P Mares

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

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Publications (248)474.91 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Few studies have evaluated urine postvoid residuals (PVRs) and their risk factors during the post-partum (PP) period. The aim of this prospective study was to screen postvoid residuals in a cohort of patients in PP, and to identify the risk factors. For three months, patients in PP were given an evaluation of their PVR (ultrasounds method) after a spontaneous urination. Clinical data as regards delivery were collected. One hundred and sixty-eight patients were included. Among them, 61% had a urine volume at the first urination over 500 mL, and 52% presented with a pathological PVR (PVR over 150mL for a urine volume over 150 mL). The median PVR was 153.50 mL. The median volume of the first spontaneous urination was 400mL. Among patients with a pathological PVR, the total duration of the labor and the duration of its second phase were significantly longer (P=0.003 and P<0.05, respectively), and the volume of the first urination was higher. Indwelling catheterization during the delivery decreased the volume of the first spontaneous urination (volume over 500mL in 28% vs 72% of patients, P=0.017) but was not associated with a decreased PVR in non-pathological deliveries. Instrumental deliveries were associated with higher PVRs than caesarean or physiological deliveries (244mL, 180mL et 156mL; P=0.033). A bacteriuria was not significantly associated with PVR (54% vs 49%, P>0.05). We were able to identify risk factors for PVR in the PP, such as the duration of labor, instrumental delivery and elevated volume of the first urination after delivery. 3. Copyright © 2014 Elsevier Masson SAS. All rights reserved.
    Progres en urologie : journal de l'Association francaise d'urologie et de la Societe francaise d'urologie. 10/2014;
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    ABSTRACT: The aim of this study was to assess the gynecology obstetric residents training on a birth simulator.
    Journal de gynecologie, obstetrique et biologie de la reproduction. 09/2014;
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    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: 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 09/2014; · 0.80 Impact Factor
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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. · 1.84 Impact Factor
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    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;
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    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: Introduction Few studies have evaluated urine postvoid residuals (PVRs) and their risk factors during the post-partum (PP) period. The aim of this prospective study was to screen postvoid residuals in a cohort of patients in PP, and to identify the risk factors. Materials and methods For three months, patients in PP were given an evaluation of their PVR (ultrasounds method) after a spontaneous urination. Clinical data as regards delivery were collected. Results One hundred and sixty-eight patients were included. Among them, 61% had a urine volume at the first urination over 500 mL, and 52% presented with a pathological PVR (PVR over 150 mL for a urine volume over 150 mL). The median PVR was 153.50 mL. The median volume of the first spontaneous urination was 400 mL. Among patients with a pathological PVR, the total duration of the labor and the duration of its second phase were significantly longer (P = 0.003 and P < 0.05, respectively), and the volume of the first urination was higher. Indwelling catheterization during the delivery decreased the volume of the first spontaneous urination (volume over 500 mL in 28% vs 72% of patients, P = 0.017) but was not associated with a decreased PVR in non-pathological deliveries. Instrumental deliveries were associated with higher PVRs than caesarean or physiological deliveries (244 mL, 180 mL et 156 mL; P = 0.033). A bacteriuria was not significantly associated with PVR (54% vs 49%, P > 0.05). Conclusion We were able to identify risk factors for PVR in the PP, such as the duration of labor, instrumental delivery and elevated volume of the first urination after delivery. Level of evidence 3.
    Progrès en Urologie. 01/2014;
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    ABSTRACT: Objective The aim of this study was to assess the gynecology obstetric residents training on a birth simulator. Materials and methods This is a prospective monocentric study, which had included residents at the beginning of their formation and performed on SIMone™, 3B SCIENTIFIC® birth simulator. It had included four sessions (supervised by two seniors registrar): two on instrumental extraction (vacuum and forceps) and two on labor monitoring. The two sessions were performed at one month. A theoretical formation was accomplished after the first assessment. Three assessments were performed based on two score scales (extraction and labor monitoring). A free training was allowed at each extraction session. Results Twelve interns were included in this study. There was a significant scores improvement between first and third session for instrumental extraction (2.4 points on 11 [± 1.8] vs. 8 [± 0.9]; [P < 0.05]) and for labor monitoring (5.2 [± 1.4] points on 9 vs. 6.6 [± 1.3]; [P < 0.05]). Interns considered this training improved their theoretical and practical knowledge for respectively 11 and 12 interns on 12. For 9 interns, a most important debriefing with teachers was desirable. Conclusion Training on birth simulator allows an improvement of knowledge and skill of gynecology obstetric interns. A structured debriefing should be instituted after the sessions.
    Journal de Gynécologie Obstétrique et Biologie de la Reproduction. 01/2014;
