P Mares

Hôpital Antoine-Béclère – Hôpitaux universitaires Paris-Sud, Clamart, Île-de-France, France

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Publications (242)461.63 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Describe the central nervous system (CNS) adverse effects of anticholinergic drugs used for the treatment of overactive bladder (OAB) in the elderly.
    Progrès en urologie : journal de l'Association française d'urologie et de la Société française d'urologie. 09/2014; 24(11):672-81.
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    ABSTRACT: The aim of the present study was to evaluate the value of a box trainer simulator in laparoscopy training. A further aim was to determine if robotic-assisted approaches further improved the young residents' skills in laparoscopic surgery. The study was a prospective randomized study. Twelve residents in obstetrics & gynecology completed four laparoscopy-related procedures of varying complexity using a box trainer simulator. Participants were randomized into two groups; robotic-assisted laparoscopy (LRA) and traditional laparoscopy (TL). All subjects were assessed with a time and technical score, which are quantitative and qualitative approaches (respectively). All residents completed the training and a satisfaction questionnaire, which confirmed that the training was well regarded. Regardless of the workshop type, there was a clear time and technical improvement for the difficult tasks. The improvement of time score was most apparent for simple tasks in LRA and for more complex tasks in TL. After training, we did not find a significant difference for the technical score between Novices and Experts in TL and LRA. These findings suggest that training in laparoscopy surgery is useful, reproducible and well accepted by both novice and more advanced trainees. Furthermore, gynecological endoscopy center consider including robotic-assisted approaches in their surgical training program.
    European journal of obstetrics, gynecology, and reproductive biology. 08/2014; 181C:321-327.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Cervical agenesis is a rare congenital pathology linked to an anomaly of development of the Mullerian system. We described a case report about a 22-year old woman, consulting for infertility, who had a complete cervical agenesis. The first evaluation suggested a 46 XX karyotype and a normal ovarian reserve. The surgical examination confirmed the absence of cervix with impossibility of catheterization. She became pregnant thanks to an in vitro fertilization (IVF) with transmyometrial embryo transfer. Caesarean was decided at 36weeks of gestation (WG) due to spontaneous uterine contractions. An injection of medroxyprogesterone was made after the placenta delivery in order to warning the partum hemorrhage. The ultrasound examination, realized 15days after caesarean, underlined a good uterine involution. The surgery by cervico-vaginal anastomosis can be offered to patients because it offers chances of spontaneous pregnancies. But this surgery exposes women to a risk of failure, and of severe complications such as pain or infection, and might end in a hysterectomy. By choosing the transmyometrial transfer by vaginal way, the patient was exposed to the risk of spontaneous miscarriage. It was raising the problem of the uterine evacuation. This delivery after 34WG is encouraging for the infertility by cervical agenesis.
    Journal de gynecologie, obstetrique et biologie de la reproduction. 05/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Provide guidelines presented as an algorithm for practical evaluation and first line therapy of urinary incontinence in elderly. Guidelines using formalized consensus guidelines method. These guidelines have been validated by a group of 40 experts quoting proposals, subsequently reviewed by an independent group of multidisciplinary experts (urologist, general practitioner, neurologist, gynecologist, geriatrist, specialist in physical medicine and rehabilitation). By means of 3 rounds of interrogation of the expert panel, GRAPPPA algorithm was constructed. This algorithm take in account both evaluation and first line therapeutic options in the different type of incontinences observed in this population (urge, stress and mixed incontinence). Initial evaluation consists to track down urinary retention (and subsequently fecal stool impaction, use of anticholinergic or morphinic drugs), urinary tract infection and cognitive impairment. Haematuria, bladder-pelvic pain, history of radiotherapy or recent pelvic surgery, lead to refer the patient to a specialized unit. First line therapy is in all the cases pelvic floor training, use of local oestrogenotherapy and dietetic measures. In urge incontinence, anticholinergic drugs may be used. Implementation of this algorithm may promote best practice in management of urinary incontinence in elderly.
