81: Obstetric Outcome After Endoscopic Transection of the Uterine Septum

Oral Presentations uroflowmetry. No statistical correlation was found between VD symptoms and BOO defined on uroflowmetry (p⫽0.64) in this specific SUI population. Conclusion: Since pre-existing BOO is known to be a risk factor for post-surgery obstructive disorders, our results suggest that a systematic urodynamic evaluation of the voiding phase should be performed in all women presenting with SUI before continence surgery. 80 Hysteroscopic Resection of Placenta Accreta After Conservative Management Deffieux X, Faivre E, Gervaise A, Frydman R, Fernandez H. Hoˆpital Antoine Be´cle`re, Clamart, France Study Objective: We report our experience concerning the efficacy and the reproductive outcome of selective hysteroscopic removal of placental remnants following conservative management of placenta accreta. Design: Retrospective study. Setting: French university hospital. Patients: Ten patients were diagnosed with placenta accreta and managed conservatively after cesarean section (n⫽8) or vaginal delivery (n⫽2). Intervention: Hysteroscopic selective resection with a loop was performed when ultrasound vascularization inside the placental tissue has disappeared. Complete removal of placental tissue was performed in one operative time for 6 patients (66%), and needed a second procedure in 4 cases, because of the important volume of the remained placenta (diameter between 3 and 10 cm). The median operative time was 30.6 minutes (range 12 – 60 min). No preoperative and immediate postoperative complication occurred. The median time from pregnancy termination to surgery was 147 days (range 60 – 240 days). Measurements and Main Results: Eight patients underwent hysteroscopic control: 4 had already known persistence of placental tissue after incomplete resection, 2 had a normal uterine cavity, 1 had an endometrial atrophy, and an another one had an Asherman syndrome. Four patients tried to get pregnant: two of them had a successful term pregnancy without repeated placenta accreta or any other incident. The third one is undergoing In Vitro-Fertilization. The last one has presented an Asherman Syndrome nowadays unsuccessfully treated. Conclusion: Hysteroscopic resectin after conservative treatment in case of placenta accreta is a simple and safety method. Because of the possibility of secondary IUA, the place of this alternative has to be defined. 81 Obstetric Outcome After Endoscopic Transection of the Uterine Septum Deffieux X, Gervaise A, Faivre E, Fernandez H. Hoˆpital Antoine Be´cle`re, Clamart, France

S31 Study Objective: To evaluate the reproductive outcome following endoscopic transection of uterine septum in women with primary infertility and history of recurrent abortion or late abortion. Design: Retrospective study. Setting: French university hospital. Patients: One hundred and twenty-two women (mean age 32.2 years, range 23-43 years) with septate uterus were treated by hysteroscopic transection between 1993 to 2005. Intervention: Surgery was performed under general anaesthesia after cervical dilatation using an operative hysteroscope fitted with a monopolar or bipolar electrode. Secondlook hysteroscopy was performed 2 months later in order to assess whether a residual septum longer than 1 cm was present or not and to identify the absence of synechiae. Measurements and Main Results: Among the 112 patients, 6 did not wish to conceive and 17 patients were lost to follow-up. Fifty seven patients (64%) out of 89 became pregnant; 16 after reproductive treatments and 39 spontaneously. Seven patients had cervical cerclage. The reproductive outcome after septum transection was 11 (22%) abortions (52% before surgery, p⫽0.01), 46 (77%) live births (22% before surgery, p⬍0.001) and 15 (23%) preterm deliveries (35% before surgery, p⫽0.36). Conclusion: Endoscopic transection of septum should be proposed to women with recurrent abortions as soon when a septate uterus is diagnosed. Endoscopic surgery reduces morbidity and postoperative adhesions, restores the normal size of the uterus cavity and does not require routine caesarean section. 82 Posterior Infracoccygeal Sacropexy Procedure for Vaginal Vault Prolapse: Anatomical and Functional Results on a Series of 86 Patients Deffieux X, Faivre E, Gervaise A, Fernandez H. Hoˆpital Antoine Be´cle`re, Clamart, France Study Objective: To evaluate the results of infracoccygeal sacropexy procedure for cure of vaginal vault prolapse. Design: Retrospective study. Setting: French university hospital. Patients: A continuous series of 86 women, mean age 63 years (⫹/⫺11), who have undergone infracoccygeal sacropexy procedure for the treatment of vaginal vault prolapse. Mean follow-up was 15 months (⫹/⫺ 10). All subjects were asked to complete the PFDI and PFIQ questionnaires. Intervention: The IVS (n⫽53) or I-STOP (n⫽33) tunneller was placed by trans-gluteal approach into the ischiorectal fossa, and then turned inwards for passage through the rectovaginal fascia, so as to reach the transverse vaginal incision. Tape is secured to the vaginal vault and also to the remnants of the uterosacral ligaments. Measurements and Main Results: Two patients required sling removal (one case of pudendal nerve damage). Vaginal extrusion of the sling occurred in 5 women with IVS