 IVS (0.6%). Surgical approaches consisted of an ascending retropubic approach in 60.2% of cases, a transobturator approach in 26.9% of cases, a descending retropubic approach in 10.8% of cases and a prepubic approach in 2.1% of cases. Ascending retropubic TVT represented the majority of operations for female stress urinary incontinence performed in Parisian public hospitals in 2002-2003. The obturator approach represented almost one-third of surgical approaches for suburethral tape placement.

Our goal was to develop quality of life questionnaires in French for women with pelvic organ prolapse. From two questionnaires previously developed for prolapse and validated in English, the Pelvic Floor Distress Inventory and the Pelvic Floor Impact Questionnaire, we have developed two questionnaires in French, the Inventaire des Symptômes de Prolapsus (ISP) and the Questionnaire sur l'Impact du Prolapsus (QIP). The ISP assesses symptom distress in women with pelvic floor disorders and measures how much these symptoms bother women. The QIP assesses life and emotional impact. These questionnaires were constructed after a double translation, a double expertise and patient interviews. A complete cross-validation into French is currently unfeasible due to cost considerations. The ISP and QIP questionnaires assess urinary, colorectal-anal and vaginal symptoms in relation to pelvic floor disorders. Both questionnaires significantly correlated with urinary and colorectal-anal symptoms. The main advantage of these instruments is the use of scales, with separate simple score for each scale. Based on two previously validated English questionnaires, the PFDI and the PFIQ, we have developed the first quality-of-life instruments in French for women with pelvic organ prolapse, the ISP and the QIP.