Los labios menores son dos repliegues cutaneomucosos situados entre los labios mayores. La hipertrofia de los labios menores puede deberse a varios factores, sobre todo congénitos. El objetivo de este artículo es describir las técnicas de reducción de la hipertrofia de los labios menores y sus resultados. Hay pocos datos referentes a las indicaciones y las expectativas precisas de las pacientes que solicitan una ninfoplastia de reducción. Aunque algunas mujeres requieren una reducción por motivos funcionales (molestias físicas o sexuales) o por una situación patológica (espina bífida), la mayoría de las pacientes que solicitan una ninfoplastia de reducción lo hacen por motivos psicológicos. Las técnicas consistentes en un colgajo y una resección en «V» son las más descritas. De forma global, estas técnicas se asocian a buenos resultados anatómicos y funcionales (que van del 89 al 100%). Las complicaciones graves, como las infecciones y las necrosis son muy infrecuentes (<1%). Sin embargo, se debe advertir a las pacientes y los cirujanos de las posibles complicaciones: hematomas (hasta el 7%), dolor postoperatorio (hasta el 64%), dehiscencia cutánea o mucosa (7%), dispareunias (1-23%) y reintervención (3-7%). La hipertrofia de uno o de ambos labios menores puede causar problemas funcionales, estéticos y sexuales. Los resultados son globalmente satisfactorios.

El diagnóstico de incontinencia urinaria (IU) es clínico: la anamnesis diferencia una incontinencia urinaria de esfuerzo (IUE), una incontinencia urinaria de urgencia (IUU) (hiperactividad vesical) y una incontinencia urinaria mixta (IUM). Esta distinción es esencial, porque las estrategias terapéuticas son diferentes. La fisiopatología es compleja y multifactorial. Es cierto que el embarazo, el parto, la edad, un cierto grado de predisposición genética tisular y el sobrepeso son factores de riesgo demostrados, pero todavía no se conocen los mecanismos precisos que conducen a la génesis de uno u otro tipo de incontinencia. Aparte de los raros casos en que se sospecha una enfermedad orgánica subyacente (neurológica o uroginecológica) y después de haber descartado una infección urinaria y un residuo posmiccional, puede proponerse un tratamiento de primera línea sin exploración urodinámica previa. En la IUE, se recomienda la reeducación (ejercicios de contracción voluntaria de los músculos perineales) de entrada, en ocasiones asociada a una reducción ponderal. En la hiperactividad vesical, la reeducación (técnicas conductuales, ejercicios de contracción muscular y electroestimulación) y los anticolinérgicos (con o sin estrógenos tópicos después de la menopausia) constituyen los tratamientos de primera línea, en ocasiones asociados a una reducción ponderal. En caso de fracaso de un tratamiento de primera línea, está indicada una exploración urodinámica. En la IUE, tras el fracaso de la reeducación, se propone una intervención quirúrgica con colocación de un cabestrillo suburetral (CSU). En caso de fracaso, se discuten otras alternativas: inyecciones/balones parauretrales y esfínter artificial. En la hiperactividad vesical, en caso de fracaso de los anticolinérgicos, se puede proponer a la paciente una neuromodulación (sacra o del ciático poplíteo interno) o inyecciones intradetrusorianas de toxina botulínica. Sea cual sea el tipo de incontinencia, se puede proponer a las mujeres que presentan una IU durante el embarazo o en el posparto una reeducación, que se ha mostrado eficaz en estas dos indicaciones. En cambio, esta reeducación no parece tener un efecto protector de larga duración.

Objective: To provide clinical practice guidelines (CPGs) based on the best evidence available (level of evidence (LE)), concerning colpocleisis as a surgical treatment of pelvic organ prolapse.Methods: This article concern a systematically review of the literature concerning colpocleisis (obliterative surgery).Results: At short term follow-up, colpocleisis is associated with an anatomical success rate of 98 % (LE3) and a subjective success rate of 93% (LE3). A decrease in genital, urinary and anorectal symptoms and an enhancement of quality of life are observed in most women following colpocleisis (LE4). At mid-term (1 to 3 years) follow-up, patients' satisfaction ("satisfied" or "very satisfied" ranges from 85 to 100% (LE3)). At long-term follow-up, regret rate (women who regret having had the surgery) is 5% (LE4). In women over 80 years old, colpocleisis is associated with a decrease in per- and post-operative complication rates when compare to other surgical techniques used for pelvic organ prolapse surgery (LE2).Conclusion: Colpocleisis is a valid surgical option for elderly patients with pelvic organ prolapse surgery, and who are definitely permanently sexually inactive (Grade C). (C) 2016 Published by Elsevier Masson SAS.

