Christine Bain

Efficacy and safety of using mesh or grafts in surgery for anterior and/or posterior vaginal wall prolapse: systematic review and meta‐analysis

Background  The efficacy and safety of mesh/graft in surgery for anterior or posterior pelvic organ prolapse is uncertain.

Childbirth and prolapse : long-term associations with the symptoms and objective measurement of pelvic organ prolapse

To investigate prolapse symptoms and objectively measured pelvic organ prolapse, 12 years after childbirth, and association with delivery mode history.

A randomised comparison of microwave endometrial ablation with transcervical resection of the endometrium; follow up at a minimum of five years

Objective  To compare long term outcomes following microwave endometrial ablation (MEA) or transcervical resection of the endometrium (TCRE).

Microwave endometrial ablation versus endometrial resection: a randomized controlled trial.

OBJECTIVE To compare menstrual status, satisfaction, and acceptability of microwave endometrial ablation with transcervical endometrial resection for the treatment of heavy menstrual bleeding. METHODS Women were randomized to either endometrial ablative method. Menstrual status, satisfaction, acceptability, and changes in health‐related quality of life were obtained by a self‐completed questionnaire. Case note review and personal communication identified further surgery rates at 2 years after each procedure. RESULTS Among the original 263 women who underwent endometrial ablation, 249 (95%) returned questionnaires at 2 years. Menstrual status in both groups was similar, although the amenorrhea rate was higher after microwave endometrial ablation. Seventy‐nine percent of women were either completely or generally satisfied after microwave ablation compared with 67% after transcervical endometrial resection. Health‐related quality‐of‐life scores remained higher than at recruitment for both treatments. Hysterectomy rates were similar at 2 years (11.6% after microwave endometrial ablation and 12.7% after transcervical endometrial resection), and no repeat endometrial ablative procedures were required. CONCLUSION Microwave endometrial ablation is an effective alternative to transcervical endometrial resection for dysfunctional uterine bleeding.

A randomised controlled trial evaluating the use of polyglactin mesh, polydioxanone and polyglactin sutures for pelvic organ prolapse surgery

Summary To compare the effectiveness of polyglactin mesh, and polydioxanone or polyglactin sutures in women having pelvic organ prolapse surgery. Randomised controlled trial with a factorial 2(2 design of polyglactin mesh or not, and polydioxanone or polyglactin suture. Outcomes were assessed using questionnaires at baseline and on the third day and at 6 months after surgery. Women were also examined clinically 3 months after surgery. The primary outcome was the subjective improvement in prolapse symptoms and quality of life scores from baseline to 6 months. There was a subjective improvement in the prolapse symptom score from baseline to 6 months after surgery (mean difference of 9.2 (95% CI for difference 7.2–11.2, p < 0.001) and an improvement in the mean quality of life score over the same period with a reduction of 3.4 (95% CI for difference 2.4–4.3, p < 0.001). However, there were no significant differences in the mean difference in prolapse symptoms and quality of life (QoL) scores according to the randomised groups. The majority (86%) of women were satisfied with their surgery. Our study demonstrated that at short-term follow-up, there was no significant difference in the mean differences in prolapse symptoms and QoL scores after surgery using polyglactin mesh or not, polyglactin or polyglactin sutures, but the numbers were too small for a definitive conclusion. Longer-term follow-up and/or a larger trial are required.

A randomised controlled trial evaluating the use of polyglactin (Vicryl) mesh, polydioxanone (PDS) or polyglactin (Vicryl) sutures for pelvic organ prolapse surgery: outcomes at 2 years.

Summary The effects at 2 years of polyglactin (Vicryl) mesh inlay and polydioxanone (PDS) or polyglactin (Vicryl) suture material on prolapse symptoms, urinary, bowel, sexual function and prolapse related Quality-of-Life (QoL) in women undergoing pelvic organ prolapse surgery were evaluated in a randomised controlled trial with a 2 × 2 factorial design of Vicryl mesh (n = 32) or not (n = 34) and PDS (n = 33) or Vicryl suture (n = 33). The response rate at 2 years was 82%. There were no differences in the prolapse symptom scores between the randomised groups. Prolapse-related QoL score (mean difference: 2.05, 95% CI 0.19–3.91) and urinary incontinence score (mean difference: 2.56, 95% CI 0.02–5.11) were significantly lower (better) in women who had Vicryl compared with PDS sutures. The apparent superiority of the prolapse-related QoL and urinary incontinence scores in women using Vicryl suture material (vs PDS) needs to be confirmed in a larger trial.

A randomised comparison of microwave endometrial ablation with transcervical resection of the endometrium: follow up at a minimum of 10 years: Randomised comparison: MEA versus TCRE

Objective  To compare outcomes and further operations at a minimum of 10 years following microwave endometrial ablation (MEATM) or transcervical resection of the endometrium (TCRE).

Comparison of the long‐term effects of simple total abdominal hysterectomy with transcervical endometrial resection on urinary incontinence

Objective  To test the hypothesis that the hospital referral rate for urinary incontinence (UI) symptoms, within 10 years of a simple total abdominal hysterectomy (TAH) for dysfunctional uterine bleeding (DUB), would differ to that after a transcervical resection of the endometrium (TCRE).

Three surgically managed ipsilateral spontaneous ectopic pregnancies.

BACKGROUND: Recurrence of ectopic pregnancy is usually associated with assisted reproductive techniques, being less likely to occur after natural conception. CASE: We report the case of a patient who had three consecutive ectopic pregnancies on the ipsilateral side after natural conception and was treated surgically in each case with partial salpingectomy, removal of tubal stump, and resection of the uterine cornua, respectively. The contralateral normal tube was resected at the time of last operation. CONCLUSION: We indicate the high risk for tubal rupture and bleeding and the need for appropriate surgical intervention when managing recurrent ectopic pregnancies. Furthermore, care should be undertaken not to leave a long tubal stump when performing salpingectomy for ectopic pregnancy, to decrease risk of recurrence.

Is outpatient diagnostic hysteroscopy more useful than endometrial biopsy alone for the investigation of abnormal uterine bleeding in unselected premenopausal women

Objective To formally evaluate the clinical benefit of additional outpatient hysteroscopy over traditional vaginal examination and endometrial biopsy.