Urinary incontinence is a frequent affliction in women and may be disabling and costly {LE1}. Whe... more Urinary incontinence is a frequent affliction in women and may be disabling and costly {LE1}. When consulting for urinary incontinence, it is recommended that circumstances, frequency and severity of leaks be specified {Grade B}. The cough test is recommended prior to surgery {Grade C}. Urodynamic investigations are not needed before lower urinary tract rehabilitation {Grade B}. A complete urodynamic investigation is recommended prior to surgery for urinary incontinence {Grade C}. In cases of pure stress urinary incontinence, urodynamic investigations are not essential prior to surgery provided the clinical assessment is fully comprehensive (standardised questionnaire, cough test, bladder diary, post-void residual volume) with concordant results {PC}. It is recommended to start treatment for stress incontinence with pelvic floor muscle training {Grade C}. Bladder training is recommended at first intention in cases with overactive bladder syndrome {Grade C}. For overweight patients, loss of weight improves stress incontinence {LE1}. For surgery, sub-urethral tape (retropubic or transobturator route) is the first-line recommended technique {Grade B}. Sub-urethral tape surgery involves intraoperative risks, postoperative risks and a risk of failure which must be the subject of prior information {Grade A}. Elective caesarean section and systematic episiotomy are not recommended methods of prevention for urinary incontinence {Grade B}. Pelvic floor muscle training is the treatment of first intention for pre-and postnatal urinary incontinence {Grade A}. Prior to any treatment for an elderly woman, it is recommended to screen for urinary infection using a test strip, ask for a bladder diary and measure postvoid residual volume {Grade C}. It is recommended to carry out a cough test and look for occult incontinence prior to surgery for pelvic organ prolapse {Grade C}. It is recommended to carry out urodynamic investigations prior to pelvic organ prolapse surgery when there are urinary symptoms or occult urinary incontinence {Grade C}. ß
Objective. — To study whether post-partum dyspareunia one year after a delivery is associated wit... more Objective. — To study whether post-partum dyspareunia one year after a delivery is associated with characteristics of delivery: perineal trauma, obstetric interventions and women’s experience. Methods. — A self-administered questionnaire on post-partum sexual function was mailed in May 2002 to all consecutive women who gave birth to a live-born term infant in a maternity unit, between January 2001 and June 2001. Obstetric data were abstracted from the hospital computerized medical database. Late dyspareunia was defined as pain during intercourse, one year after delivery. Multiple logistic regression modeling was used to select independent predictors of late post-partum dyspareunia. Results. — Seventy (27.6%) of the 254 women studied experienced late dyspareunia. There was no relation between late post-partum dyspareunia and neither the mode of delivery nor state of the perineum, including perineal laceration or episiotomy. Multiple logistic regression analysis showed that late post-partum dyspareunia was associated with dyspareunia before pregnancy, low satisfaction with delivery, and employment status. Conclusions. — Late post-partum dyspareunia seemed to be linked more with the mother’s experience of childbirth than with perineal trauma. This hypothesis should be investigated further.
OBJECTIVE: To estimate obstetric risk factors of fecal incontinence among middle-aged women.
METH... more OBJECTIVE: To estimate obstetric risk factors of fecal incontinence among middle-aged women. METHODS: We conducted a mail survey of the Gazel cohort of volunteers for epidemiologic research. In 2000, a questionnaire on anal incontinence was mailed to 3,114 women who were then between the ages of 50 and 61years; 2,640 (85%) women returned the completed questionnaire. Fecal incontinence was defined by involuntary loss of stool. Logistic regression was used to estimate the effect of obstetric and general risk factors. RESULTS: Prevalence of fecal incontinence in the past 12 months was 9.5% (250). Significant risk factors for fecal incontinence were completion of high school (adjusted odds ratio [OR] 1.5, 95% confidence interval [CI] 1.1–2.0), self-reported depression (OR 2.1, 95% CI 1.6 –2.7), overweight or obesity measured by body mass index (BMI) (OR 1.5 for BMI of 25–30, 95% CI 1.1–2.0; OR 1.6 for BMI more than 30, 95% CI 1.1–2.5), surgery for urinary incontinence (OR 3.5, 95% CI 2.0–6.1), and anal surgery (OR 1.7, 95% CI 1.1–2.9). No obstetric variable (parity, mode of delivery, birth weight, episiotomy, or third-degree perineal tear) was significant. Prevalence of fecal incontinence was similar for nulliparous, primiparous, secundiparous, and multiparous women (11.3%, 9.0%, 9.0%, and 10.4%, respectively), and among parous women, it was similar for women with spontaneous vaginal, instrumental (at least one), or only cesarean deliveries (9.3%, 10.0%, and 6.6%, respectively). CONCLUSION: In our population of women in their 50s, fecal incontinence was not associated with either parity or mode of delivery.
La douleur pelvienne aiguë constitue une situation clinique très fréquente dans la pratique gynéc... more La douleur pelvienne aiguë constitue une situation clinique très fréquente dans la pratique gynécologique d'urgence. Les pathologies rencontrées dans cette situation sont à la fois nombreuses et de gravité variable, certaines de ces pathologies pouvant mettre en jeu la vie des patientes ou avoir des conséquences graves sur la fertilité ultérieure. investigations coûteuses. Le diagnostic de l'affection en cause est difficile à établir par les moyens diagnostiques conventionnels, ce qui est à l'origine de la diffusion de la coelioscopie diagnostique, son utilisation sans limite peut, cependant être à l'origine d'incidents ou d'accidents. Les auteurs proposent une stratégie diagnostique basée sur une utilisation rigoureuse de l'examen clinique et des examens complémentaires non invasifs (test de prossesse, biologie standard et échographie). Le recours à la coelioscopie ne doit pas être systématique mais se justifie dans certaines situations de doute diagnostique ou dans un but thérapeutique.
The aim was to assess the long-term results of vaginal surgery on pelvic support defects and cont... more The aim was to assess the long-term results of vaginal surgery on pelvic support defects and continence by a Prospective study of 218 patients operated on between 1982 and 1992. The mean age was 66 years. Half had stress incontinence of urine (SIU) associated with prolapse, which extended outside the introitus in Z8olo of cases. The procedure included vaginal hysterectomy, tightening of the round and sacrouterine ligaments' suspension of the bladder-neck by the Bologna procedure and myorrhaphy of the levator muscles. The mean follow-up was 69 months. Thirty-two Patients (r5olo) had recurrent pelvic relaxation, in 84% of these there was vaginal vault prolapse with enterocele. Recurrence was commoner in cases of urge incontinence or pauciParity. Postoperative SIU occurred in 29 Patients with previous SIU (zZ%) and in 10 without (golo). The recurrence of SIU was commoner when there was sphincter incompetence or SIU grade z or 3. The Bologna procedure allows good correction of SIU. Its combination with vaginal hysterectomy, tightening of the uterine ligaments and myorrhaphy of the levators provides a comPlete treatment for genital prolapse by the vaginal route. So as not to reduce the size of the vagina, the operation should be reserved for maior cystocele or for Patients bevond sexual activitv.