    Progrès en Urologie 03/2014; 24(4):215-21. · 0.80 Impact Factor
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    ABSTRACT: To show place and usefulness of intra-uterine compression in management of post-partum haemorrhage (PPH). Retrospective cohort study, monocentric, including all consecutive cases of PPH during four years in an obstetric department of level IIa. The compression technique was the use of intra-uterine meshes, and efficacy was defined as a total and immediate bleeding interruption. Apart of meshes, patients received sulprostone then ocytocine and antibiotics. The rate of PPH was 3.8% on 3913 deliveries. One hundred and fifty patients with PPH were managed following CNGOF guidelines. Ninety-nine patients were also treated with intra-uterine meshes during 24hours. The rate of mesh success was 91.9%. Sixty-two cases of subsequent pregnancies were also reported. In case of PPH, intra-uterine compression using meshes is simple, cheap and efficient. That technique could avoid the use of invasive surgical procedures and a safer post-natal transfer.
    Journal de Gynécologie Obstétrique et Biologie de la Reproduction 02/2014; · 0.45 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The aim of the present study was to evaluate the value of a box trainer simulator in laparoscopy training. A further aim was to determine if robotic-assisted approaches further improved the young residents’ skills in laparoscopic surgery. The study was a prospective randomized study. Twelve residents in obstetrics & gynecology completed four laparoscopy-related procedures of varying complexity using a box trainer simulator. Participants were randomized into two groups; robotic-assisted laparoscopy (LRA) and traditional laparoscopy (TL). All subjects were assessed with a time and technical score, which are quantitative and qualitative approaches (respectively). All residents completed the training and a satisfaction questionnaire, which confirmed that the training was well regarded. Regardless of the workshop type, there was a clear time and technical improvement for the difficult tasks. The improvement of time score was most apparent for simple tasks in LRA and for more complex tasks in TL. After training, we did not find a significant difference for the technical score between Novices and Experts in TL and LRA. These findings suggest that training in laparoscopy surgery is useful, reproducible and well accepted by both novice and more advanced trainees. Furthermore, gynecological endoscopy center consider including robotic-assisted approaches in their surgical training program.
    European Journal of Obstetrics & Gynecology and Reproductive Biology. 01/2014; 181:321–327.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objectives Provide guidelines presented as an algorithm for practical evaluation and first line therapy of urinary incontinence in elderly. Patients and methods Guidelines using formalized consensus guidelines method. These guidelines have been validated by a group of 40 experts quoting proposals, subsequently reviewed by an independent group of multidisciplinary experts (urologist, general practitioner, neurologist, gynecologist, geriatrist, specialist in physical medicine and rehabilitation). Results By means of 3 rounds of interrogation of the expert panel, GRAPPPA algorithm was constructed. This algorithm take in account both evaluation and first line therapeutic options in the different type of incontinences observed in this population (urge, stress and mixed incontinence). Initial evaluation consists to track down urinary retention (and subsequently fecal stool impaction, use of anticholinergic or morphinic drugs), urinary tract infection and cognitive impairment. Haematuria, bladder-pelvic pain, history of radiotherapy or recent pelvic surgery, lead to refer the patient to a specialized unit. First line therapy is in all the cases pelvic floor training, use of local oestrogenotherapy and dietetic measures. In urge incontinence, anticholinergic drugs may be used. Conclusions Implementation of this algorithm may promote best practice in management of urinary incontinence in elderly.
    Progrès en Urologie. 01/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objectives Describe the central nervous system (CNS) adverse effects of anticholinergic drugs used for the treatment of overactive bladder (OAB) in the elderly. Patients and methods Relevant data from the literature were identified primarily through a Medline search of articles published through December 2013. The search terms included overactive bladder, central nervous system, elderly, anticholinergic, and antimuscarinic. Articles were chosen for inclusion based on their pertinence to the focus on treatment of OAB in the elderly. Results Several anticholinergic drugs are available for the treatment of OAB, including oxybutinin, tolterodine, trospium chloride, solifenacine, fesoterodine. Among the agents reviewed, penetration of the blood-brain barrier (as predicted by lipophilicity, polarity, and molecular size and structure) is highest for oxybutinin, lower for tolterodine, solifenacine, and darifenacine, and lowest for fesoterodine and trospium chloride. Unwanted CNS adverse effects depend in part on patient specific variability in pharmacokinetic parameters, blood-brain barrier permeability, degree of cholinergic neuronal degeneration, total anticholinergic drug burden and patient's baseline cognitive status. The spectrum of anticholinergic CNS adverse effects ranges from drowsiness to hallucinations, severe cognitive impairment, and coma. Among the different anticholinergic agents, oxybutinin has been associated with cognitive impairment and trospium chloride and fesoterodine have shown favorable CNS tolerability. Conclusions Anticholinergic drugs improve significatively overactive bladder symptoms in older adults. However, potential CNS adverse effects of anticholinergic agents used in OAB must lead to a full evaluation before and during the treatment in order to evaluate benefice, risks and central side effects in this frail population.