Abstract Background: A care pathway is defined as patient-focused global care that addresses temporal (effective and coordinated management throughout the illness) and spatial issues (treatment is provided near the health territory in or around the patient's home). Heterogeneity of the care pathways in breast cancer (BC) is presumed but not well evaluated. The OPTISOINS01 study aims to assess every aspect of the care pathway for early BC patients using a temporal and spatial scope. Trial design: An observational, prospective, multicenter study in a regional health territory (Ile-de-France, France) in different types of structures: university or local hospitals and comprehensive cancer centers. The study consists of three work-packages: - Cost of pathway The aim of this WP is to calculate the overall costs of the early BC pathway at one year from different perspectives (society, health insurance and patient) using a cost-of-illness analysis. Using a bottom-up method, we will assess direct costs, including medical direct costs and nonmedical direct costs (transportation, home modifications, home care services, and social services), and indirect costs (loss of production). - Patient satisfaction and work reintegration Three questionnaires will assess the patients' satisfaction and possible return to work: the occupational questionnaire for employed women; the questionnaire on the need for supportive care, SCNS-SF34 ('breast cancer' module, SCNS-BR8); and the OUTPASSAT-35 questionnaire. - Quality, coordination and access to innovation Quality will be evaluated based on visits and treatment within a set period, whether the setting offers a multidisciplinary consultative framework, the management by nurse coordinators, the use of a personalized care plan, the provision of information via documents about treatments and the provision of supportive care. The coordination between structures and caregivers will be evaluated at several levels. Day surgery, home hospitalization and one-stop breast clinic visits will be recorded to assess the patient's access to innovation. Inclusion criteria: Histologically confirmed, previously untreated, operable breast cancer women; residence in the Yvelines, Hauts-de-Seine or Val d'Oise departments, Ile-de-France, France. Exclusion criteria: previous history of breast cancer; metastatic, locally advanced, or inflammatory breast cancer, as defined by the AJCC (7th Edition); unstable over the following 12 months. Statistical methods: Homogeneous groups of patients will be established based on the patients' individual medical information, and care pathways will be compared. The endpoints are the costs of care pathways, patients' satisfaction, work reintegration, readmissions and time lapses between care stages. A multiple correspondence analysis will be conducted with care resource use and socio-demographic and medical characteristics as active variables. The variables that constitute the endpoints will be projected onto a space defined by appropriate axes. Present accrual and target accrual: 307 patients have been included on 800 scheduled. Citation Format: Lerebours F, Héquet D, Baffert S, Hoang HL, Brédart A, Asselain B, Alran S, Berseneff H, Huchon C, Trichot C, Combes A, Alves K, Koskas M, Nguyen T, Roulot A, Rouzier R. Optisoins01: Optimizing the patient-breast cancer care pathway; An observational multicentric prospective study. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr OT2-04-01.