Objective
To estimate the prevalence of severe stress urinary incontinence (SUI) among perimenop... more Objective To estimate the prevalence of severe stress urinary incontinence (SUI) among perimenopausal women and to examine potential obstetric risk factors. Design Mail survey of female volunteers for epidemiological research. Setting Postal questionnaire on SUI. Population Three thousand one hundred and fourteen women aged 49–61 years who comprised the GAZEL cohort. Methods Logistic regression using data from the entire cohort to estimate the impact of risk factors. A second logistic regression using data from women who had given birth included obstetric history. Main outcome measure Prevalence of severe SUI defined by the response ‘often’ or ‘all the time’ to the question ‘Does urine leak when you are physically active, cough or sneeze?’ Results Two thousand six hundred and twenty-five women (85%) completed and returned the questionnaire. The frequency of SUI reported in the preceding four weeks was as follows: ‘never’ 32%, ‘occasionally’ 28%, ‘sometimes’ 26%, ‘often’ 10% and ‘all the time’ 5%. Prevalence of severe SUI was lowest among nulliparous women (7%), but it was similar among parous women regardless of birth number (14–17%). The prevalence of severe SUI was not associated with mode of delivery (14% for women delivered by caesarean only vs 16% for vaginal births). Significant risk factors for severe SUI were high body mass index (BMI >30), diabetes mellitus, previous incontinence surgery, parity and first delivery under the age of 22 years. Conclusion Previous pregnancy itself is a risk factor for severe SUI among women who reach the age of 50. In this age group the impact of the mode of delivery (spontaneous, forceps or caesarean) on severe SUI is slight.
To determine whether preoperative urethra mobility is able to predict sub-urethra tape procedure ... more To determine whether preoperative urethra mobility is able to predict sub-urethra tape procedure outcome for women with urinary stress incontinence. Materials and methods This retrospective study included 78 women who underwent a complete work-up with preoperative standing urethrocystography. Proximal urethra support was assessed on lateral urethrocystograms taken at rest and at strain. The two images were anatomically superimposed and the angle formed by the 2 proximal urethra axes defined urethra mobility. Surgical outcome was assessed by negative stress and pad tests. Results Median follow-up was 9 months (1–37) and the objective success rate was 85% (66/78). Median rotation of the proximal urethra was 67° without prior surgery for incontinence, 33° with 1 previous procedure and 28° with ≥ 2 procedures (p < 0.0001). The success rate was 97% (29/30) when urethra mobility exceeded 60° versus 86% (18/21) for mobility between 30 and 60°, and 70% (19/27) when it was < 30° (p = 0.023). The success rate was 96% (26/27) without prior surgery for incontinence versus 84% (31/37) when 1 unsuccessful procedure had been performed, and 64% (9/14) with ≥ 2 surgical failures (p = 0.026). Age at surgery, menopausal status, mixed incontinence, body mass index, parity, overactive bladder and low maximal urethral closure pressure had no significant prognostic value. Conclusions The sub-urethra sling procedure takes advantage of urethra mobility to avoid leakage. The more the proximal part of the urethra moves under stress, the better the continence achieved. Risk factors for failure are poor mobility of the proximal urethra and previous surgery for incontinence.
Purpose: We evaluated the medium-term efficiency of silicone microimplants injected into women wi... more Purpose: We evaluated the medium-term efficiency of silicone microimplants injected into women with intrinsic sphincter deficiency. Materials and Methods: Twenty-one women with intrinsic sphincter deficiency underwent transurethral injection of silicone microimplants between August 1996 and February 1997. Each patient was assessed preoperatively by questionnaire, physical examination and urodynamic study. The results were evaluated by questionnaire at 1 month, 1 year, and 2 years after silicone injection. The outcome was classified as dry in all circumstances, improved or failure. Results: All patients (median age: 68 years, range: 46 to 83) had undergone previous antiincontinence or prolapse surgeries. At one month, 2 patients (10%) were dry, 9 (42%) were improved and 10 (48%) were failures. At one year (median: 16 months, range: 14 to 22), 2 patients (10%) were dry, 8 (38%) were improved and 11 (52%) were failures. At the last follow-up (median: 31 months, range: 24 to 34), 4 patients (19%) were dry, 6 (29%) were improved and 11 (52%) were failures. None of the 6 patients with bladder neck hypermobility were dry. Conclusions: Our results of silicone transurethral injection are disappointing but comparable to other bulking agents without a time-dependent decrease in efficiency. The use of silicone microimplants is an alternative in the treatment of intrinsic sphincter deficiency in patients without bladder neck hypermobility and who have failed to improve after sling procedure.
Cette revue de la littérature a pour but de préciser la définition, les différentes formes anatom... more Cette revue de la littérature a pour but de préciser la définition, les différentes formes anatomocliniques et l’histoire naturelle de l’endométriose afin d’établir des recommandations pour la pratique clinique. Définition. — L’endométriose est définie par la présence de tissu endométrial (glandes et stroma) en dehors de la cavité utérine. Cette définition histologique n’est pas synonyme de symptômes. Les lésions macroscopiques qui évoquent l’endométriose ne sont pas toujours confirmées par l’examen histologique. Un examen histologique est recommandé pour confirmer le diagnostic. Une histologie négative ne permet pas d’exclure la maladie. Formes anatomocliniques. — Il est décrit trois formes d’endométriose : endométriose péritonéale superficielle, endométriome de l’ovaire et endométriose sous-péritonéale profonde. Il n’y a pas de données établissant que la pathogénie de ces entités soit différente. Histoire naturelle de l’endométriose. — Elle reste mal connue. Elle peut progresser ou régresser avec ou sans traitement. Il n’y a pas d’indication à traiter une endométriose asymptomatique. Il existe une association entre endométriose et cancer de l’ovaire. Le risque de transformation maligne de l’endométriose reste un sujet de controverse. Il n’existe pas de recommandations pour un suivi carcinologique particulier de la femme porteuse d’une endométriose.