    Progrès en Urologie. 01/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective To show place and usefulness of intra-uterine compression in management of post-partum haemorrhage (PPH). Material and methods Retrospective cohort study, monocentric, including all consecutive cases of PPH during four years in an obstetric department of level IIa. The compression technique was the use of intra-uterine meshes, and efficacy was defined as a total and immediate bleeding interruption. Apart of meshes, patients received sulprostone then ocytocine and antibiotics. Results The rate of PPH was 3.8% on 3913 deliveries. One hundred and fifty patients with PPH were managed following CNGOF guidelines. Ninety-nine patients were also treated with intra-uterine meshes during 24 hours. The rate of mesh success was 91.9%. Sixty-two cases of subsequent pregnancies were also reported. Conclusion In case of PPH, intra-uterine compression using meshes is simple, cheap and efficient. That technique could avoid the use of invasive surgical procedures and a safer post-natal transfer.
    Journal de Gynécologie Obstétrique et Biologie de la Reproduction. 01/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Cervical agenesis is a rare congenital pathology linked to an anomaly of development of the Mullerian system. We described a case report about a 22-year old woman, consulting for infertility, who had a complete cervical agenesis. The first evaluation suggested a 46 XX karyotype and a normal ovarian reserve. The surgical examination confirmed the absence of cervix with impossibility of catheterization. She became pregnant thanks to an in vitro fertilization (IVF) with transmyometrial embryo transfer. Caesarean was decided at 36 weeks of gestation (WG) due to spontaneous uterine contractions. An injection of medroxyprogesterone was made after the placenta delivery in order to warning the partum hemorrhage. The ultrasound examination, realized 15 days after caesarean, underlined a good uterine involution. The surgery by cervico-vaginal anastomosis can be offered to patients because it offers chances of spontaneous pregnancies. But this surgery exposes women to a risk of failure, and of severe complications such as pain or infection, and might end in a hysterectomy. By choosing the transmyometrial transfer by vaginal way, the patient was exposed to the risk of spontaneous miscarriage. It was raising the problem of the uterine evacuation. This delivery after 34 WG is encouraging for the infertility by cervical agenesis.
    Journal de Gynécologie Obstétrique et Biologie de la Reproduction. 01/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: The incidence of pregnancy outcomes in women with constitutive thrombophilia is uncertain. We observed women with no history of thrombotic events (non-thrombotic), who had experienced three consecutive spontaneous abortions before the 10th week of gestation or one fetal death at or beyond the 10th week of gestation. We compared the frequencies of complications during a new pregnancy attempt among women carrying the F5 rs6025 or F2 rs1799963 polymorphism (n=279; LMWH treatment during pregnancy only in case of prior fetal death), and women with negative thrombophilia screening results as control women (n=796; no treatment). Among women with prior recurrent abortions, thrombophilic women were at increased risk of fetal death. Among women with prior fetal death, thrombophilic women experienced less fetal death recurrences, less preterm births and pre-eclampsia, and more live births as they were treated with LMWH. In non-thrombotic F5 rs6025 or F2 rs1799963 heterozygous women with prior pregnancy loss, fetal loss may indicate a clinical subgroup in which future therapeutic randomized controlled trials testing the effect of LMWH prophylaxis are required in priority.
