B. Cotte

Clinique du Val d'Ouest, Rhône-Alpes, France

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Publications (26)17.73 Total impact

  • 01/2011; 6(2):1-23. DOI:10.1016/S0246-1064(11)50383-4
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    ABSTRACT: El hallazgo de un quiste o de un tumor ovárico es un hecho corriente en la práctica ginecológica. En la mayoría de los casos, se trata de un hallazgo fortuito cuando se practica un tacto vaginal o una ecografía solicitada por síntomas pélvicos o abdominales. El estudio por imagen, ampliamente representado por la ecografía pélvica, tiene por finalidad confirmar la localización ovárica del tumor, distinguir los quistes funcionales (que no necesitan tratamiento) de los quistes orgánicos y, entre estos últimos, buscar signos orientadores de su malignidad. La ecografía fue primero abdominal, luego endovaginal y después pasó del modo 2D al modo 3D. Siempre acoplada al Doppler, sus resultados mejoran sin cesar y revolucionan la práctica diaria. La adquisición de la tercera dimensión ofrece una vista complementaria de una notable precisión. Hoy está bien establecida la buena correlación entre la ecografía y los datos macroscópicos, pero, cualquiera que sea la experiencia del operador, no debe olvidarse que nada supera a la histología. La ecografía es el paso previo indispensable y a veces el único de la evaluación prequirúrgica, que a la vez va a indicar el procedimiento y a definir la estrategia quirúrgica inicial. El aprendizaje es difícil y se tarda en adquirir experiencia, pero es lo que garantiza una precisión diagnóstica óptima. En su defecto, el uso de puntuaciones ecográficas, de modelos matemáticos y de programas informáticos de cuantificación vascular puede ayudar al ecografista principiante a responder a las preguntas del cirujano. El objetivo de este artículo es explicar la técnica de una ecografía pélvica para tumor ovárico, tal y como debe efectuarse en la actualidad, y describir con precisión la semiología ecográfica, morfológica y vascular en 2D y 3D.
    01/2011; 47(4):1–24. DOI:10.1016/S1283-081X(11)71166-3
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    ABSTRACT: In this retrospective study of 314 patients undergoing surgery for ovarian dermoid cysts, conducted over a 20-year period, we evaluated the impact of the routine use of laparoscopic surgery without recourse to laparotomy to retrieve the specimen, using an endoscopic retrieval bag placed under the cyst to prevent intraperitoneal spillage of cyst contents, and subsequent postoperative granulomatous peritonitis. Accidental cyst rupture was more frequent when a total laparoscopic approach was used (26/174 or 15% versus 39/140 or 28%; P = 0.005), but there were no cases of intraperitoneal spillage when an endoscopic bag was used. Two cases of granulomatous peritonitis developed out of 26 women with intraperitoneal spillage of cyst contents (8%). We conclude that the risk of granulomatous peritonitis can be minimised by undertaking laparoscopic removal of dermoid cysts with the routine intraoperative use of an endoscopic retrieval bag to prevent intraperitoneal spillage of cyst contents.
    BJOG An International Journal of Obstetrics & Gynaecology 07/2010; 117(8):1027-30. DOI:10.1111/j.1471-0528.2010.02580.x · 3.86 Impact Factor
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    ABSTRACT: To assess the health-related quality of life (Contilife) after three surgical anti-incontinence procedures (Tension-Free Vaginal Tape [TVT], Transobturator Vaginal Tape [TOT], and Transobturator Vaginal Tape [TVT-O]). We performed a prospective analysis of 90 women (30 TVT, 30 TOT, 30 TVT-0) with genuine stress incontinence pre- and postoperatively at 18 months. The objective cure rate was determined by clinical and urodynamic examination and the subjective cure rate by the Contilife questionnaire. Prior to surgery, patients complained more of effort activities, followed by global well-being. Postoperatively, all domains improved significantly without statistical difference between the three groups and 90% of the patients would advise the intervention to one of their friends. Surgical outcomes vary greatly depending on the methodology of the study. Health-related quality of life seems paramount to decide time of surgery and to evaluate postoperatory results. We have chosen the Contilife questionnaire because of its scientific and clinical validity, reliability, responsiveness and linguistic validation. These results confirm that TVT/TOT/TVT-O procedures are a safe and effective surgical method and that they significantly improved health-related quality of life.