Urinary incontinence occurs in 40 % of women aged 65 years and over; however, only 15 % seek care... more Urinary incontinence occurs in 40 % of women aged 65 years and over; however, only 15 % seek care and many delay healthcare seeking for years. Incontinence is associated with depression, social isolation, reduced quality of life, falls and other comorbidities. It is accompanied by an enormous cost to the individual and society. Despite the substantial implications of urinary incontinence on social, psychological and physical well-being of older women, the impact of continence promotion on urinary symptom improvement and subsequent effects on falls, quality of life, stigma, social participation and the cost of care remains unknown. This study is a mixed methods multi-national open-label 2-arm parallel cluster randomized controlled trial aiming to recruit 1000 community-dwelling incontinent women aged 65 years and older across Quebec, Western Canada, France and United Kingdom. Participants will be recruited through community organizations. Data will be collected at 6 time points: base...
La relation entre les algies pelviennes chroniques (APC) et l’endométriose est mal comprise, en r... more La relation entre les algies pelviennes chroniques (APC) et l’endométriose est mal comprise, en raison de la banalité des symptômes douloureux chez des femmes indemnes de pathologie et de l’existence de formes asymptomatiques d’endométriose. Notre revue systématique a pour but de clarifier le lien entre les caractéristiques des lésions d’endométriose et la sémiologie des APC. Chez des femmes qui présentent une endométriose diagnostiquée, cette maladie ne serait en fait responsable des APC que dans un peu plus d’un cas sur deux. Il existe une association bien documentée entre la dysménorrhée sévère et l’endométriose, probablement de nature causale. La dysménorrhée sévère ne semble pas liée à un type particulier de lésion, ni à une localisation particulière, elle est provoquée par des microsaignements menstruels récidivants, au sein des lésions. En ce qui concerne les autres symptômes douloureux, il existe des arguments histologiques et physiopathologiques en faveur de la responsabilité de l’endométriose sous-péritonéale profonde (EP) sur leur genèse. Ces douleurs sont en rapport avec la compression ou l’infiltration des nerfs de l’espace pelvi-sous-péritonéal par les lésions d’EP. De ce fait, les symptômes douloureux causés par l’EP présentent des caractéristiques particulières. Elles sont spécifiques de l’atteinte d’une localisation anatomique précise (dyspareunie sévère, douleur à la défécation) ou d’un organe précis (signes fonctionnels urinaires, signes digestifs). Ces symptômes peuvent ainsi être qualifiés de « douleurs localisatrices ». L’analyse sémiologique précise des caractéristiques des APC est utile pour la prise en charge diagnostique et thérapeutique de l’endométriose dans le cadre des APC. L’utilisation d’autoquestionnaires standardisés peut apporter une aide à cette analyse. Les traitements médicamenteux hormonaux sont généralement efficaces sur l’ensemble des symptômes douloureux en rapport avec les lésions d’endométriose comportant du tissu glandulaire actif.The relationship between chronic pelvic pain symptoms and endometriosis is unclear because painful symptoms are frequent in women without this pathology, and because asymptomatic forms of endometriosis exist. Our comprehensive review attempts to clarify the links between the characteristics of lesions and the semiology of chronic pelvic pain symptoms. Based on randomized trials against placebo, endometriosis appears to be responsible for chronic pelvic pain symptoms in more than half of confirmed cases. A causal association between severe dysmenorrhoea and endometriosis is very probable. This association is independent of the macroscopic type of the lesions or their anatomical locations and may be related to recurrent cyclic microbleeding in the implants. Endometriosis-related adhesions may also cause severe dysmenorrhoea. There are histological and physiopathological arguments for the responsibility of deeply infiltrating endometriosis (DIE) in severe chronic pelvic pain symptoms. DIE-related pain may be in relation with compression or infiltration of nerves in the subperitoneal pelvic space by the implants. The painful symptoms caused by DIE present particular characteristics, being specific to involvement of precise anatomical locations (severe deep dyspareunia, painful defecation) or organs (functional urinary tract signs, bowel signs). They can thus be described as “location indicating pain”. A precise semiological analysis of the chronic pelvic pain symptoms characteristics is useful for the diagnosis and therapeutic.
Objet : La prévalence et la prévention des troubles génito-sexuels consécutifs à l'accouchement s... more Objet : La prévalence et la prévention des troubles génito-sexuels consécutifs à l'accouchement sont peu connues. Il serait logique de penser que la césarienne qui évite le traumatisme périnéal s'accompagne de moins de troubles de la fonction sexuelle.
This article appeared in a journal published by Elsevier. The attached copy is furnished to the a... more This article appeared in a journal published by Elsevier. The attached copy is furnished to the author for internal non-commercial research and education use, including for instruction at the authors institution and sharing with colleagues.
Urinary incontinence is a frequent affliction in women and may be disabling and costly {LE1}. Whe... more Urinary incontinence is a frequent affliction in women and may be disabling and costly {LE1}. When consulting for urinary incontinence, it is recommended that circumstances, frequency and severity of leaks be specified {Grade B}. The cough test is recommended prior to surgery {Grade C}. Urodynamic investigations are not needed before lower urinary tract rehabilitation {Grade B}. A complete urodynamic investigation is recommended prior to surgery for urinary incontinence {Grade C}. In cases of pure stress urinary incontinence, urodynamic investigations are not essential prior to surgery provided the clinical assessment is fully comprehensive (standardised questionnaire, cough test, bladder diary, post-void residual volume) with concordant results {PC}. It is recommended to start treatment for stress incontinence with pelvic floor muscle training {Grade C}. Bladder training is recommended at first intention in cases with overactive bladder syndrome {Grade C}. For overweight patients, loss of weight improves stress incontinence {LE1}. For surgery, sub-urethral tape (retropubic or transobturator route) is the first-line recommended technique {Grade B}. Sub-urethral tape surgery involves intraoperative risks, postoperative risks and a risk of failure which must be the subject of prior information {Grade A}. Elective caesarean section and systematic episiotomy are not recommended methods of prevention for urinary incontinence {Grade B}. Pelvic floor muscle training is the treatment of first intention for pre-and postnatal urinary incontinence {Grade A}. Prior to any treatment for an elderly woman, it is recommended to screen for urinary infection using a test strip, ask for a bladder diary and measure postvoid residual volume {Grade C}. It is recommended to carry out a cough test and look for occult incontinence prior to surgery for pelvic organ prolapse {Grade C}. It is recommended to carry out urodynamic investigations prior to pelvic organ prolapse surgery when there are urinary symptoms or occult urinary incontinence {Grade C}. ß
Objective. — To study whether post-partum dyspareunia one year after a delivery is associated wit... more Objective. — To study whether post-partum dyspareunia one year after a delivery is associated with characteristics of delivery: perineal trauma, obstetric interventions and women’s experience. Methods. — A self-administered questionnaire on post-partum sexual function was mailed in May 2002 to all consecutive women who gave birth to a live-born term infant in a maternity unit, between January 2001 and June 2001. Obstetric data were abstracted from the hospital computerized medical database. Late dyspareunia was defined as pain during intercourse, one year after delivery. Multiple logistic regression modeling was used to select independent predictors of late post-partum dyspareunia. Results. — Seventy (27.6%) of the 254 women studied experienced late dyspareunia. There was no relation between late post-partum dyspareunia and neither the mode of delivery nor state of the perineum, including perineal laceration or episiotomy. Multiple logistic regression analysis showed that late post-partum dyspareunia was associated with dyspareunia before pregnancy, low satisfaction with delivery, and employment status. Conclusions. — Late post-partum dyspareunia seemed to be linked more with the mother’s experience of childbirth than with perineal trauma. This hypothesis should be investigated further.
