Lynne Rogerson

Female sterilisation: a cohort controlled comparative study of ESSURE versus laparoscopic sterilisation

Objective  To compare patient satisfaction, discomfort, procedure time, success rate and adverse events of hysteroscopic (ESSURE, Conceptus Inc, San Carlos, USA) versus laparoscopic sterilisation.

A comparison of outpatient hysteroscopy with saline infusion hysterosonography

Objectives To establish the accuracy of saline infusion hysterosonography in diagnosing uterine pathology when compared with outpatient hysteroscopy.

A randomised controlled trial comparing outpatient versus daycase endometrial polypectomy

Objective  To evaluate outpatient versus daycase endometrial polypectomy by comparing success rate, complications, patient tolerance, pain score, analgesia requirement and recovery.

Groin abscess secondary to trans obturator tape erosion: Case report and literature review

AIMS To report a case of groin abscess secondary to trans obturator tape erosion and review the literature on the incidence, predisposing factors, symptoms and management of tape erosion. METHODS The clinical history, operative details, postoperative symptoms, findings and management of this case are reported. A thorough literature review of midurethral tape erosions and, in particular, transobturator tape erosions was performed. RESULTS A 46-year-old woman with urodynamic stress incontinence underwent trans obturator tape insertion. Eight weeks later she developed vaginal discharge and was subsequently diagnosed with a left lateral vaginal wall tape erosion. The eroded section was excised under general anaesthetic. Two weeks later she presented with a large right sided groin abscess which required incision, drainage and debridement of necrotic areas of gracillis and adductor muscles. Short term results following trans obturator tape insertion report excellent efficacy rates (90-96% after 1 year), however there is a lack of long term data on safety and efficacy. Current literature on transobturator tape erosion is scanty and reported rates range from 1.9-7% depending on the tape inserted. Tape erosion commonly presents with vaginal discharge, bleeding or dyspareunia and several methods of management have been reported including conservative management, excision of the eroded section or removal of the entire tape. CONCLUSIONS Groin abscess following tape erosion is a serious complication resulting in further surgery and months of morbidity for the woman. Prompt management of tape erosion is essential to minimise such complications and more data is required on the long term efficacy and safety of transobturator tapes.

Management of menorrhagia – SMART study (Satisfaction with Mirena and Ablation: a Randomised Trial)

They found that 19/35 women had a recurrence (or persistence) of prolapse after the Burch colposuspension. In contrast, only one (of 33 women) had a recurrent cystocele after anterior vaginal repair, and she was continent and asymptomatic. However, none of the 19 women consented to a subsequent repair, including the six who were deemed symptomatic, presumably because they were not sufficiently troubled by it. Therefore, we do not feel that this ‘disadvantage’ of the Burch colposuspension is sufficient grounds for recommending concomitant primary (vaginal repair) surgery, as the authors suggest. Indeed, combining the data with those from the one other study which reported it’.’ (3183 after anterior repair vs 5/140 after abdominal retropubic suspension), gave an aggravated relative risk of having further prolapse surgery of 1.26, 95% CI 0.3 1-506. This highlights one of the pragmatic drawbacks of objective scoring systems for conditions versus subjective complaint. Also given that hysterectomy was undertaken by different routes in each arm, this in itself could have a confounding influence. On the other hand, the authors found that dyspareunia was more common in the anterior repair group. However, all women who had the vaginal approach also had a posterior repair, whereas only 12/35 women in the Burch group had this additional procedure. Not all the women were sexually active. Could the authors clarify the incidence of dyspareunia amongst the 24 sexually active women in the Burch group who did have a posterior repair, and also compare the consequent shortening of the vaginal lengths in these women with those who had an anterior repair? This would lend weight to their conclusion that routine posterior repair should be abandoned, and only performed after careful consideration of symptoms in sexually active women.

Hysteroscopic sterilisation: a study of women's attitudes to a novel procedure

Laparoscopy is the most common mode of surgery for female tubal sterilisation. Hysteroscopic sterilisation is a new method which can be performed in the outpatient setting under local anaesthetic. We carried out a prospective cohort trial to determine whether women would actually favour hysteroscopic sterilisation over laparoscopic sterilisation. Data analysis in a cohort of 96 women showed that 77% would prefer laparoscopic sterilisation over the hysteroscopic procedure (23%), despite the advantages of an outpatient setting. Age, obstetric history, employment and marital status, access to transport and previous anaesthetic did not significantly influence the choice made.

Imaging of the endometrium in postmenopausal women

Ultrasound can offer cheap, quick, relatively non-invasive assessment of the endometrium in postmenopausal women. Its inability to effectively discriminate benign from malignant pathology means its place is to select those in whom further investigation is required. Saline instillation sonography may allow clarification of the image and allow the discrimination of a submucosal fibroid with thin overlying endometrium from a central uterine homogeneous mass seen on standard transvaginal ultrasound. In addition it may identify eccentric endometrial thickening or other intracavity lesions. The role of three-dimensional ultrasound is ill defined at present and magnetic resonance because of its cost should be confined to complex cases.