    Gynécologie Obstétrique & Fertilité 01/2009; 37(1):3-10. · 0.58 Impact Factor
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    ABSTRACT: Objectives To assess the health-related quality of life (Contilife®) after three surgical anti-incontinence procedures (Tension-Free Vaginal Tape [TVT], Transobturator Vaginal Tape [TOT], and Transobturator Vaginal Tape [TVT-O]).
    Gynécologie Obstétrique & Fertilité 01/2009; 37(1):3-10. DOI:10.1016/j.gyobfe.2008.09.020 · 0.58 Impact Factor
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    ABSTRACT: The aim of this study was to compare ultrasonographic findings on tape position, angulation and mobility following three surgical anti-incontinence procedures (trans-obturator tape (TOT), tension-free vaginal tape (TVT), tension-free vaginal tape obturator (TVT-O)) and to correlate these data with clinical signs of cures and failures and de novo voiding disorders. In this prospective study, vesicourethral static and dynamic analysis of 81 patients (30 TOT, 28 TVT, 23 TVT-O) were evaluated using introital ultrasonography. Width, position and appearance of the tape were similar in all three groups, i.e. like a "V" at rest, round angulation on Valsalva and closed angulation at maximum retaining. Moreover, closer angulation on Valsalva was associated with voiding disorders. Closer angulation at retaining was associated with de novo urge incontinence. Larger angulation of the tape at rest appeared to be significantly associated with recurrent stress incontinence. Ultrasonography could a be useful tool assessing anti-incontinence procedures and investigating post-operative voiding disorders.
    International Urogynecology Journal 09/2008; 19(8):1125-31. DOI:10.1007/s00192-008-0593-z · 2.16 Impact Factor
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    ABSTRACT: We report one case of unilateral ovarian Sertoli-Leydig tumor with intermediate grade and heterologous element, in a young woman with clinical and biological typical presentation. We discuss 2D and 3D ultrasonographic and doppler features.
    Gynécologie Obstétrique & Fertilité 06/2008; 36(5):532-5. DOI:10.1016/j.gyobfe.2008.01.016 · 0.58 Impact Factor
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    ABSTRACT: To evaluate results of laparoscopic sacropexy with introital and vaginal ultrasonography, that is to observe dynamic behavior of the mesh, to measure precisely its position and to conclude on the feasibility of this exam. The surgery was a laparoscopic subtotal hysterectomy and a suspension of the cervix with an anterior vesicovaginal mesh and a posterior rectovaginal mesh. These meshes are joined together and fixed on the sacrum. Ultrasound was performed in fifteen patients to see in the sagital plane the position of the mesh. The distance anterior mesh-bladder neck and the distance posterior mesh-anal sphincter were measured at rest, during straining and during retaining. The spreading out and the dynamic behavior of the mesh were studied. The distance anterior mesh-bladder neck is 12 mm at rest, 15 mm during straining and 13 mm during retaining. The distance posterior mesh-anal sphincter is 30 mm at rest, 26 mm during straining and 31 mm during retaining. The mesh is always seen as spread out, or folded, but never strained. Video recording shows that sacropexy does not block pelvic dynamics. Ultrasound imaging appears in this study as a simple and efficient exam to study and measure prosthesis. It could be a good help for clinical examination to explain failure or complication of surgery.
    Gynécologie Obstétrique & Fertilité 05/2008; 36(4):373-8. · 0.58 Impact Factor
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    ABSTRACT: Objectives To evaluate results of laparoscopic sacropexy with introital and vaginal ultrasonography, that is to observe dynamic behavior of the mesh, to measure precisely its position and to conclude on the feasibility of this exam.
    Gynécologie Obstétrique & Fertilité 04/2008; 36(4):373-378. DOI:10.1016/j.gyobfe.2007.12.017 · 0.58 Impact Factor
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    ABSTRACT: Spontaneous evolution of autoimmune hepatitis during pregnancy is not well known, nor are its consequences on pregnancy evolution. Immunosuppressive treatment during pregnancy is sometimes necessary but the long- and short-term consequences are unrecognized. We relate a patient's disease with autoimmune hepatitis and cirrhosis and three consecutive pregnancies with different obstetrical and medical complications.
    Gynécologie Obstétrique & Fertilité 04/2008; 36(3):299-305. · 0.58 Impact Factor
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    ABSTRACT: We report two cases of persistent [correction of persistant] perineal pain in postpartum period due to transfixation of the anus with a suture and the contribution of perineal ultrasound in the diagnosis of unusual perineal pain.