OBJECTIVE: To estimate obstetric risk factors of fecal incontinence among middle-aged women.
METH... more OBJECTIVE: To estimate obstetric risk factors of fecal incontinence among middle-aged women. METHODS: We conducted a mail survey of the Gazel cohort of volunteers for epidemiologic research. In 2000, a questionnaire on anal incontinence was mailed to 3,114 women who were then between the ages of 50 and 61years; 2,640 (85%) women returned the completed questionnaire. Fecal incontinence was defined by involuntary loss of stool. Logistic regression was used to estimate the effect of obstetric and general risk factors. RESULTS: Prevalence of fecal incontinence in the past 12 months was 9.5% (250). Significant risk factors for fecal incontinence were completion of high school (adjusted odds ratio [OR] 1.5, 95% confidence interval [CI] 1.1–2.0), self-reported depression (OR 2.1, 95% CI 1.6 –2.7), overweight or obesity measured by body mass index (BMI) (OR 1.5 for BMI of 25–30, 95% CI 1.1–2.0; OR 1.6 for BMI more than 30, 95% CI 1.1–2.5), surgery for urinary incontinence (OR 3.5, 95% CI 2.0–6.1), and anal surgery (OR 1.7, 95% CI 1.1–2.9). No obstetric variable (parity, mode of delivery, birth weight, episiotomy, or third-degree perineal tear) was significant. Prevalence of fecal incontinence was similar for nulliparous, primiparous, secundiparous, and multiparous women (11.3%, 9.0%, 9.0%, and 10.4%, respectively), and among parous women, it was similar for women with spontaneous vaginal, instrumental (at least one), or only cesarean deliveries (9.3%, 10.0%, and 6.6%, respectively). CONCLUSION: In our population of women in their 50s, fecal incontinence was not associated with either parity or mode of delivery.
La douleur pelvienne aiguë constitue une situation clinique très fréquente dans la pratique gynéc... more La douleur pelvienne aiguë constitue une situation clinique très fréquente dans la pratique gynécologique d'urgence. Les pathologies rencontrées dans cette situation sont à la fois nombreuses et de gravité variable, certaines de ces pathologies pouvant mettre en jeu la vie des patientes ou avoir des conséquences graves sur la fertilité ultérieure. investigations coûteuses. Le diagnostic de l'affection en cause est difficile à établir par les moyens diagnostiques conventionnels, ce qui est à l'origine de la diffusion de la coelioscopie diagnostique, son utilisation sans limite peut, cependant être à l'origine d'incidents ou d'accidents. Les auteurs proposent une stratégie diagnostique basée sur une utilisation rigoureuse de l'examen clinique et des examens complémentaires non invasifs (test de prossesse, biologie standard et échographie). Le recours à la coelioscopie ne doit pas être systématique mais se justifie dans certaines situations de doute diagnostique ou dans un but thérapeutique.
The aim was to assess the long-term results of vaginal surgery on pelvic support defects and cont... more The aim was to assess the long-term results of vaginal surgery on pelvic support defects and continence by a Prospective study of 218 patients operated on between 1982 and 1992. The mean age was 66 years. Half had stress incontinence of urine (SIU) associated with prolapse, which extended outside the introitus in Z8olo of cases. The procedure included vaginal hysterectomy, tightening of the round and sacrouterine ligaments' suspension of the bladder-neck by the Bologna procedure and myorrhaphy of the levator muscles. The mean follow-up was 69 months. Thirty-two Patients (r5olo) had recurrent pelvic relaxation, in 84% of these there was vaginal vault prolapse with enterocele. Recurrence was commoner in cases of urge incontinence or pauciParity. Postoperative SIU occurred in 29 Patients with previous SIU (zZ%) and in 10 without (golo). The recurrence of SIU was commoner when there was sphincter incompetence or SIU grade z or 3. The Bologna procedure allows good correction of SIU. Its combination with vaginal hysterectomy, tightening of the uterine ligaments and myorrhaphy of the levators provides a comPlete treatment for genital prolapse by the vaginal route. So as not to reduce the size of the vagina, the operation should be reserved for maior cystocele or for Patients bevond sexual activitv.
Objective
To estimate the prevalence of severe stress urinary incontinence (SUI) among perimenop... more Objective To estimate the prevalence of severe stress urinary incontinence (SUI) among perimenopausal women and to examine potential obstetric risk factors. Design Mail survey of female volunteers for epidemiological research. Setting Postal questionnaire on SUI. Population Three thousand one hundred and fourteen women aged 49–61 years who comprised the GAZEL cohort. Methods Logistic regression using data from the entire cohort to estimate the impact of risk factors. A second logistic regression using data from women who had given birth included obstetric history. Main outcome measure Prevalence of severe SUI defined by the response ‘often’ or ‘all the time’ to the question ‘Does urine leak when you are physically active, cough or sneeze?’ Results Two thousand six hundred and twenty-five women (85%) completed and returned the questionnaire. The frequency of SUI reported in the preceding four weeks was as follows: ‘never’ 32%, ‘occasionally’ 28%, ‘sometimes’ 26%, ‘often’ 10% and ‘all the time’ 5%. Prevalence of severe SUI was lowest among nulliparous women (7%), but it was similar among parous women regardless of birth number (14–17%). The prevalence of severe SUI was not associated with mode of delivery (14% for women delivered by caesarean only vs 16% for vaginal births). Significant risk factors for severe SUI were high body mass index (BMI >30), diabetes mellitus, previous incontinence surgery, parity and first delivery under the age of 22 years. Conclusion Previous pregnancy itself is a risk factor for severe SUI among women who reach the age of 50. In this age group the impact of the mode of delivery (spontaneous, forceps or caesarean) on severe SUI is slight.
