Symptomatic Fibroid Uterus Research Articles

Clinico-demographic features and the benign diseases requiring hysterectomy; A Cross Sectional Study.

Objective: To evaluate the relationship between the clinic-demographic features and the benign diseases requiring hysterectomy. Study Design: Cross sectional study. Setting: Department of Obstetrics & Gynecology, Peshawar Medical College and its Affiliate Tertiary Care Hospitals. Period: 03 Oct, 2020 to 03 Oct, 2021. Methods: It was a part of the dissertation mandated by the college of physician and surgeons as part of the FCPS program. Using WHO sample size calculator a sample size of 104 patients was obtained and consecutive sampling was done. Logistic regression was used to co-relate clinic-demographic features with different diseases with 5% level of significance. Results: Mean of age of the patients was 48.55 years (±10.5years SD), mean height was 5.508 feet (±1.1feet SD), mean weight was 73.20 kg (±15.4kg SD) and the mean BMI was 26.58 (±4.5 SD). Diabetes mellitus was significantly more common in patients with leiomyoma and abnormal uterine bleeding, whereas, the social class and body mass index did not have an impact on the benign gynecological condition (p>0.05). Conclusion: Patients with symptomatic fibroid uterus and abnormal uterine bleeding are more likely to be hypertensive and diabetic, whereas, BMI, social class and residence area does not significantly differ among patients.

Surgical impact of bilateral transient occlusion of uterine and utero-ovarian arteries during laparoscopic myomectomy

The objective of this article is to compare the amount of intraoperative blood loss during laparoscopic myomectomy when performing bilateral transient clamping of the uterine and utero-ovarian arteries versus no intervention. It´s a randomized controlled prospective study carried out in the Department of Obstetrics and Gynecology Ramón y Cajal University Hospital and HM Montepríncipe-Sanchinarro University Hospital, Madrid, Spain, in women with fibroid uterus undergoing laparoscopic myomectomy. Eighty women diagnosed with symptomatic fibroid uterus were randomly assigned to undergo laparoscopic myomectomy without additional intervention (Group A) or temporary clamping of bilateral uterine and utero-ovarian arteries prior to laparoscopic myomectomy (Group B). Estimated blood loss, operating time, length of hospital stay, and postoperative hemoglobin values were compared in both groups. The number of fibroids removed was similar in both groups (p = 0.77). Estimated blood loss was lower in the group of patients with prior occlusion of uterine arteries (p = 0.025) without increasing operating time (p = 0.17) nor length of stay (p = 0.17). No patient had either intra or postoperative complications. Only two patients (2.5%) required blood transfusion after surgery. We conclude that temporary clamping of bilateral uterine arteries prior to laparoscopic myomectomy is a safe intervention that reduces blood loss without increasing operative time.

Frequency of Diseases Requiring Hysterectomy: A Cross Sectional Study at Tertiary Care Hospitals in Peshawar

Hysterectomy, after cesarean section is the most common performed major surgical procedures all over the world. In the united states, 5.5/1000 women underwent hysterectomy in the years 2001 to 2005. Objective: To estimate the frequencies of different diseases that needs hysterectomy at Peshawar Medical College and its affiliate hospitals. Methods: This cross-sectional study was carried out from 3rd Oct, 2020 to 3rd Oct, 2021 at the Department of Obstetrics and Gynecology, Peshawar Medical College and its affiliated hospitals. Consecutive sampling was done and a sample size of 104 patients was obtained. Those patients who recently underwent abdominal or vaginal hysterectomies aged 25-60 years with history of any parity were included. Patients with co-morbid conditions such ischemic heart disease, chronic kidney disease, malignancies and other obstetric complications such as emergency cesarean hysterectomies were excluded. Results: Mean age with standard deviation was 48.55 ± 8.53. Mean and standard deviation for weight was 73.20 ± 6.103. Of total patients, 44 (42.3%) patients had symptomatic fibroid uterus, 29 (27.9%) patients had uterovaginal prolapse while 31 (29.8%) patients had abnormal uterine bleeding as indication for hysterectomy. Among these patients, 66 (63.5%) were subjected to abdominal hysterectomy while 38 (36.5%) went through vaginal hysterectomy. Conclusions: The most common disease that needs hysterectomy in our study was symptomatic leiomyomas of uterus followed by abnormal uterine bleeding due to other causes and uterovaginal prolapse.

