Papers by Krystel Nyangoh Timoh
Chirurgie de L'endométriose
International Journal of Gynecology & Obstetrics
Journal of Gynecology Obstetrics and Human Reproduction
Journal of Gynecology Obstetrics and Human Reproduction
Journal of Gynecology Obstetrics and Human Reproduction
Fertility and Sterility
OBJECTIVE To better understand the physiology of pain in pelvic pain pathological conditions, suc... more OBJECTIVE To better understand the physiology of pain in pelvic pain pathological conditions, such as endometriosis, in which alterations of uterine innervation have been highlighted, we performed an anatomic and functional mapping of the macro- and microinnervation of the human uterus. Our aim was to provide a 3-dimensional reconstruction model of uterine innervation. DESIGN This was an experimental study. We dissected the pelvises of 4 human female fetuses into serial sections, and treated them with hematoxylin and eosin staining before immunostaining. SETTING Academic Research Unit. PATIENTS None. INTERVENTIONS None. MAIN OUTCOME MEASURES Detection of nerves (S100 +) and characterization of the types of nerves. The slices obtained were aligned to construct a 3-dimensional model. RESULTS A 3-dimensional model of uterine innervation was constructed. The nerve fibers appeared to have a centripetal path from the uterine serosa to the endometrium. Within the myometrium, innervation was dense. Endometrial innervation was sparse but present in the functional layer of the endometrium. Overall innervation was richest in the supravaginal cervix and rarer in the body of the uterus. Innervation was rich particularly laterally to the cervix next to the parametrium and paracervix. Four types of nerve fibers were identified: autonomic sympathetic (TH+), parasympathetic (VIP+), and sensitive (NPY+, CGRP1+ and VIP+). They were found in the 3 portions and the 3 layers of the uterus. CONCLUSIONS We constructed a 3-dimensional model of the human uterine innervation. This model could provide a solid base for studying uterine innervation in pathologic situations, in order to find new therapeutic approaches.
Journal of Gynecology Obstetrics and Human Reproduction
Clinical Anatomy, 2022
BACKGROUND Uterine transplantation is on the rise worldwide. In contrast to its arterial anatomy,... more BACKGROUND Uterine transplantation is on the rise worldwide. In contrast to its arterial anatomy, venous drainage of the uterus is poorly defined in the literature. Our aim was to provide a standardized description of uterine veins through a multimodal approach to establish anatomical landmarks for the uterine transplantation surgeon. METHODS Data were obtained from: (1) an anatomical study of eight fresh female cadavers (16 hemipelves) studied separately by an extrafascial dissection from the iliac bifurcation to the uterine pedicle, with analysis of the urinary tract and nerve structures; and (2) a virtual anatomical study from the Anatomage® Table comprising a high-fidelity virtual reconstruction of two deceased female subjects by imaging and anatomical methods. RESULTS An inconstant duality of uterine veins was identified: a deep uterine vein of larger caliber, and a superficial uterine vein observed in 25% of cases. A close relationship of the ureter passing posterior to the superficial uterine vein and anterior to the deep uterine vein was evident in the parametrium. The inferior hypogastric plexus was identified in all cases immediately behind the deep uterine vein. The data obtained from the fresh female cadavers were validated by the Anatomage® Table. CONCLUSIONS We describe the close relationship of the uterine veins with the ureter and the inferior hypogastric plexus. This knowledge represents a surgical landmark to support the success of uterine transplantation by respecting both the graft and the safety of the living donor by limiting the risk of injuries during uterus procurement. This article is protected by copyright. All rights reserved.
Journal of Gynecology Obstetrics and Human Reproduction, 2022
INTRODUCTION Non-tubal ectopic pregnancies (NTEP) in France constitute approximately 5% of ectopi... more INTRODUCTION Non-tubal ectopic pregnancies (NTEP) in France constitute approximately 5% of ectopic pregnancies (EP). A NTEP can be abdominal, ovarian, cervical, interstitial, on a caesarean scar, or cornual. These pregnancies, which are sometimes difficult to diagnose and are often diagnosed late, carry a high risk of complications, particularly haemorrhages. Many treatments have been described for treating these NTEP. Our objective is to assess how they are cared for in terms of diagnosis, treatment and monitoring. EQUIPMENT AND METHODOLOGY An online questionnaire was sent out to all members of the French Society of Gynecologic and Pelvic Surgery (SCGP) in September 2020. The questionnaire was in the form of two clinical cases on interstitial and caesarean scar pregnancies. RESULTS 141 SCGP members responded (36%). For diagnosis, 58% of respondents enlisted the help of a specialist sonographer. MRI is rarely used for diagnosis to the extent that it was only requested in 7% of cases for interstitial pregnancy and 23.6% of cases for caesarean scar pregnancy. In the case of stable interstitial pregnancy without signs of complications, treatment is predominantly medical (90%), with the use of methotrexate (MTX) by intramuscular injection in 33.3% of cases, by in situ injection in 30.7% of cases, or a combination of the two in 36% of cases. If there were signs of pre-rupture, the majority of respondents performed laparoscopic surgical treatment (79.3%). In terms of caesarean scar pregnancies, the treatment was predominantly medical (78.2%) with the use of MTX only, as an intramuscular injection in 23.3% of cases, in situ in 36% of cases, and as a combination of intramuscular and in situ in 37.2% of cases. DISCUSSION Non-tubal ectopic pregnancies are sometimes difficult to diagnose in the first trimester and constitute a significant haemorrhage risk for patients. In France, there is currently no specific recommendation on this subject and there is huge disparity in practice.