To determine whether preoperative urethra mobility is able to predict sub-urethra tape procedure ... more To determine whether preoperative urethra mobility is able to predict sub-urethra tape procedure outcome for women with urinary stress incontinence. Materials and methods This retrospective study included 78 women who underwent a complete work-up with preoperative standing urethrocystography. Proximal urethra support was assessed on lateral urethrocystograms taken at rest and at strain. The two images were anatomically superimposed and the angle formed by the 2 proximal urethra axes defined urethra mobility. Surgical outcome was assessed by negative stress and pad tests. Results Median follow-up was 9 months (1–37) and the objective success rate was 85% (66/78). Median rotation of the proximal urethra was 67° without prior surgery for incontinence, 33° with 1 previous procedure and 28° with ≥ 2 procedures (p < 0.0001). The success rate was 97% (29/30) when urethra mobility exceeded 60° versus 86% (18/21) for mobility between 30 and 60°, and 70% (19/27) when it was < 30° (p = 0.023). The success rate was 96% (26/27) without prior surgery for incontinence versus 84% (31/37) when 1 unsuccessful procedure had been performed, and 64% (9/14) with ≥ 2 surgical failures (p = 0.026). Age at surgery, menopausal status, mixed incontinence, body mass index, parity, overactive bladder and low maximal urethral closure pressure had no significant prognostic value. Conclusions The sub-urethra sling procedure takes advantage of urethra mobility to avoid leakage. The more the proximal part of the urethra moves under stress, the better the continence achieved. Risk factors for failure are poor mobility of the proximal urethra and previous surgery for incontinence.
Purpose: We evaluated the medium-term efficiency of silicone microimplants injected into women wi... more Purpose: We evaluated the medium-term efficiency of silicone microimplants injected into women with intrinsic sphincter deficiency. Materials and Methods: Twenty-one women with intrinsic sphincter deficiency underwent transurethral injection of silicone microimplants between August 1996 and February 1997. Each patient was assessed preoperatively by questionnaire, physical examination and urodynamic study. The results were evaluated by questionnaire at 1 month, 1 year, and 2 years after silicone injection. The outcome was classified as dry in all circumstances, improved or failure. Results: All patients (median age: 68 years, range: 46 to 83) had undergone previous antiincontinence or prolapse surgeries. At one month, 2 patients (10%) were dry, 9 (42%) were improved and 10 (48%) were failures. At one year (median: 16 months, range: 14 to 22), 2 patients (10%) were dry, 8 (38%) were improved and 11 (52%) were failures. At the last follow-up (median: 31 months, range: 24 to 34), 4 patients (19%) were dry, 6 (29%) were improved and 11 (52%) were failures. None of the 6 patients with bladder neck hypermobility were dry. Conclusions: Our results of silicone transurethral injection are disappointing but comparable to other bulking agents without a time-dependent decrease in efficiency. The use of silicone microimplants is an alternative in the treatment of intrinsic sphincter deficiency in patients without bladder neck hypermobility and who have failed to improve after sling procedure.
Cette revue de la littérature a pour but de préciser la définition, les différentes formes anatom... more Cette revue de la littérature a pour but de préciser la définition, les différentes formes anatomocliniques et l’histoire naturelle de l’endométriose afin d’établir des recommandations pour la pratique clinique. Définition. — L’endométriose est définie par la présence de tissu endométrial (glandes et stroma) en dehors de la cavité utérine. Cette définition histologique n’est pas synonyme de symptômes. Les lésions macroscopiques qui évoquent l’endométriose ne sont pas toujours confirmées par l’examen histologique. Un examen histologique est recommandé pour confirmer le diagnostic. Une histologie négative ne permet pas d’exclure la maladie. Formes anatomocliniques. — Il est décrit trois formes d’endométriose : endométriose péritonéale superficielle, endométriome de l’ovaire et endométriose sous-péritonéale profonde. Il n’y a pas de données établissant que la pathogénie de ces entités soit différente. Histoire naturelle de l’endométriose. — Elle reste mal connue. Elle peut progresser ou régresser avec ou sans traitement. Il n’y a pas d’indication à traiter une endométriose asymptomatique. Il existe une association entre endométriose et cancer de l’ovaire. Le risque de transformation maligne de l’endométriose reste un sujet de controverse. Il n’existe pas de recommandations pour un suivi carcinologique particulier de la femme porteuse d’une endométriose.
Urinary incontinence occurs in 40 % of women aged 65 years and over; however, only 15 % seek care... more Urinary incontinence occurs in 40 % of women aged 65 years and over; however, only 15 % seek care and many delay healthcare seeking for years. Incontinence is associated with depression, social isolation, reduced quality of life, falls and other comorbidities. It is accompanied by an enormous cost to the individual and society. Despite the substantial implications of urinary incontinence on social, psychological and physical well-being of older women, the impact of continence promotion on urinary symptom improvement and subsequent effects on falls, quality of life, stigma, social participation and the cost of care remains unknown. This study is a mixed methods multi-national open-label 2-arm parallel cluster randomized controlled trial aiming to recruit 1000 community-dwelling incontinent women aged 65 years and older across Quebec, Western Canada, France and United Kingdom. Participants will be recruited through community organizations. Data will be collected at 6 time points: base...