    Gynécologie Obstétrique & Fertilité 03/2008; 36(2):169-72. · 0.58 Impact Factor
  • Gynécologie Obstétrique & Fertilité 03/2008; 36(2):218-21. · 0.58 Impact Factor
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    ABSTRACT: Spontaneous evolution of autoimmune hepatitis during pregnancy is not well known and nor is its consequences on pregnancy evolution. Immunosuppressive treatment during pregnancy is sometimes necessary but the long- and short-term consequences are unrecognized. We relate a patient's disease with autoimmune hepatitis and cirrhosis and three consecutive pregnancies with different obstetrical and medical complications.
    Gynécologie Obstétrique & Fertilité 03/2008; 36(3):299-305. DOI:10.1016/j.gyobfe.2007.07.044 · 0.58 Impact Factor
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    ABSTRACT: IntroductionLe but de cette étude prospective est d’établir une comparaison échographique (aspect, angulation et mobilité) entre les bandelettes TVT (Tension-free vaginal tape), TOT out-in (Transobturator urethral tape out-in), et TVT-O in-out (Transobturator vaginal tape in-out) et d’en déduire une corrélation avec la symptomatologie clinique. Patients et méthodesQuatre-vingt une patientes (30 TOT, 28 TVT, et 23 TVT-O) ont bénéficié d’un examen clinique et urodynamique postopératoire. Parallèlement, une échographie par voie introïtale a été systématiquement réalisée permettant une évaluation statique (largeur et position de la bandelette dans un plan sagittal) et dynamique (aspects et angulation entre les deux branches de la bandelette au repos, à l’effort de poussée et à la retenue maximale dans un plan frontal). Résultats Dans le plan sagittal : Les trois types de bandelette sont localisés à mi-ure`tre et ont une largeur équivalente de 6,3 mm (4,7–8,5, NS). Dans le plan frontal : L’aspect est identique dans les trois groupes (au repos, celui d’un « V »; à la poussée, la bandelette s’arrondit; à la retenue, le « V » se ferme par traction des branches). De plus, au repos, une angulation plus large, voire une véritable horizontalisation est davantage associée à une persistance de l’incontinence urinaire d’effort. À l’effort, une angulation plus fermée s’associe significativement à une dysurie postopératoire. À la retenue, une angulation plus fermée s’associe statistiquement à des impériosités de novo. Discussion et conclusionL’échographie est une technique d’imagerie simple et accessible permettant d’explorer le bas appareil urinaire. Elle pourrait aider à appréhender les troubles mictionnels postopératoires des cures chirurgicales d’incontinence urinaire d’effort. ObjectiveTo evaluate and compare tape position, angulation and mobility after transobturator urethral sling outside-in (TOT), tension-free vaginal tape (TVT), and transobturator urethral sling inside-out (TVT-O) procedures using introit ultrasonography, and to correlate these data with clinical symptoms, clinical failures and voiding disorders (de novo urge incontinence and de novo voiding difficulties). Study designIn this prospective study, 81 patients (30 TOT, 28 TVT, and 23 TVT-O) received clinical examinations, quality of life assessments, and uroflowmetry assessments after surgery. Vesicoureteral static (tape width and position) and dynamic (angulation between the two limbs of the sling) were evaluated using introit ultrasonography. ResultsThe midurethral tape location and the width of the tape were similar in the 3 groups (6.3 mm, 4.7–8.5). The appearance of the tape at rest was similar to a “V” in both groups. However, the angle between the two limbs of the mesh was more open in TOT and TVT-O than in TVT (130.75 vs. 116.3°, p = 0.002; and 137.84 vs. 116.3°, p = 0.001). When performing the Valsalva manoeuvre, there was mechanical compression of the urethra against the mesh in the three groups, and the angle becomes rounded like a “U”. At maximum retention, the angle closed through traction on the limbs in all three groups. Moreover, closer angulation when performing the Valsalva manoeuvre was associated with voiding disorders. Closer angulation at retention was associated with de novo urge incontinence. Larger angulation or horizontalization of the tape at rest seemed to be significantly associated with recurrent stress incontinence. ConclusionThere is probably a relationship between angulation of the two limbs of the tape and clinical symptoms. Ultrasonography is a non-invasive and technically simple means of imaging the lower urinary tract and could be useful in understanding anti-incontinence procedures and investigating postoperative voiding disorders.
