Although the transobturator technique is considered minimally invasive surgery, morbidity can be severe and require specific management.

Objective To evaluate the risk of vascular injury during transobturator approach of cystocele repair.Design Dissection of the obturator area by perineal approach was performed after placement of mesh needles used for cystocele mesh repair.Setting Surgery school of Paris.Population or sample Twenty obturator regions in ten fresh female cadavers.Methods Transperineal dissection of the obturator area was conducted in ten fresh female anatomic subjects after inserting anterior Prolift Ò needles.Main outcome measures The vascular anatomy of the obturator region was mapped. Distances between needles and vascular structures of the obturator area were measured three times and averaged for each side.Results The anterior cannula-equipped needle perforated the gracilis and the adductor brevis muscles. The mean (SD) distance to the anterior obturator vessels was 21.2 (1.6) mm on the right side and 20.4 (1.5) mm on the left. The posterior needle perforated the adductor magnus. Its distance to the posterior division of the obturator vessels was 1.8 (1.0) mm on the right side and 1.1 (0.9) mm on the left.Conclusions During mesh cystocele repair by transobturator approach, the posterior obturator vessels division seems at risk of injury during the posterior needle insertion.

Overall, during the COVID-19 pandemic, a large proportion of uterine fibroids were not managed in the hospital setting. The lockdown period was associated with large reductions in hospital service utilisation, particularly for non-emergency patients. As we observed no shortterm post-lockdown catch-up, two questions arise: What became of these untreated patients? How has their future health been affected? Two hypotheses appear likely. The first is that the

Endometriosis is a female hormone-dependent disease, possibly related to endocrine disruptor exposure. We aimed to monitor this disease nationwide in France and analyze spatial trends at a fine scale to explore possible environmental contributing risk factors. We conducted a retrospective national descriptive study from 2011 to 2017 in females aged 10 years old and over, using comprehensive hospital discharge data. Cases were identified using ICD-10 N80 codes and were localized at their municipality of residence. We defined incident cases as the first hospital stay of patients, without a stay in at least the previous 5 years. We performed statistical analyses according to age and type of endometriosis, and we modeled the temporal, spatial and spatiotemporal trends. We identified 207,462 incident cases of all-type hospitalized endometriosis (83,112 for non-adenomyosis cases). The crude incidence rate for the study period was 9.85/10,000 person-years (3.95/10,000 for non-adenomyosis cases). From 2011 to 2017, the risk of all-type endometriosis increased by 8.5% (95% CI: 3.9; 13.4) (by 3.6% (95% CI: 0.6; 6.8) for non-adenomyosis cases). The risk was geographically heterogeneous, with 20 high-risk hotspots, showing similar results for non-adenomyosis cases. Shifting practice patterns, improved awareness and healthcare disparities interlinked with environmental risk factors could explain these trends.