La relation entre les algies pelviennes chroniques (APC) et l’endométriose est mal comprise, en r... more La relation entre les algies pelviennes chroniques (APC) et l’endométriose est mal comprise, en raison de la banalité des symptômes douloureux chez des femmes indemnes de pathologie et de l’existence de formes asymptomatiques d’endométriose. Notre revue systématique a pour but de clarifier le lien entre les caractéristiques des lésions d’endométriose et la sémiologie des APC. Chez des femmes qui présentent une endométriose diagnostiquée, cette maladie ne serait en fait responsable des APC que dans un peu plus d’un cas sur deux. Il existe une association bien documentée entre la dysménorrhée sévère et l’endométriose, probablement de nature causale. La dysménorrhée sévère ne semble pas liée à un type particulier de lésion, ni à une localisation particulière, elle est provoquée par des microsaignements menstruels récidivants, au sein des lésions. En ce qui concerne les autres symptômes douloureux, il existe des arguments histologiques et physiopathologiques en faveur de la responsabilité de l’endométriose sous-péritonéale profonde (EP) sur leur genèse. Ces douleurs sont en rapport avec la compression ou l’infiltration des nerfs de l’espace pelvi-sous-péritonéal par les lésions d’EP. De ce fait, les symptômes douloureux causés par l’EP présentent des caractéristiques particulières. Elles sont spécifiques de l’atteinte d’une localisation anatomique précise (dyspareunie sévère, douleur à la défécation) ou d’un organe précis (signes fonctionnels urinaires, signes digestifs). Ces symptômes peuvent ainsi être qualifiés de « douleurs localisatrices ». L’analyse sémiologique précise des caractéristiques des APC est utile pour la prise en charge diagnostique et thérapeutique de l’endométriose dans le cadre des APC. L’utilisation d’autoquestionnaires standardisés peut apporter une aide à cette analyse. Les traitements médicamenteux hormonaux sont généralement efficaces sur l’ensemble des symptômes douloureux en rapport avec les lésions d’endométriose comportant du tissu glandulaire actif.The relationship between chronic pelvic pain symptoms and endometriosis is unclear because painful symptoms are frequent in women without this pathology, and because asymptomatic forms of endometriosis exist. Our comprehensive review attempts to clarify the links between the characteristics of lesions and the semiology of chronic pelvic pain symptoms. Based on randomized trials against placebo, endometriosis appears to be responsible for chronic pelvic pain symptoms in more than half of confirmed cases. A causal association between severe dysmenorrhoea and endometriosis is very probable. This association is independent of the macroscopic type of the lesions or their anatomical locations and may be related to recurrent cyclic microbleeding in the implants. Endometriosis-related adhesions may also cause severe dysmenorrhoea. There are histological and physiopathological arguments for the responsibility of deeply infiltrating endometriosis (DIE) in severe chronic pelvic pain symptoms. DIE-related pain may be in relation with compression or infiltration of nerves in the subperitoneal pelvic space by the implants. The painful symptoms caused by DIE present particular characteristics, being specific to involvement of precise anatomical locations (severe deep dyspareunia, painful defecation) or organs (functional urinary tract signs, bowel signs). They can thus be described as “location indicating pain”. A precise semiological analysis of the chronic pelvic pain symptoms characteristics is useful for the diagnosis and therapeutic.
Objet : La prévalence et la prévention des troubles génito-sexuels consécutifs à l'accouchement s... more Objet : La prévalence et la prévention des troubles génito-sexuels consécutifs à l'accouchement sont peu connues. Il serait logique de penser que la césarienne qui évite le traumatisme périnéal s'accompagne de moins de troubles de la fonction sexuelle.
This article appeared in a journal published by Elsevier. The attached copy is furnished to the a... more This article appeared in a journal published by Elsevier. The attached copy is furnished to the author for internal non-commercial research and education use, including for instruction at the authors institution and sharing with colleagues.
La douleur pelvienne chronique de la femme est un symptôme fréquent en consultation mais sa patho... more La douleur pelvienne chronique de la femme est un symptôme fréquent en consultation mais sa pathogénie reste mal comprise. D'un côté une douleur peut persister après l'exérèse de la lésion algogène, et de l'autre, des douleurs peuvent disparaître alors que la coelioscopie était négative. La recherche de la cause risque d'être décevante car le lien causal est difficile à établir et qu'il n'existe pas toujours de traitement spécifique. Le pronostic à long terme semble peu amélioré par la découverte d'une cause organique. La coelioscopie est une étape facultative et ne résume pas la prise en charge. Une coelioscopie normale ne signifie pas absence de cause organique, et un échec du traitement chirurgical ne signifie pas absence de solutions antalgiques. Les meilleurs résultats sont observés en cas de prise en charge multidisciplinaire. L'objectif principal de la prise en charge est le soulagement de la patiente et non la détermination de la cause.
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Papers by Xavier Fritel
Methods. — A self-administered questionnaire on post-partum sexual function was mailed in May 2002 to all consecutive women who gave birth to a live-born term infant in a maternity unit, between January 2001 and June 2001. Obstetric data were abstracted from the hospital computerized medical database. Late dyspareunia was defined as pain during intercourse, one year after delivery. Multiple logistic regression modeling was used to select independent predictors of late post-partum dyspareunia.
Results. — Seventy (27.6%) of the 254 women studied experienced late dyspareunia. There was no relation between late post-partum dyspareunia and neither the mode of delivery nor state of the perineum, including perineal laceration or episiotomy. Multiple logistic regression analysis showed that late post-partum dyspareunia was associated with dyspareunia before pregnancy, low satisfaction with delivery, and employment status.
Conclusions. — Late post-partum dyspareunia seemed to be linked more with the mother’s experience of childbirth than with perineal trauma. This hypothesis should be investigated further.
METHODS: We conducted a mail survey of the Gazel cohort of volunteers for epidemiologic research. In 2000, a questionnaire on anal incontinence was mailed to 3,114 women who were then between the ages of 50 and 61years; 2,640 (85%) women returned the completed questionnaire. Fecal incontinence was defined by involuntary loss of stool. Logistic regression was used to estimate the effect of obstetric and general risk factors.
RESULTS: Prevalence of fecal incontinence in the past 12
months was 9.5% (250). Significant risk factors for fecal
incontinence were completion of high school (adjusted odds ratio [OR] 1.5, 95% confidence interval [CI] 1.1–2.0), self-reported depression (OR 2.1, 95% CI 1.6 –2.7), overweight or obesity measured by body mass index (BMI) (OR 1.5 for BMI of 25–30, 95% CI 1.1–2.0; OR 1.6 for BMI more than 30, 95% CI 1.1–2.5), surgery for urinary incontinence (OR 3.5, 95% CI 2.0–6.1), and anal surgery (OR 1.7, 95% CI 1.1–2.9). No obstetric variable (parity, mode of delivery, birth weight, episiotomy, or third-degree perineal tear) was significant. Prevalence of fecal incontinence was similar for nulliparous, primiparous, secundiparous, and multiparous women (11.3%, 9.0%, 9.0%, and 10.4%, respectively), and among parous women, it was similar for women with spontaneous vaginal, instrumental (at least one), or only cesarean deliveries (9.3%, 10.0%, and 6.6%, respectively).
CONCLUSION: In our population of women in their 50s, fecal incontinence was not associated with either parity or mode of delivery.
