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La lésion iatrogène des voies urinaires chez les femmes soumises à la chirurgie pelvienne Introduction. La lésion iatrogène des voies urinaires chez les femmes subissant des interventions pelviennes est l'une des complications les plus redoutées et une source importante de morbidité significative. En outre, elles provoquent beaucoup d'anxiété en égale mesure pour le patient et le chirurgien et elles créent également de nombreuses préoccupations juridiques. Les organes les plus fréquemment touchés sont l'uretère, la vessie et l'urètre. Les lésions urologiques en obstétrique et en chirurgie gynécologique devraient toujours être une question de prévention, mais il y a des situations où la ABSTRACT Introduction. Iatrogenic injury of the urinary tract in women undergoing pelvic surgeries is one of the most feared complications and an important source of significant morbidity. Moreover, they cause a lot of anxiety to both patient and surgeon and they also create many legal concerns. The most commonly affected organs are the ureter, bladder and urethra. Urologic injury during obstetrics and gynecologic surgery should always be a matter of prevention, but there are situations in which prevention fails. With this article we intend to raise the awareness on potential situations leading to iatrogenic urinary tract lesions during obstetrics and gynecology surgery.

Malpractice is a relatively new term in terms of litigation. Prior to the early 18 th century, medical malpractice lawsuits were mainly limited to cases that resulted in severe injury and death. At the beginning of the 19 th century, things started to change for the medical practitioners, unfortunately not in a good way. What seemed to have started in the USA, spread like fi re throughout the Western Europe. This state of affair prompted physicians to practice the socalled "defensive medicine". It is well known that surgery in general and urologic surgery in particular is associated with iatrogenic injury and high-risk procedures that do not always have a positive outcome. Moreover, offi ce urology seems to also imply a high degree of litigation risk. The aim of this paper was to determine the fi elds in Urology that are most prone to litigation and malpractice lawsuits.

Benign prostatic hyperplasia (BPH) is induced by a persistent local inflammatory process that leads to cell proliferation. Viral infections associated with immune deficiencies can trigger the chronic inflammation of the prostate. Therefore, we have investigated several viral expressions in BPH patients and tried to establish a link with the diagnosed hyperplasia. 50 patients with BPH without urinary tract infection were tested for the presence of the following viruses: human papilloma virus (HPV), cytomegalovirus (CMV) and Epstein-Barr virus (EBV). These viruses are the most common cause of asymptomatic viral infections. HPV-specific DNA detection by polymerase chain reaction (PCR) was used for freshly surgical removed tissue sample. Both anti-CMV (IgG, IgM) and anti-EBV (IgG, IgM) antibodies were detected in the patients� serum with standard enzyme-Linked Immunosorbent Assay technique (ELISA). Specific HPV-DNA in prostate tissue was found only in 4% of patients, while 98% and 100% patients were positive for serum anti-CMV IgG or anti-EBV, proving intense earlier contact with the virus. IgM anti-CMV evaluation was found in around 10% of the cases which were also negative for EBV, sustaining that this was a non-acute infection. The findings showed that BPH may be associated with a chronic inflammation due to the post-viral infection with CMV or EBV, or secondary to the presence of these viruses in the prostate, while the involvement of HPV infection in BPH development is comparably lower. Our data suggests that viral investigation in BPH should be considered in the screening protocol of BPH as an indicator of possible inflammatory-mediated tumorigenesis of urinary tract.

Endometriosis is an important public health issues concerning women of reproductive age due to its debilitating painful symptoms. Deep infiltrating endometriosis is the severe form, involving uterosacral ligaments, rectum, bowel and bladder. There is no optimal treatment for this disease, but there are 3 main therapeutic options: medical, surgical and a combination of both. A modern approach for the treatment of endometriosis pain uses dienogest, a progestin, as a long-term solution for women who do not wish to procreate or to whom surgery is not an option. Dienogest 2mg daily has a positive effect on the reduction of pain and endometrial lesions when used perioperatively or as a long-term postoperative treatment. This article focuses on the literature evidence on the efficacy of newly approved oral synthetic progestins in the treatment of severe endometriosis.