Uterine Artery Embolization for Symptomatic Fibroids Uterus in Gaza

Background: To evaluate interventional success, clinical success and reduction of fibroid diameter after uterine artery embolization (UAE) for patients with symptomatic fibroid uterus in Gaza. Methods: Retrospective study of thirty -two women with symptomatic uterine underwent uterine magnetic resonance imaging (MRI) before and 6 months after UAE. Primary outcome: clinical success is the improvement of the patients presenting symptoms, such as menorrhagia or pain without additional therapy. Secondary outcome: interventional success is a complete occlusion in both uterine arteries and reduction measures of fibroid diameter after 6 months after embolization. Results: Of 32 patients with mean age 44±7.6 years and follow-up between 6-70 months, 30 (93.7%) patients completed follow-up, 1 (3 %) patient had a second procedure and 2 (6 %) were lost to follow-up. Primary outcome: the improvement of symptoms, such as menorrhagia or bulk-related pain without additional therapy was seen in 29 (90%) patients. one patient underwent surgery hysterectomy on 14 months after UAE related complaints and failure of conservative treatment and 2 patients still received therapy to control symptoms. interventional success is a complete occlusion in both uterine arteries was seen in 31 (97%) patients. The mean dominant fibroid diameter reduced from 6.2 ± 2.4 cm to 1.7± 1.44 cm (p = 0.001). Conclusions: Uterine artery embolization significant improvements in fibroid uterus symptoms and long -term follow-ups with low complication rates and very good clinical efficacy

CLINICAL PROFILE OF SUBJECTS AND INDICATIONS OF GYNAECOLOGICAL HYSTERECTOMY IN A TERTIARY CARE CENTRE.

Objective: To study the clinical profile of subjects and indications of Gynaecological Hysterectomy in a tertiary care centre of South Gujarat.Methods:An observational study was conducted by collecting data from medical records of 126 consecutive subjects undergoing hysterectomy for gynaecological reasons in a tertiary care centre over a period of 12 months.Results: 61% of subjects were between 40-60 years of age.50% had studied upto primary schooling,46% were illiterate.52% had Abnormal uterine Bleeding and the commonest indication for hysterectomy was symptomatic fibroid uterus in 31.74% subjects. Conclusion: As Hysterectomy being a surgical procedure,it is associated with its own risks and complications,hence it is important to evaluate the patient properly,monitor and regulate the use of Hysterectomy particularly for the management of Benign gynaecological conditions.

Posterior Colpotomy: A Less Invasive Option for Tissue Extraction

<h3>Study Objective</h3> To review critical steps of specimen extraction through a posterior colpotomy during laparoscopic and robotic myomectomy. <h3>Design</h3> Stepwise demonstration of the technique with narrated video footage. <h3>Setting</h3> Power morcellation was the primary method of removing larger specimens without performing a mini-laparotomy for minimally invasive gynecologic surgery until 2014. This changed when the FDA placed restrictions due to concern for the spread of unsuspected cancer cells with power morcellators. Gynecologic surgeons have since been required to search for the best methods to remove large specimens, such as leiomyomas, in safe and efficient ways. One technique is the use of posterior colpotomy for removal of specimens up to 10 cm in size to avoid performing a laparotomy or mini-laparotomy. <h3>Patients or Participants</h3> The first case demonstrates a patient with a 6 cm pedunculated fibroid removed laparoscopically. The second case depicts a patient with a symptomatic fibroid uterus, the largest fibroid 9 cm in diameter. All specimens are removed via posterior colpotomy within containment bag. <h3>Interventions</h3> This video demonstrates how to identify key anatomic landmarks for safe colpotomy creation during laparoscopic and robotic surgery. Tips for extracting larger specimens are covered with review of important aspects of colpotomy closure. <h3>Measurements and Main Results</h3> Both patients did well postoperatively with resolution of symptoms and no complications. Specimens were removed intact with no issues related to creation of colpotomy. <h3>Conclusion</h3> Minimally invasive gynecologic surgery has proven benefits over laparotomy but creates the challenge of safe and efficient specimen extraction. Use of a posterior colpotomy, either robotically or laparoscopically, allows for maintenance of small skin incisions and efficient removal of an intact, contained, solid specimens up to 10cm in size. This technique is demonstrated via myomectomy and removal of leiomyoma but can be applied to safe removal of other types of large intra-abdominal specimens.