To estimate the prevalence of severe stress urinary incontinence (SUI) among perimenopausal women and to examine potential obstetric risk factors.
Design
Mail survey of female volunteers for epidemiological research.
Setting
Postal questionnaire on SUI.
Population
Three thousand one hundred and fourteen women aged 49–61 years who comprised the GAZEL cohort.
Methods
Logistic regression using data from the entire cohort to estimate the impact of risk factors. A second logistic regression using data from women who had given birth included obstetric history. Main outcome measure Prevalence of severe SUI defined by the response ‘often’ or ‘all the time’ to the question ‘Does urine leak when you are physically active, cough or sneeze?’
Results
Two thousand six hundred and twenty-five women (85%) completed and returned the questionnaire. The frequency of SUI reported in the preceding four weeks was as follows: ‘never’ 32%, ‘occasionally’ 28%, ‘sometimes’ 26%, ‘often’ 10% and ‘all the time’ 5%. Prevalence of severe SUI was lowest among nulliparous women (7%), but it was similar among parous women regardless of birth number (14–17%). The prevalence of severe SUI was not associated with mode of delivery (14% for women delivered by caesarean only vs 16% for vaginal births). Significant risk factors for severe SUI were high body mass index (BMI >30), diabetes mellitus, previous incontinence surgery, parity and first delivery under the age of 22 years.
Conclusion
Previous pregnancy itself is a risk factor for severe SUI among women who reach the age of 50. In this age group the impact of the mode of delivery (spontaneous, forceps or caesarean) on severe SUI is slight.
Materials and methods
This retrospective study included 78 women who underwent a complete work-up with preoperative standing urethrocystography. Proximal urethra support was assessed on lateral urethrocystograms taken at rest and at strain. The two images were anatomically superimposed and the angle formed by the 2 proximal urethra axes defined urethra mobility. Surgical outcome was assessed by negative stress and pad tests.
Results
Median follow-up was 9 months (1–37) and the objective success rate was 85% (66/78). Median rotation of the proximal urethra was 67° without prior surgery for incontinence, 33° with 1 previous procedure and 28° with ≥ 2 procedures (p < 0.0001). The success rate was 97% (29/30) when urethra mobility exceeded 60° versus 86% (18/21) for mobility between 30 and 60°, and 70% (19/27) when it was < 30° (p = 0.023). The success rate was 96% (26/27) without prior surgery for incontinence versus 84% (31/37) when 1 unsuccessful procedure had been performed, and 64% (9/14) with ≥ 2 surgical failures (p = 0.026). Age at surgery, menopausal status, mixed
incontinence, body mass index, parity, overactive bladder and low maximal urethral closure pressure had no significant prognostic value.
Conclusions
The sub-urethra sling procedure takes advantage of urethra mobility to avoid leakage. The more the proximal part of the urethra moves under stress, the better the continence achieved. Risk factors for failure are poor mobility of the proximal urethra and previous surgery for incontinence.
Materials and Methods: Twenty-one women with intrinsic sphincter deficiency underwent transurethral injection of silicone microimplants between August 1996 and February 1997. Each patient was assessed preoperatively by questionnaire, physical examination and urodynamic study. The results were evaluated by questionnaire at 1 month, 1 year, and 2 years after silicone injection. The outcome was classified as dry in all circumstances, improved or failure.
Results: All patients (median age: 68 years, range: 46 to 83) had undergone previous antiincontinence or prolapse surgeries. At one month, 2 patients (10%) were dry, 9 (42%) were improved and 10 (48%) were failures. At one year (median: 16 months, range: 14 to 22), 2 patients (10%) were dry, 8 (38%) were improved and 11 (52%) were failures. At the last follow-up (median: 31 months, range: 24 to 34), 4 patients (19%) were dry, 6 (29%) were improved and 11 (52%) were failures. None of the 6 patients with bladder neck hypermobility were dry.
Conclusions: Our results of silicone transurethral injection are disappointing but comparable to other bulking agents without a time-dependent decrease in efficiency. The use of silicone microimplants is an alternative in the treatment of intrinsic sphincter deficiency in patients without bladder neck hypermobility and who have failed to improve after sling procedure.
Définition. — L’endométriose est définie par la présence de tissu endométrial (glandes et stroma) en dehors de la cavité utérine. Cette définition histologique n’est pas synonyme de symptômes. Les lésions macroscopiques qui évoquent l’endométriose ne sont pas toujours confirmées par l’examen histologique. Un examen histologique est recommandé pour confirmer le diagnostic. Une histologie négative ne permet pas d’exclure la maladie.
Formes anatomocliniques. — Il est décrit trois formes d’endométriose : endométriose péritonéale superficielle, endométriome de l’ovaire et endométriose sous-péritonéale profonde. Il n’y a pas de données établissant que la pathogénie de ces entités soit différente.
Histoire naturelle de l’endométriose. — Elle reste mal connue. Elle peut progresser ou régresser avec ou sans traitement. Il n’y a pas d’indication à traiter une endométriose asymptomatique.
Il existe une association entre endométriose et cancer de l’ovaire. Le risque de transformation maligne de l’endométriose reste un sujet de controverse. Il n’existe pas de recommandations pour un suivi carcinologique particulier de la femme porteuse d’une endométriose.
Methods. — A self-administered questionnaire on post-partum sexual function was mailed in May 2002 to all consecutive women who gave birth to a live-born term infant in a maternity unit, between January 2001 and June 2001. Obstetric data were abstracted from the hospital computerized medical database. Late dyspareunia was defined as pain during intercourse, one year after delivery. Multiple logistic regression modeling was used to select independent predictors of late post-partum dyspareunia.
Results. — Seventy (27.6%) of the 254 women studied experienced late dyspareunia. There was no relation between late post-partum dyspareunia and neither the mode of delivery nor state of the perineum, including perineal laceration or episiotomy. Multiple logistic regression analysis showed that late post-partum dyspareunia was associated with dyspareunia before pregnancy, low satisfaction with delivery, and employment status.
Conclusions. — Late post-partum dyspareunia seemed to be linked more with the mother’s experience of childbirth than with perineal trauma. This hypothesis should be investigated further.
METHODS: We conducted a mail survey of the Gazel cohort of volunteers for epidemiologic research. In 2000, a questionnaire on anal incontinence was mailed to 3,114 women who were then between the ages of 50 and 61years; 2,640 (85%) women returned the completed questionnaire. Fecal incontinence was defined by involuntary loss of stool. Logistic regression was used to estimate the effect of obstetric and general risk factors.
