RESUMEN
OBJECTIVE: To assess morbidity and mortality following pelvic organ prolapse surgery in France, irrespective of the surgical technique, using a broad national database. MATERIALS AND METHODS: This descriptive multicenter retrospective study was conducted using a database populated via an application run by a professional association. RESULTS: 286 gynecologists contributed data to the database. Of the 4322 surgeries analyzed, an abdominal approach was used in 975 of cases (22.5%), a vaginal approach in 3277 (75.9%), and a combined approach in 68 (1.6%). After one year, abdominal surgery was associated with higher rates of de novo urinary incontinence, constipation, and intestinal obstruction, whereas vaginal surgery was associated with higher rates of urinary retention, hematoma, de novo chronic pain, and vaginal mesh extrusion. There was no significant difference between the groups in the incidence of severe complications. After one year, vaginal mesh-augmented cystocele repair was associated with higher rates of de novo urinary incontinence, de novo chronic pain, and reoperation than native tissue repair. Mesh repair was also associated with higher rates of severe complications at one year. CONCLUSION: After pelvic organ prolapse surgery, the perioperative morbidity and mortality associated with transabdominal and transvaginal approaches are similar. However, transvaginal mesh repair is associated with greater perioperative morbidity than transvaginal native tissue repair.
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Procedimientos Quirúrgicos Ginecológicos/efectos adversos , Procedimientos Quirúrgicos Ginecológicos/estadística & datos numéricos , Prolapso de Órgano Pélvico/epidemiología , Prolapso de Órgano Pélvico/cirugía , Complicaciones Posoperatorias/epidemiología , Cirujanos/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Competencia Clínica/estadística & datos numéricos , Bases de Datos Factuales , Femenino , Francia/epidemiología , Procedimientos Quirúrgicos Ginecológicos/mortalidad , Ginecología/normas , Ginecología/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Morbilidad , Mortalidad , Prolapso de Órgano Pélvico/mortalidad , Periodo Perioperatorio , Complicaciones Posoperatorias/mortalidad , Prótesis e Implantes/efectos adversos , Prótesis e Implantes/estadística & datos numéricos , Reoperación/mortalidad , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Cirujanos/normas , Mallas Quirúrgicas/efectos adversos , Mallas Quirúrgicas/estadística & datos numéricosRESUMEN
The objective of our observational prospective study was to investigate the severity and prevalence of urinary and pelvic floor disorders in gynecologic cancer survivors. All patients surviving gynecological cancer in the region as well as women receiving invitations to attend breast-screening checkups as the control population were asked to fill-in questionnaires assessing pelvic prolapse symptoms (PFDI-20, Wexner) and associated quality of life (PFIQ-7). Eighty-nine women were included in the cancer survivor group and 1088 in the control group. Pelvic floor symptoms (PFDI-20 questionnaire) were significantly worse in cancer survivors than in control women (score: 33.3 [14.6-74.1] vs. 20 [4.2-50.0], p = 0.0003). Urge incontinence was significantly worse in cancer survivors in both univariable (ORb = 2.061 [95% CI = 1.284-3.309], p = 0.0027) and multivariable analyses (ORa = 1.672 [95% CI = 1.014-2.758], p = 0.0442), as was fecal incontinence in univariable (ORb = 3.836 [95% CI = 1.710-8.602], p = 0.0011) and in multivariable (ORa = 3.862 [95% CI = 1.657-9.001], p = 0.0018) analyses. Women with benign hysterectomies had poorer quality of life and increased pelvic floor disorders compared to women with no history of surgery. Survivors of gynecological cancer experience significantly more pelvic floor symptoms and an associated reduction in quality of life.