    Blood 11/2013; · 9.78 Impact Factor
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    ABSTRACT: The incidence of pregnancy outcomes for women with the purely obstetric form of antiphospholipid syndrome (APS) treated with prophylactic low-molecular weight heparin LMWH plus low-dose aspirin LDA has not been documented. We observed women without a history of thrombosis, who had experienced three consecutive spontaneous abortions before the 10th week of gestation or one fetal loss at or beyond the 10th week. We compared the frequencies of complications during new pregnancies between treated women with APS (n=513; LMWH+LDA) and women negative for antiphospholipid antibodies as controls (n=791; no treatment). Among APS women, prior fetal loss was a risk factor for fetal loss, pre-eclampsia (PE), premature birth and the occurrence of any placenta-mediated complication. Being positive for anticardiolipin-IgM antibodies was a risk factor for any placenta-mediated complication. Among women with a history of recurrent abortion, APS women were at a higher risk than other women of PE, placenta-mediated complications and neonatal mortality. Among women with prior fetal loss, LMWH+LDA-treated APS women had lower pregnancy loss rates but higher PE rates than other women. Improved therapies, in particular better prophylaxis of late pregnancy complications, are urgently needed for obstetric APS and should be evaluated according to the type of pregnancy loss.
    Blood 11/2013; · 9.78 Impact Factor
  • Source
    Ultrasound in Obstetrics and Gynecology 10/2013; 42(s1). · 3.56 Impact Factor
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    ABSTRACT: To determine the indications and contraindications concerning prosthetic surgery by vaginal route for pelvic organ prolapse. Literature review and rating of proposals using a formal consensus method. Before surgery for genital prolapse, the patient should be counselled about the different existing techniques (abdominal and vaginal surgery with and without mesh), the reasons why the surgeon offered her the placement of a synthetic mesh and also other nonsurgical treatments (pelvic floor rehabilitation and pessary). The intervention must be preceded by an assessment of bothersome pelvic, urinary, digestive and sexual symptoms. For the surgical treatment of cystocele, the use of a synthetic mesh placed by vaginal route is not recommended routinely. It should be discussed on a case by case considering the risk/benefit ratio. In patients presenting with cystocele recurrence, the placement of a synthetic mesh is a reasonable option, in order to reduce the risk of cystocele recurrence. With the exception of a few situations (rectocele recurrence), the placement of a synthetic mesh is not recommended as first-line therapy for the surgical treatment of rectocele by vaginal route. In case of uterine or vaginal vault prolapse, repositioning the vaginal vault or uterus using synthetic mesh arms is not recommended as first-line surgical therapy. Surgeons should implement established preventive recommendations that may reduce the risk of complications.
    Journal de Gynécologie Obstétrique et Biologie de la Reproduction 10/2013; · 0.45 Impact Factor
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    ABSTRACT: To determine a syndrome score threshold on PFDI or PFIQ predictive of a significant improvement in post-operative functional results. A retrospective case review (Canadian Task Force Classification II-2). University and research hospital. Women diagnosed with pelvic organ prolapse and repaired with synthetic vaginal mesh. Quality of life was arbitrarily considered to have improved significantly if the score decreases by more than 50% between pre-operatively and 36 months post-operatively. We investigated the pre-operative cut-off score predictive of no quality of life improvement at M36 from a prospective trial for surgical pelvic organ prolapse treatment. The most accurate pre-operative cut-off score predicting a failure to improve quality of life at 36 months post-operatively was 62/300 (PFDI Score). This cut-off value had a positive predictive value of 83.6% and specificity of 62.1%. No significant threshold was obtained from the PFIQ score. The intensity of symptoms before surgery may interfere as a predictive factor for outcome.
    Progrès en Urologie 09/2013; 23(11):940-5. · 0.80 Impact Factor
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    ABSTRACT: OBJECTIVE: We sought to validate a sequence of ultrasonographic mesh measurements to determine the relevant time points in the postoperative monitoring of mesh size. METHODS: Mesh was measured preoperatively ex vivo, prior to insertion, in 25 patients scheduled to undergo vaginal repair of cystocele involving insertion of a Ugytex™ transobturating polypropylene mesh. A 2D/3D perineal ultrasound scan was performed at the end of the surgical procedure (D0), then on third day after surgery (D3) and 6weeks (W6) after the operation. Medio-sagittal view was used to measure mesh total length and the sagittal arc (length between the most distant points of the mesh). RESULTS: Time-course changes in sagittal arc were marked by a 8% increase on D3 (with respect to D0) and a 20% decrease at W6 (with respect to D3). Mesh total length at W6 on average corresponded to 74% (±20) of mesh total length measured on D3. CONCLUSION: This study showed the changes in the mesh ultrasonographic measurements following vaginal placement by vaginal route. The D3 ultrasound scan should appear to be suitable as a reference for subsequent ultrasonographic monitoring.