RESULTS: Prevalence of fecal incontinence in the past 12
months was 9.5% (250). Significant risk factors for fecal
incontinence were completion of high school (adjusted odds ratio [OR] 1.5, 95% confidence interval [CI] 1.1–2.0), self-reported depression (OR 2.1, 95% CI 1.6 –2.7), overweight or obesity measured by body mass index (BMI) (OR 1.5 for BMI of 25–30, 95% CI 1.1–2.0; OR 1.6 for BMI more than 30, 95% CI 1.1–2.5), surgery for urinary incontinence (OR 3.5, 95% CI 2.0–6.1), and anal surgery (OR 1.7, 95% CI 1.1–2.9). No obstetric variable (parity, mode of delivery, birth weight, episiotomy, or third-degree perineal tear) was significant. Prevalence of fecal incontinence was similar for nulliparous, primiparous, secundiparous, and multiparous women (11.3%, 9.0%, 9.0%, and 10.4%, respectively), and among parous women, it was similar for women with spontaneous vaginal, instrumental (at least one), or only cesarean deliveries (9.3%, 10.0%, and 6.6%, respectively).
CONCLUSION: In our population of women in their 50s, fecal incontinence was not associated with either parity or mode of delivery.
To estimate the prevalence of severe stress urinary incontinence (SUI) among perimenopausal women and to examine potential obstetric risk factors.
Design
Mail survey of female volunteers for epidemiological research.
Setting
Postal questionnaire on SUI.
Population
Three thousand one hundred and fourteen women aged 49–61 years who comprised the GAZEL cohort.
Methods
Logistic regression using data from the entire cohort to estimate the impact of risk factors. A second logistic regression using data from women who had given birth included obstetric history. Main outcome measure Prevalence of severe SUI defined by the response ‘often’ or ‘all the time’ to the question ‘Does urine leak when you are physically active, cough or sneeze?’
Results
Two thousand six hundred and twenty-five women (85%) completed and returned the questionnaire. The frequency of SUI reported in the preceding four weeks was as follows: ‘never’ 32%, ‘occasionally’ 28%, ‘sometimes’ 26%, ‘often’ 10% and ‘all the time’ 5%. Prevalence of severe SUI was lowest among nulliparous women (7%), but it was similar among parous women regardless of birth number (14–17%). The prevalence of severe SUI was not associated with mode of delivery (14% for women delivered by caesarean only vs 16% for vaginal births). Significant risk factors for severe SUI were high body mass index (BMI >30), diabetes mellitus, previous incontinence surgery, parity and first delivery under the age of 22 years.
Conclusion
Previous pregnancy itself is a risk factor for severe SUI among women who reach the age of 50. In this age group the impact of the mode of delivery (spontaneous, forceps or caesarean) on severe SUI is slight.
Materials and methods
This retrospective study included 78 women who underwent a complete work-up with preoperative standing urethrocystography. Proximal urethra support was assessed on lateral urethrocystograms taken at rest and at strain. The two images were anatomically superimposed and the angle formed by the 2 proximal urethra axes defined urethra mobility. Surgical outcome was assessed by negative stress and pad tests.
Results
Median follow-up was 9 months (1–37) and the objective success rate was 85% (66/78). Median rotation of the proximal urethra was 67° without prior surgery for incontinence, 33° with 1 previous procedure and 28° with ≥ 2 procedures (p < 0.0001). The success rate was 97% (29/30) when urethra mobility exceeded 60° versus 86% (18/21) for mobility between 30 and 60°, and 70% (19/27) when it was < 30° (p = 0.023). The success rate was 96% (26/27) without prior surgery for incontinence versus 84% (31/37) when 1 unsuccessful procedure had been performed, and 64% (9/14) with ≥ 2 surgical failures (p = 0.026). Age at surgery, menopausal status, mixed
incontinence, body mass index, parity, overactive bladder and low maximal urethral closure pressure had no significant prognostic value.
Conclusions
The sub-urethra sling procedure takes advantage of urethra mobility to avoid leakage. The more the proximal part of the urethra moves under stress, the better the continence achieved. Risk factors for failure are poor mobility of the proximal urethra and previous surgery for incontinence.
Materials and Methods: Twenty-one women with intrinsic sphincter deficiency underwent transurethral injection of silicone microimplants between August 1996 and February 1997. Each patient was assessed preoperatively by questionnaire, physical examination and urodynamic study. The results were evaluated by questionnaire at 1 month, 1 year, and 2 years after silicone injection. The outcome was classified as dry in all circumstances, improved or failure.
Results: All patients (median age: 68 years, range: 46 to 83) had undergone previous antiincontinence or prolapse surgeries. At one month, 2 patients (10%) were dry, 9 (42%) were improved and 10 (48%) were failures. At one year (median: 16 months, range: 14 to 22), 2 patients (10%) were dry, 8 (38%) were improved and 11 (52%) were failures. At the last follow-up (median: 31 months, range: 24 to 34), 4 patients (19%) were dry, 6 (29%) were improved and 11 (52%) were failures. None of the 6 patients with bladder neck hypermobility were dry.
Conclusions: Our results of silicone transurethral injection are disappointing but comparable to other bulking agents without a time-dependent decrease in efficiency. The use of silicone microimplants is an alternative in the treatment of intrinsic sphincter deficiency in patients without bladder neck hypermobility and who have failed to improve after sling procedure.
Définition. — L’endométriose est définie par la présence de tissu endométrial (glandes et stroma) en dehors de la cavité utérine. Cette définition histologique n’est pas synonyme de symptômes. Les lésions macroscopiques qui évoquent l’endométriose ne sont pas toujours confirmées par l’examen histologique. Un examen histologique est recommandé pour confirmer le diagnostic. Une histologie négative ne permet pas d’exclure la maladie.
Formes anatomocliniques. — Il est décrit trois formes d’endométriose : endométriose péritonéale superficielle, endométriome de l’ovaire et endométriose sous-péritonéale profonde. Il n’y a pas de données établissant que la pathogénie de ces entités soit différente.
Histoire naturelle de l’endométriose. — Elle reste mal connue. Elle peut progresser ou régresser avec ou sans traitement. Il n’y a pas d’indication à traiter une endométriose asymptomatique.
Il existe une association entre endométriose et cancer de l’ovaire. Le risque de transformation maligne de l’endométriose reste un sujet de controverse. Il n’existe pas de recommandations pour un suivi carcinologique particulier de la femme porteuse d’une endométriose.