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Supervivientes de Cáncer , Neoplasias de los Genitales Femeninos/epidemiología , Trastornos del Suelo Pélvico , Prolapso de Órgano Pélvico , Calidad de Vida , Encuestas y Cuestionarios , Anciano , Estudios Transversales , Femenino , Humanos , Persona de Mediana Edad , Trastornos del Suelo Pélvico/epidemiología , Trastornos del Suelo Pélvico/fisiopatología , Prolapso de Órgano Pélvico/epidemiología , Prolapso de Órgano Pélvico/fisiopatología , Estudios ProspectivosRESUMEN
INTRODUCTION AND HYPOTHESIS: The use of mesh in pelvic organ prolapse (POP) surgery has become a widespread treatment option, but carries a risk of specific complications. The objective was to report the rate and type of reoperation for mesh-related complications after pelvic organ prolapse surgery in an urogynecological referral center over a period of 8 years. METHODS: A retrospective study was carried out including all patients operated for a mesh complication after prolapse surgery between September 2006 and September 2014 in the urogynecology unit in Nîmes hospital. RESULTS: Sixty-nine mesh complications were recorded among the 67 patients included. Surgical treatment of mesh-related complications accounted for 7% of all pelvic surgeries performed in our center. Thirty-two patients (47.8%) were referred from other centers and 35 patients (52.2%) were initially operated in our unit. The global rate of reintervention for mesh-related complications after prolapse repair performed in our unit was 2.8%. Of 69 mesh complications, 48 patients (71.6%) had transvaginal mesh (TVM) and 19 patients (28.4%) sacrocolpopexy (SCP). The indication for surgery was a symptomatic or large vaginal erosion (47.8%), symptomatic mesh contraction (20.3%), and infection (11.6%). The most frequent primary symptom was pelvic/perineal pain or dyspareunia (33.3% of cases). The mean time between initial mesh surgery and the reoperation for a complication was 33.4 months (95% CI, 24.5 to 42.2). Eleven patients (15.9%) required several interventions. In total, 77.9% of patients experienced complete recovery of symptoms after surgical management. CONCLUSION: In a referral center the global rate of reinterventions for mesh-related complications after POP repair is 2.8%. The surgical treatment of mesh complications appears to be a safe and effective procedure with cure of the symptoms in most cases.
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Prolapso de Órgano Pélvico/cirugía , Complicaciones Posoperatorias/cirugía , Reoperación/estadística & datos numéricos , Mallas Quirúrgicas/efectos adversos , Adulto , Anciano , Anciano de 80 o más Años , Dispareunia/etiología , Dispareunia/cirugía , Femenino , Humanos , Persona de Mediana Edad , Dolor Pélvico/etiología , Dolor Pélvico/cirugía , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Centros de Atención Terciaria , Resultado del Tratamiento , Vagina/cirugíaRESUMEN
UNLABELLED: Previous studies have emphasized the increasing incidence of colorectal cancer (CCR) among young adults and suggest that they may have more aggressive disease and worse five-year survivals than their older counterparts. PURPOSE: Describe the profile of sporadic colorectal cancer in young patients focusing on its prevalence, clinicopathological characteristics, prognostic and survival factors. METHODS: Three hundred and twenty-five CCR patients were divided in two groups : G1 < 45 years and G2 > 45 years. RESULTS: 13.2% of patients were less than 45 years old. A family history of a first-degree relative with colorectal cancer was more frequent in young patients: 44.1% vs 18.2% (p = 0.025). A significant delay in seeking medical care was noted in G1 patients: 29.7 weeks vs 18.6 weeks (p = 0.01). A trend to have more aggressive stages III and IV at presentation was observed among young patients: 55.8% vs 48.6% (p = 0.8). Mucin-producing tumors were more frequently observed in G1 group: 41.9% vs 12% (p = 0.000). Mean survival was 76.9 months in G1 group and 91.7 months in G2 group (p = NS). Five-year survival was 52% in G1 group and 58% in G2 group (p = 0.6). Stage for stage comparison was not significant in determining survival. The only independent factors were delay in consultation, right location of the tumor, peritoneal carcinomatosis, and the need for chemotherapy. CONCLUSION: This study confirms that colorectal cancer in young patients is frequent. Despite more frequent occurrence of mucin-producing tumors, age is not by itself a worse outcome predictor.