    Pelvi-périnéologie 03/2008; 3(1):7-14. DOI:10.1007/s11608-008-0173-1 · 0.03 Impact Factor
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    ABSTRACT: We report two cases of persistant perineal pain in postpartum period due to transfixation of the anus with a suture and the contribution of perineal ultrasound in the diagnosis of unusual perineal pain.
    Gynécologie Obstétrique & Fertilité 02/2008; 36(2):169-172. DOI:10.1016/j.gyobfe.2007.10.023 · 0.58 Impact Factor
  • Gynécologie Obstétrique & Fertilité 02/2008; 36(2):218-221. DOI:10.1016/j.gyobfe.2007.12.008 · 0.58 Impact Factor
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    ABSTRACT: Laparoscopic surgery takes place in a closed environment, the peritoneal cavity distended by the pneumoperitoneum whose parameters, such as pressure, composition, humidity and temperature of the gas, may be changed and adapted to influence the intra and postoperative surgical processes. Such changes were impossible in the "open" environment. This review includes recent data on peritoneal physiology, which are relevant for surgeons, and on the effects of the pneumoperitoneum on the peritoneal membrane. The ability to work in a new surgical environment, which may be adapted to each situation, opens a new era in endoscopic surgery. Using nebulizers, the pneumoperitoneum may become a new way to administer intraoperative treatments. Most of the current data on the consequences of the pneumoperitoneum were obtained using poor animal models so that it remains difficult to estimate the progresses, which will be brought to the operative theater by this new concept. However this revolution will likely be used by thoracic or cardiac surgeon who are also working in a serosa. This approach may even appear essential to all the surgeons who are using endoscopy in a retroperitoneal space such as urologists or endocrine surgeons.
    Bulletin du cancer 01/2008; 94(12):1043-51. DOI:10.1684/bdc.2007.0519 · 0.64 Impact Factor
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    ABSTRACT: La cirugía laparoscópica ha marcado un punto de inflexión en la historia de la cirugía ginecológica. Esta vía de acceso ofrece una visión anatómica aumentada, lo que mejora la precisión del diagnóstico quirúrgico. Gracias al mantenimiento constante de la distancia entre el ojo, el instrumento y el tejido, así como a la posibilidad de realizar una disección atraumática de los planos de separación, permite un tratamiento seguro y eficaz con el máximo respeto a la integridad de los órganos y a su función. La reducción de los traumatismos parietales y peritoneales que la caracterizan se asocia a una disminución del dolor postoperatorio inmediato y a una estancia hospitalaria y una convalecencia más cortas. Tras las publicaciones descriptivas de los equipos pioneros respecto a las primeras indicaciones de la cirugía laparoscópica en la década de 1980, estas técnicas quirúrgicas se han aplicado a numerosos tipos de intervención y se han difundido en la mayoría de los centros sanitarios a partir del comienzo de la década de 1990. En la actualidad, todas las indicaciones quirúrgicas ginecológicas pueden realizarse por laparoscopia, desde las indicaciones más validadas, como el embarazo extrauterino o las masas anexiales benignas, a las intervenciones más complejas que se aplican en los prolapsos o en los cánceres. Para realizar las numerosas intervenciones que se describen en este artículo, se requiere una formación adecuada y sólida, una anestesia adaptada a la cirugía laparoscópica, un dominio perfecto de la realización de la laparoscopia y del material que requiere, así como una técnica quirúrgica rigurosa.
    01/2008; 44(2):1–22. DOI:10.1016/S1283-081X(08)70810-5
  • Gynécologie Obstétrique & Fertilité 12/2007; 35(11):1181-2. · 0.58 Impact Factor
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    ABSTRACT: We report a case of unexpected severe hypertriglyceridemia (140N) diagnosed at 33 weeks during a second gestation. The risk of acute pancreatitis indicated plasmapheresis (three procedures) with reduction of hypertriglyceridemia (6N) and no impact on fetal well-being. Immediate recurrence led to induction of labour at 34 weeks. Spontaneous regression occurred after delivery. We demonstrated reduced lipoprotein lipase activity with no mutation for apolipoprotein E, nor lipoprotein lipase in favour of a potential pregnancy-induced inhibitor of lipoprotein degradation.
    Gynécologie Obstétrique & Fertilité 12/2007; 35(11):1133-5. · 0.58 Impact Factor