Background: A care pathway is defined as patient-focused global care that addresses temporal (effective and coordinated management throughout the illness) and spatial issues (treatment is provided near the health territory in or around the patient9s home). Heterogeneity of the care pathways in breast cancer (BC) is presumed but not well evaluated. The OPTISOINS01 study aims to assess every aspect of the care pathway for early BC patients using a temporal and spatial scope. Trial design: An observational, prospective, multicenter study in a regional health territory (Ile-de-France, France) in different types of structures: university or local hospitals and comprehensive cancer centers. The study consists of three work-packages: - Cost of pathway The aim of this WP is to calculate the overall costs of the early BC pathway at one year from different perspectives (society, health insurance and patient) using a cost-of-illness analysis. Using a bottom-up method, we will assess direct costs, including medical direct costs and nonmedical direct costs (transportation, home modifications, home care services, and social services), and indirect costs (loss of production). - Patient satisfaction and work reintegration Three questionnaires will assess the patients9 satisfaction and possible return to work: the occupational questionnaire for employed women; the questionnaire on the need for supportive care, SCNS-SF34 (9breast cancer9 module, SCNS-BR8); and the OUTPASSAT-35 questionnaire. - Quality, coordination and access to innovation Quality will be evaluated based on visits and treatment within a set period, whether the setting offers a multidisciplinary consultative framework, the management by nurse coordinators, the use of a personalized care plan, the provision of information via documents about treatments and the provision of supportive care. The coordination between structures and caregivers will be evaluated at several levels. Day surgery, home hospitalization and one-stop breast clinic visits will be recorded to assess the patient9s access to innovation. Inclusion criteria: Histologically confirmed, previously untreated, operable breast cancer women; residence in the Yvelines, Hauts-de-Seine or Val d9Oise departments, Ile-de-France, France. Exclusion criteria: previous history of breast cancer; metastatic, locally advanced, or inflammatory breast cancer, as defined by the AJCC (7th Edition); unstable over the following 12 months. Statistical methods: Homogeneous groups of patients will be established based on the patients9 individual medical information, and care pathways will be compared. The endpoints are the costs of care pathways, patients9 satisfaction, work reintegration, readmissions and time lapses between care stages. A multiple correspondence analysis will be conducted with care resource use and socio-demographic and medical characteristics as active variables. The variables that constitute the endpoints will be projected onto a space defined by appropriate axes. Present accrual and target accrual: 307 patients have been included on 800 scheduled. Citation Format: Lerebours F, Hequet D, Baffert S, Hoang HL, Bredart A, Asselain B, Alran S, Berseneff H, Huchon C, Trichot C, Combes A, Alves K, Koskas M, Nguyen T, Roulot A, Rouzier R. Optisoins01: Optimizing the patient-breast cancer care pathway; An observational multicentric prospective study. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr OT2-04-01.

To analyse the prevalence of postpartum anal incontinence, its risk factors, and its management.A comprehensive systematic review of the literature on PubMed, Medline, Embase and Cochrane using: postpartum anal incontinence, postpartum fecal incontinence, perineal rehabilitation, anal surgery.The prevalence of postpartum anal incontinence varied from 4% (primipare) to 39% (multipare) at 6 weeks postpartum, whereas fecal incontinence can reach respectively 8 to 12% 6 years after delivery. Identified risk factors were: vaginal delivery (OR: 1.32 [95%CI: 1.04-1.68]) compared to cesarean section, instrumental extractions (OR: 1.47 [95%CI: 1.22-1.78]) compared to spontaneous vaginal delivery but it was only with forceps (OR: 1.50 [95%CI: 1.19-1.89]) and not with vaccum (OR: 1.31 [95%CI: 0.97-1.77]). Maternal age over 35 years (OR: 6 [95%CI: 1.85-19.45]), number of births (3 births: OR: 2.91 [95%CI: 1.32-6.41]) and the occurrence of anal-sphincter injury (OR: 2.3 [95%CI: 1.1-5]) were associated with an increased risk of anal incontinence regardless of the type of delivery compared to a group of women without anal incontinence. Perineal rehabilitation should be interpreted with caution because of the lack of randomized controlled trials. A reassessment at 6 months postpartum in order to propose a surgical treatment by sphincteroplasty could be considered if symptoms persist. The results of the sphincteroplasty were satisfactory but with a success rate fading in time (60 to 90% at 6 months against 50 to 40% at 5 and 10 years).Postpartum anal incontinence requires special care. Recommendations for the management of postpartum anal incontinence would be useful.

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 MyoSure (R) and 13 with bipolar resection loop Versapoint (R) 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. (C) 2014 Elsevier Masson SAS. All rights reserved.

