Long-term follow-up of uterine artery embolization for symptomatic adenomyosis.

INTRODUCTION: Long-term results of uterine artery embolization (UAE) for adenomyosis are largely unknown. We assess long-term outcome of UAE in 40 women with adenomyosis. MATERIALS AND METHODS: Between March 1999 and October 2006, 40 consecutive women with adenomyosis (22 in combination with fibroids) were treated with UAE. Changes in junction zone thickness were assessed with magnetic resonance imaging (MRI) at baseline and again at 3 months. After a mean clinical follow-up of 65 months (median 58 [range 38-129]), women filled out the uterine fibroid symptom and quality of life (UFS-QoL) questionnaire, which had additional questions on the long-term evolution of baseline symptoms and adverse events. RESULTS: During follow-up, 7 of 40 women (18%) underwent hysterectomy. Among these 7 women, the junction zones were significantly thicker, both at baseline (mean 23 vs. 16 mm, P = 0.028) and at 3-month follow-up (mean 15 vs. 9 mm, P = 0.034). Of 33 women with preserved uterus, 29 were asymptomatic. Four patients had symptom severity scores of 50 to 85 and overall QoL scores of 60 to 66, indicating substantial clinical symptoms. There was no relation between clinical outcome and the initial presence of fibroids in addition to adenomyosis. CONCLUSION: In women with therapy-resistant adenomyosis, UAE resulted in long-term preservation of the uterus in the majority. Most patients with preserved uterus were asymptomatic. The only predictor for hysterectomy during follow-up was initial thickness of the junction zone. The presence or absence of fibroids in addition to adenomyosis had no relation with the need for hysterectomy or clinical outcome.

[Outcomes of disciplinary proceedings against gynaecologists: comparison between the periods 1980-1991 and 1992-2003]. / Uitkomsten van de tuchtrechtspraak over gynaecologen: vergelijkingen tussen 1980-1991 en 1992-2003.

In a study of the archives of the Chief Inspector for Healthcare in The Netherlands during the period 1992-2003, the number of complaints against gynaecologists submitted to disciplinary boards (n = 371) was found to be higher than during the period of 1980-1991 (n = 240). On the other hand, the number of complaints per gynaecologist had decreased from 6.3 complaints per 100 gynaecologists in 1992 to 2.6/100 in 2003. The number ofcomplaints declared legitimate relative to the number of submitted complaints remained the same in both periods (55/240 (23%) in 1980-1991 and 84/371 (23%) in 1992-2003), although the percentage ofcomplaints ruled as legitimate did increase during the course of the second period from 14 between 1992-1997 to 28 during the 1998-2003 period. Interesting points included the number of rulings regarding the death of an infant (40%), the interpretation of the cardiotocography recording, the need to keep medical records up to date (in particular the informed consent) and the fact that almost 50% of complaints ruled to be legitimate related to how the locum position was arranged, the role of the duty gynaecologist and that of the house officer.

Removal of a missed polypropylene tape by a combined transurethral and transabdominal endoscopic approach.

Surgical intervention for bladder perforation caused by application of a transvaginally placed polypropylene tape is rare. Open as well as endoscopic procedures for removal from the bladder have been described earlier. In this case report we describe the removal of an intravesical polypropylene tape by a combined transurethral and transabdominal endoscopic approach 3 months after the initial surgical procedure.

Anorectal symptoms after various modes of vaginal delivery.

The aim of this study was to determine the prevalence of, and the changes in, anorectal symptoms following different modes of vaginal delivery in primiparous women. Six hundred and seventeen questionnaires were distributed to primiparous women 3-4 years after delivery. The questionnaires were designed to obtain information regarding the development of anorectal symptoms, including the type of symptoms experienced, their severity and their impact on lifestyle. A total of 479 questionnaires were returned, representing a response rate of 77.6%. Women included in the study were divided into three groups on the basis of the mode of delivery (normal vaginal, vacuum extraction and forceps). Any episode of fecal incontinence was considered to be abnormal. Following delivery, de novo incontinence developed in 22%. There was no significant difference between the three modes of vaginal delivery in terms of the development of fecal incontinence (normal vaginal delivery 22%, vacuum extraction 20%, forceps delivery 26%). Furthermore, analysis of obstetric variables could not identify one significant independent risk factor for anorectal incontinence. The results of this study suggest that instrumental vaginal deliveries are as safe as a normal vaginal delivery in terms of the development of anorectal symptoms.