Management of Pelvic Organ Prolapse with or without Hysterectomy Via Transvaginal Robotic Notes High Uterosacral Ligament

<h3>Study Objective</h3> To demonstrate stepwise techniques for the successful use of the robotic-assisted transvaginal natural orifice transluminal endoscopy surgery high uterosacral ligament suspension (RvNOTES-HUS) technique for pelvic organ prolapse with and without uterine preservation. <h3>Design</h3> Stepwise demonstration with narrated video footage (Canadian Task Force classification III). <h3>Setting</h3> An academic tertiary care hospital. <h3>Patients or Participants</h3> Case 1: 62-year-old G0P0 with a symptomatic stage Ⅱ anterior vaginal prolapse and Stage Ⅱ uterine prolapse. Preoperative vaginal length was measured at 9cm. Case 2: 42-year-old G3P2 with a symptomatic fibroid uterus with stage Ⅱ anterior vaginal prolapse and Stage Ⅱ uterine prolapse. Preoperative vaginal length was measured at 8cm. <h3>Interventions</h3> Since the approval of the robotic platforms in gynecologic surgery by the Food and Drug Administration in 2005¹, robotic assisted surgery has been proliferating in the treatment of benign gynecological diseases including sacrocolpopexy, hysterectomy, myomectomy and endometriosis resection^2-5. In recent years, publications have demonstrated the feasibility and safety of traditional laparoscopic assisted high uterosacral ligament suspension for pelvic organ prolapse with long term follow up^6-8. However, robotic assisted RvNOTES-HUS has yet to be investigated in a publication. Utilizing the RvNOTES-HUS technique with or without uterine preservation operations greatly reduces the difficulty of intraperitoneal suture for the surgeon and postoperative pain for the patient. <h3>Measurements and Main Results</h3> Case 1: Procedure was successfully performed with a postoperative vaginal length of 8cm. Pain level was 4/10 in the first week, 2/10 in the second, 0/10 in the third. POP was stage 0. Case 2: Procedure was successfully performed with a postoperative vaginal length of 7cm. She had one day of post-operative pain. POP was stage 0. <h3>Conclusion</h3> RvNOTES-HUS is a practical technique in women with uterine prolapse while choosing whether to preserve the uterus. This technique allows for the better exposure of the ureter, while the articulating robotic joints allow for increased precision of dissection and suturing.

Reoperation rates for recurrence of fibroids after abdominal myomectomy in women with large uterus.

BackgroundThe population of women undergoing abdominal myomectomy for symptomatic large fibroid uterus is unique. We seek to characterize the timing, risk factors as well as the presenting symptoms which led patients to undergo repeat surgery in this patient population.Methods and findingsWe followed 592 patients who underwent an abdominal myomectomy from March 1998 to June 2010 at St. Vincent’s Catholic Medical Center and presented later during the study period with a recurrence of symptoms attributable to a reemergence of fibroids and who chose to undergo repeat surgical management. Twelve percent of patients exhibited symptoms of fibroid uterus which led to reoperation within the study period. The mean age at repeat surgery was 44.1 ± 0.6 years old (n = 69) and the mean time between operations was 7.9 ± 0.3 years. Presentation was variable but included bleeding, pain and infertility. Patients presented for surgery with a significantly smaller sized uterus than at their initial surgery. Timing between surgeries correlated with age at initial surgery and uterine size but race, number of fibroids, aggregate weight of fibroids removed, operative time or blood loss at the initial surgery did not correlate. Data is suggestive that intraperitoneal triamcinolone may reduce reoperation rates but not timing of recurrence.ConclusionThese results may help in counseling patients, particularly younger women, on the risks of fibroid recurrence necessitating repeat surgery. Further research is necessary to assess if triamcinolone can alter fibroid reurrence in patients who undergo uterus sparing procedures.