Aim. - To analyse the prevalence of postpartum anal incontinence, its risk factors, and its management.Materials and methods. - A comprehensive systematic review of the literature on PubMed, Medline, Embase and Cochrane using: postpartum anal incontinence, postpartum fecal incontinence, perinea( rehabilitation, anal surgery.Results. - The prevalence of postpartum anal incontinence varied from 4% (primipare) to 39% (multipare) at 6 weeks postpartum, whereas fecal incontinence can reach respectively 8 to 12% 6 years after delivery. Identified risk factors were: vaginal delivery (OR: 1.32 [95%CI: 1.04-1.68]) compared to cesarean section, instrumental extractions (OR: 1.47 [95%CI: 1.22-1.78]) compared to spontaneous vaginal delivery but it was only with forceps (OR: 1.50 [95%CI: 1.19-1.89]) and not with vaccum (OR: 1.31 [95%CI: 0.97-1.77]). Maternal age over 35 years (OR: 6 [95%CI: 1.85-19.45]), number of births (3 births: OR: 2.91 [95%CI: 1.32-6.41]) and the occurrence of anal-sphincter injury (OR: 2.3 [95%CI: 1.1-5]) were associated with an increased risk of anal incontinence regardless of the type of delivery compared to a group of women without anal incontinence. Perineal rehabilitation should be interpreted with caution because of the lack of randomized controlled trials. A reassessment at 6 months postpartum in order to propose a surgical treatment by sphincteroplasty could be considered if symptoms persist. The results of the sphincteroplasty were satisfactory but with a success rate fading in time (60 to 90% at 6 months against 50 to 40% at 5 and 10 years).Conclusion. - Postpartum anal incontinence requires special care. Recommendations for the management of postpartum anal incontinence would be useful. (C) 2015 Elsevier Masson SAS. All rights reserved.

To evaluate the results associated with hysteroscopic morcellation for submucous myomas removal, and to compare with those observed associated with bipolar loop resection.A retrospective comparative study was conducted in two universitary centers from January 2012 to December 2013. A total of 83 patients, who presented with submucous myomas type 0,1 and 2, were included. The number of myomas type 0,1 was 36 (71 %) and 15 (29 %) myomas type 2 in morcellation group versus 44 (59 %) myomas type 0,1 and 31 (41 %) type 2 in electrosurgical resection group (P=0.17). Hysteroscopic morcellation or electrosurgical resection with bipolar loop for removal submucous myomas were performed.Thirty-four patients underwent hysteroscopic morcellation using MyoSure(®), and 49 had hysteroscopic resection using Versapoint-24F(®) bipolar loop. The mean operative duration was 30minutes in morcellation group, compared to 31minutes in bipolar resection group (P=0.98). Complete myoma removal was achieved in 22 (64 %) patients in morcellation group, and in 34 (69 %) in bipolar resection group (P=0.65). There were no difference in the occuring of adverse events between the two. The prevalence of postoperative intra-uterine adherence was 10 % in morcellation group and 13.8 % in bipolar resection group (P=0.69).In the current short comparative series, hysteroscopic morcellation and bipolar loop resection were associated with comparable results for removal of submucous myomas.

Il s’agit d’une revue de la littérature réalisée sur Pubmed, Medline, Embase et Cochrane dont le but était de faire un état des lieux sur la prévalence des périnées complets, leurs facteurs de risque, leur prise en charge et pronostic fonctionnel. La prévalence des lésions périnéales du 3e et 4e degrés varie selon les études de 2,95 % quelle que soit la parité à 25 % chez les nullipares. Vingt-huit pour cent à 48 % de ces lésions sont occultes. Les facteurs de risque en analyse multivariée étaient : le forceps (OR 6,021 [IC 95 % 1,23–19,45]), la nulliparité (OR 9,8 [IC 95 % 3,6–26,2]), l’âge gestationnel supérieur à 42 SA (OR 2,5 [IC 95 % 1–6,2]), la pression du fond utérin lors de la poussée (OR 4,6 [IC 95 % 2,3–7,9]), l’épisiotomie médiane (OR 5,5 [IC 95 % 1,4–18,7]) ou encore le poids de naissance (OR 1,3 [IC 95 % 1,1–1,6]). Il n’existait pas de différence entre les deux techniques de réparation sphinctérienne. Le traitement laxatif a montré un intérêt dans le post-partum immédiat. Les données concernant l’intérêt de la rééducation sont contradictoires. Le pronostic fonctionnel après réparation montre un taux d’incontinence anale à 6 mois du post-partum de 3,6 % (stade 3) à 30,8 % (stade 4). À 30 ans la prévalence de l’incontinence fécale secondaire atteint 6,9 %.