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    ABSTRACT: It is widely supported that multicentric disease of the breast (MCDB) is a contraindication of breast conservative surgery (BCS). This is a multicentric study (two breast cancer units from Greece, one from France) involving patients with at least two primary tumors in separate quadrants of the breast and no diffuse suspicious microcalcifications on mammography. Sixty-one patients were included in the study, but 49 were followed up to the end. Patients were randomly assigned in total mastectomy (TM) and BCS groups. End point of the study was disease-free survival rates three and five years after initial operation. Three years after BCS, local recurrence (LR) was observed in two patients (7%) and one after five years (total recurrence rate: 11%). A TM was performed in these patients, and in two there was no LR or distant metastasis (DM) five years after. The third patient was disease free two-years later. Three years after TM, eight patients (36.4%) had DM and 14 (63.6%) did not (p = 0.004). Five years after TM, eight patients (36.4%) had DM and 14 patients (63.6%) di not (p = 0.03). The results showed that conservative surgery was an alternative surgical option in multicentric breast cancer with good results regarding disease-free survival and recurrence.
    European journal of gynaecological oncology 01/2014; 35(5):530-4. · 0.58 Impact Factor
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    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;
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    ABSTRACT: La prévalence de l’infection HPV dans la population féminine varie avec l’âge, avec un pic d’environ 30 % autour de 20–25 ans. Elle diminue ensuite progressivement après l’âge de 30 ans pour devenir inférieure à 10 %. Plusieurs études ont cependant rapporté une ré-augmentation de la prévalence de l’infection HPV pouvant atteindre jusqu’à 15 % à partir de 45–50 ans, autour de la ménopause. La persistance de l’infection HPV, directement corrélée au risque de cancer du col utérin, augmente avec l’âge et dépend de différents cofacteurs dont le terrain immunitaire et le type d’HPV oncogène. Chez les femmes ménopausées, l’épidémiologie de l’infection HPV ainsi que les facteurs de persistance de cette infection sont moins bien connus que dans la population féminine jeune. Notre étude vise à répondre aux questions suivantes : quelles sont les caractéristiques spécifiques de l’infection HPV dans cette population particulière (épidémiologie, persistance, facteurs de risque) ? Le test HPV permet-il d’améliorer la stratégie de dépistage en postménopause ? Il s’agit d’une étude descriptive et rétrospective, portant sur une population de femmes ménopausées recrutées, par le même observateur, lors d’une consultation gynécologique de routine au CHU de Montpellier, entre janvier 2007 et décembre 2012, suivi en moyenne pendant 28 mois. Chaque femme a bénéficié d’un FCV en phase liquide et d’un test de détection HPV oncogène (HC2 High-Risk HPV DNA Test, Qiagen). En cas de test HPV positif, un génotypage HPV par méthode INNO LiPA (Fijirebio) a été réalisé. Les patientes ont été référées en colposcopie si elles présentaient un FCV pathologique (seuil ASC-US) ou une infection HPV persistante (2 prélèvements positifs à 12 mois d’intervalle), avec réalisation de biopsies dirigées en cas d’anomalies. Un traitement adapté, par conisation ou hystérectomie, a permis d’obtenir les données histologiques définitives. Parmi les 406 patientes ménopausées incluses âgées de 44 à 84 ans, 40 présentent un test HPV positif soit une prévalence de 9,85 % ; le taux de persistance s’élève à 50 % soit 20 patientes. Un génotypage HPV a été réalisé chez 21 des 40 patientes avec test HPV positif ; nous observons une prédominante des HPV à haut risque 52 et 31 (respectivement 15 % et 10 %). Un antécédent de dysplasie cervicale, l’ancienneté de la ménopause et le tabagisme apparaissent comme des facteurs de risque significatifs d’infection à HPV persistante. Le recours à un traitement hormonal substitutif, quelle qu’en soit la durée, est un facteur protecteur de persistance de l’infection HPV. L’exploration initiale et le suivi mettent en évidence 7 lésions CIN2+ au sein des patientes avec test HPV HR positif, alors qu’aucune lésion n’est diagnostiquée parmi les 366 patientes présentant un test HPV négatif. Notre étude montre une prévalence de l’infection HPV chez les femmes ménopausées autour de 10 %, semblable aux données de la littérature. La persistance de l’infection HPV semble particulièrement élevée dans cette population (rôle de l’altération immunitaire induite par la carence estrogénique ?). Notre étude montre également que le test HPV est un élément de dépistage pertinent en post ménopause, avec une meilleure sensibilité que le FCV pour le diagnostic des lésions CIN2+. Son excellente valeur prédictive négative (VPN) en fait un outil pertinent pour pallier aux faiblesses du FCV dans cette population (50 % de cellules endocervicales absentes sur le FCV). La prévalence élevée de l’infection à HPV et son taux important de persistance suggèrent la poursuite du dépistage au-delà de 65 ans.
    Revue Francophone des Laboratoires 01/2014; 2014(465):7–8.
  • [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;
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    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
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    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

Publication Stats

1k Citations
474.91 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
  • 2001–2010
    • Centre Hospitalier Universitaire de Montpellier
      Montpelhièr, Languedoc-Roussillon, France
    • Centre Hospitalier Régional et Universitaire de Besançon
      Becoinson, Franche-Comté, France
  • 1992–2010
    • Université de Montpellier 1
      Montpelhièr, Languedoc-Roussillon, 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 Nice
      • Département de Gynécologie
      Nice, Provence-Alpes-Côte d'Azur, 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