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2018
Objective: To evaluate fertility outcomes after laparoscopic partial bladder resection in women w... more Objective: To evaluate fertility outcomes after laparoscopic partial bladder resection in women with bladder endometriosis and to review the literature. Study design: A retrospective study conducted at two tertiary referral centres
Journal of Clinical Medicine, 2022
Uterus transplantation is a new possibility for women suffering from absolute uterine infertility... more Uterus transplantation is a new possibility for women suffering from absolute uterine infertility to become pregnant and have children. In the case of a deceased donor, a list of exclusion criteria is defined to ensure the high quality of the uterus graft. This study evaluates the number of potentially available uterus grafts based on the pre-defined exclusion criteria in a national deceased donor multi-organ donation program in France. We analyzed the data reported in the CRISTAL database regarding all women aged 18 to 60 on whom organ procurement was performed between 2014 and 2019. Potential deceased women donors were classified into three categories: very ideal donor, ideal donor, and expanded criteria donor. Between 2014 and 2019, 4544 women underwent organ procurement. Using the very ideal donor, ideal donor, and expanded criteria donor classification, we found that, respectively, only 124, 264, and 936 donors were potentially eligible for UTx. This represents 2.8 per million ...
Journal of Gynecology Obstetrics and Human Reproduction, 2021
INTRODUCTION Mucosal melanomas (MM) of the female genital tract are rare a. We aimed to study the... more INTRODUCTION Mucosal melanomas (MM) of the female genital tract are rare a. We aimed to study the prognostic factors of vulvar and vaginal locations of MM. MATERIAL AND METHOD A multicenter, retrospective cohort study conducted between 01/01/2000 and 01/06/2019. RESULT Of the 33 patients included 25 (75.8%) had vulvar (VuM) and eight (24.2%) vaginal melanomas (VaM). VaMs were deeper: median Breslow index: 17.5 mm [3.5-22] versus 4.3 mm [0.35-18] (p = 0.013). Average follow-up was 24.0 ± 59.8 months. Twenty-six patients (78.8%) experienced recurrence. Disease-free survival was 52.9% at 1 year (64.7% for VuM and 14.3% for VaM) and 8.4% at 3 years (11% for VuM and 0% for VaM) (p = 0.002). Median time to the first recurrence was 9.01 months [CI95%: 2.07-56.71]. VaM recurred earlier than VuM (3.12 months [CI95%: 2.07-12.49] versus 17.72 [CI95%: 3.58-56.71], p = 0.011). VaM had a higher risk of recurrence (HR = 5.64 [CI95%: 2.01-15.82], p = 0.001) in multivariate analysis. Overall survival was 88.5% at 1 year (100% for VuM and 50% for VaM), and 59.4% at 3 years (69.3% for VuM and 25% for VaM). Women with VaM died earlier: median specific death occurrence of 8.76 months [CI95%: 6.54-24.72] versus 39.61 [CI95%: 21.89-209.21], p = 0.013 (HR = 5.08 [CI95%: 1.39-18.60], p = 0.014). A lesion size ≥3 cm was associated with an increased risk of mortality (HR = 8.45 [CI95%: 1.60-44.52], p = 0.012). In multivariate analysis, vaginal location remained an independent and predictive variable of a higher risk of specific death (HR = 8.56 [CI95%: 1.95-37.64], p = 0.005). CONCLUSION A vaginal location of MM is associated with a poorer prognosis than a vulvar location.
Chirurgie de L'endométriose
International Journal of Gynecology & Obstetrics
Journal of Gynecology Obstetrics and Human Reproduction
Journal of Gynecology Obstetrics and Human Reproduction, 2021
BACKGROUND Uterine transplant (UT) represents an opportunity to treat absolute uterine infertilit... more BACKGROUND Uterine transplant (UT) represents an opportunity to treat absolute uterine infertility. However, the use of uterine veins for venous return, in addition to ovarian veins, significantly increases the risk of ureteral wounds in the living donor and UT time for the recipient. Our aim was to demonstrate that dual ovarian venous return is sufficient for graft viability and survival. METHODS Uterine orthotopic auto-transplant was performed under general anaesthesia in six Yucatan minipig sows. The uterus graft was implanted with termino-lateral anastomoses between the ovarian and external iliac veins, and between the uterine and external iliac arteries, respectively. RESULTS The macroscopic physical aspect of the graft was adequate in 83% of the sows (5/6) 30 min after reperfusion with a surgical time of 439±54 min (mean anastomosis time: 153±49 min). Two sows died the day after surgery. In the four remaining sows, two uteri were necrotic and two were adequately vascularized on Day 7. CONCLUSIONS the learning curve was relatively fast, the sole use of bilateral ovarian venous return is possible and might reduce post-surgery morbidity in human living donors as well as UT time for the recipient.
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Papers by Krystel Nyangoh Timoh