Objective. - To evaluate the results associated with hysteroscopic morcellation for subnnucous myomas removal, and to compare with those observed associated with bipolar loop resection.Materiels and methods. - A retrospective comparative study was conducted in two universitary centers from January 2012 to December 2013. A total of 83 patients, who presented with submucous myomas type 0,1 and 2, were included. The number of myomas type 0,1 was 36 (71%) and 15 (29%) myomas type 2 in morcellation group versus 44 (59%) myomas type 0,1 and 31(41%) type 2 in electrosurgical resection group (P=0.17). Hysteroscopic morcellation or electrosurgical resection with bipolar loop for removal submucous myomas were performed.Results. - Thirty-four patients underwent hysteroscopic morcellation using MyoSure (R), and 49 had hysteroscopic resection using Versapoint24F (R) bipolar loop. The mean operative duration was 30 minutes in morcellation group, compared to 31 minutes in bipolar resection group (P=0.98). Complete myoma removal was achieved in 22 (64%) patients in morcellation group, and in 34 (69%) in bipolar resection group (P=0.65). There were no difference in the occuring of adverse events between the two. The prevalence of postoperative intra-uterine adherence was 10% in morcellation group and 13.8% in bipolar resection group (P=0.69).Conclusion. - In the current short comparative series, hysteroscopic morcellation and bipolar Loop resection were associated with comparable results for removal of submucous myomas. (C) 2014 Elsevier Masson SAS. All rights reserved.

Objective: To determine the effect of the use of auto-cross-linked hyaluronic acid (ACP) gel following hysteroscopic surgery on the prevention of intra-uterine adhesions (lUAs) and the pregnancy rate.Study design: An observational retrospective study of 90 patients who underwent hysteroscopic removal of lUAs was conducted between 2008 and 2013 at a tertiary university care centre. Thirty-two patients received ACP gel during hysteroscopic removal of IUAs, and the remaining 58 patients did not receive ACP gel. Controls were matched to cases according to infertility and severity of lUAs using the American Society for Reproductive Medicine (ASRM) score. Four to six weeks after surgery, patients underwent diagnostic hysteroscopy to determine the re-occurrence of lUAs or the presence of adhesions. The patients were contacted by telephone to answer a questionnaire concerning their fertility. The main outcomes were pregnancy rate and postoperative IUAs.Results: Pregnancy (viable or not) rates were not influenced by the use of ACP gel. The viable pregnancy rate was eight of 24 (33.3%) in the ACP gel group and 12 of 49 (24.5%) in the control group (p = 0.427). The mean interval between surgery and pregnancy was 11.8 [standard deviation (SD) 10.5] months in the ACP group compared with 13.4 (SD 14.1) months in the control group (p = 0.744). The mean ASRM score after surgery (hysteroscopic diagnosis at 4-6 weeks postoperatively) was equivalent in the two groups: 2.7 (SD 3.0) in the ACP gel group vs 2.6 (SD 3.2) in the control group (p = 0.854). The mean follow-up was 45.2 months (interquartile range 33.2-52.7), with a loss to follow-up of 25% in the ACP gel group compared with 15.5% in the control group (p = 0.817).Conclusion: Application of ACP gel did not prevent recurrence of IUAs and was not associated with an increased pregnancy rate. ACP gel should be used with caution pending assessment in a randomized control trial in a larger population. 2015 Elsevier Ireland Ltd. All rights reserved.

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.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 12.5mm in the resection group loop (P=0.06).Twelve patients underwent resection of the polyp morcellation with MyoSure(®) and 13 with bipolar resection loop Versapoint(®) 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.Results associated with hysteroscopic morcellation and bipolar loop resection seen to be comparable.