    Progrès en Urologie 06/2013; 23(8):530-537. · 0.80 Impact Factor
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    ABSTRACT: Objective To compare morbidity of robot-assisted laparoscopic myomectomy versus those performed by laparotomy. Patients and methods It reports a monocentric retrospective case matched analysis enrolling 22 patients (six laparotomic and 16 robot-assisted laparoscopic myomectomies), needing a surgical treatment for at least one myoma oversizing 6 cm. Results Both patient groups were comparable regarding their age, their weight and myoma's size. There were more complications in the laparotomy group in comparison with the robotic group (66.7%, versus 0%; P = 0.002). Average intraoperative blood losses were respectively 397 ± 377 mL versus 387 ± 349 mL (P = 0.71) and length of stay 7.2 ± 0.8 days versus 3.9 ± 2.8 days (P < 0.001). None of the robot-assisted laparoscopic myomectomy needed any conversion to laparotomy. Conclusion Robot-assisted laparoscopic myomectomy seems to be feasible for heavy fibroids, with a lower morbidity in comparison with laparotomy. These results must be confirmed by several wider prospective studies.
    Journal de Gynécologie Obstétrique et Biologie de la Reproduction. 09/2012; 41(5):439–444.
  • Ultrasound in Obstetrics and Gynecology 09/2012; 40(S1). · 3.56 Impact Factor
  • Source
    Ultrasound in Obstetrics and Gynecology 09/2012; 40(S1). · 3.56 Impact Factor
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    ABSTRACT: Endometriosis concerns 10% of childbearing age women and frequently affects the digestive tract. We report here the case of a 31-year-old patient presenting a severe occlusive syndrome while being treated with GnRH agonist, within the framework of an in vitro fertilization. The surgical treatment will find a deep endometriosis affecting the sigmoid and colorectal junction and leading to a colorectal resection. These endometriosis lesion recurrences during ovarian stimulation or by GnRH flare up effect is rare and often debated. The surgical treatment of the lesions, before the medically assisted procreation, seems to prevent these complications.
    Journal de Gynécologie Obstétrique et Biologie de la Reproduction 07/2012; 41(7):668-71. · 0.45 Impact Factor

Publication Stats

1k Citations
461.63 Total Impact Points

Institutions

  • 2011–2013
    • Hôpital Antoine-Béclère – Hôpitaux universitaires Paris-Sud
      Clamart, Île-de-France, France
    • College of Obstetrics and Gynecology of Leon
      Aquitaine, France
  • 1992–2013
    • Université de Nîmes
      Nismes, Languedoc-Roussillon, France
    • Centre Médico Chirurgical Paris V
      Lutetia Parisorum, Île-de-France, France
  • 1992–2011
    • Université Montpellier 2 Sciences et Techniques
      Montpelhièr, Languedoc-Roussillon, France
  • 2003–2010
    • Université de Montpellier 1
      Montpelhièr, Languedoc-Roussillon, France
  • 2001–2010
    • Centre Hospitalier Universitaire de Montpellier
      Montpelhièr, Languedoc-Roussillon, France
    • Centre Hospitalier Régional et Universitaire de Besançon
      Becoinson, Franche-Comté, France
  • 2009
    • Centre Hospitalier Universitaire de Clermont-Ferrand
      Clermont, Auvergne, France
  • 2000–2009
    • Centre Hospitalier Régional Universitaire de Nîmes
      Nismes, Languedoc-Roussillon, France
  • 2006
    • Centre Hospitalier Universitaire de Rennes
      Roazhon, Brittany, France
  • 2005
    • La Ligue contre le cancer
      Lutetia Parisorum, Île-de-France, France
  • 2002
    • Centre Hospitalier Universitaire de Dijon
      Dijon, Bourgogne, France
    • Centre Hospitalier Universitaire de Limoges
      Limages, Limousin, France
  • 1998–1999
    • Institut de Génétique et de Biologie Moléculaire et Cellulaire
      Strasburg, Alsace, France
  • 1996
    • Clinique Beau-Soleil
      Montpelhièr, Languedoc-Roussillon, France
  • 1993
    • CHRU de Strasbourg
      Strasburg, Alsace, France