Laparoscopic Intracapsular Myomectomy in Women 40 Years Old and Over with Symptomatic Uterine Fibroids. A Pilot Study.

Authors evaluated the impact of laparoscopic intracapsular myomectomy (LIM) in women 40 years of age and over with desire of future fertility compared with medical management of symptomatic fibroids, by a prospective cohort study in University affiliated Hospitals. This study includes a cohort of women 40 years of age and older with symptomatic intramural fibroids with desire of future fertility. Women with symptomatic fibroid uterus were offered to undergo LIM or medical management. They were encouraged to attempt conception either spontaneously or by assisted reproductive technology (ART) according to their individual preference. All women were followed for 2 years. Fibroid characteristics, pre- and post-surgical variables, including surgical complications, days of hospitalization, pregnancy rate, and obstetrical outcomes were collected. A total of 100 patient were included in the analysis. Fifty patients were assigned to the LIM group and 50 to the medical treatment group (MT). Groups were similar regarding age (43.5 ± 2.4 and 43.5 ± 2.4, p = 0.99), body mass index (23.8 ± 3.1 and 24.2 ± 3.1, p = 0.54), parity (0.46 ± 0.09 and 0.58 ± 0.09, p = 0.37), fibroid number (1.38 ± 0.6 and 1.46 ± 0.6, p = 0.53), and fibroid size (5.92 ± 1.62 cm vs. 5.94 ± 1.49 cm, p = 0.949). Of the patients who underwent LIM, 62% conceived within the study period compared with 56% in the control group ( p = 0.54). Pregnancy was achieved by ART in 44% of the patients of the LIM group and 30% in control group. There was no significant difference in pregnancy rates among the two groups regarding spontaneous pregnancy rate ( p = 0.332), nor in pregnancies obtained by ART with own eggs ( p = 0.146) and oocyte or embryo donation ( p = 0.821). The take home baby rate was 65% (20/31) in the LIM group and 61% (17/28) in the control group ( p = 0.7851). Both groups had similar rate of miscarriage ( p = 0.748). Patients 40 years old and over with symptomatic fibroid uterus who undergo LIM have similar subsequent fertility and obstetrical outcomes than women treated with medical management. LIM has no detrimental impact on future fertility in women 40 years old and over.

Surgical Treatment of Multiple Parasitic Leiomyomas 14 Years after Laparoscopic Myomectomy Utilizing Power Morcellation

Study Objective To describe a unique case-presentation and demonstrate the surgical technique used for complete excision of multiple parasitic leiomyomas 14 years after history of power morcellation. Design Video of case-presentation Setting Academic hospital Patients or Participants Single surgical patient Interventions Surgical technique used for removal of multiple parasitic leiomyomas Measurements and Main Results A 43-year-old woman presented with a symptomatic enlarged fibroid uterus, abnormal uterine bleeding, and pelvic pain 14 years after laparoscopic myomectomy using power morcellation. Diagnostic imaging revealed pelvic masses most consistent with multiple uterine fibroids with predominant large posterior pedunculated fibroid. She was scheduled for total laparoscopic hysterectomy and bilateral salpingectomy. Intraoperatively, she was found to have multiple parasitic leiomyomas throughout the abdomen and pelvis which included the abdominal wall, small bowel mesentery, and colon. Complete laparoscopic excision of all leiomyomas was performed without complication. Histopathology confirmed diagnosis of benign leiomyomata uteri. Conclusion Parasitic leiomyomas are a rare, late sequelae of laparoscopic myomectomy with power morcellation. Initial diagnostic imaging may be misleading; therefore, surgical excision is warranted for diagnosis and treatment. Laparoscopic excision of multiple parasitic myomas can be performed safely and is considered definitive treatment. To describe a unique case-presentation and demonstrate the surgical technique used for complete excision of multiple parasitic leiomyomas 14 years after history of power morcellation. Video of case-presentation Academic hospital Single surgical patient Surgical technique used for removal of multiple parasitic leiomyomas A 43-year-old woman presented with a symptomatic enlarged fibroid uterus, abnormal uterine bleeding, and pelvic pain 14 years after laparoscopic myomectomy using power morcellation. Diagnostic imaging revealed pelvic masses most consistent with multiple uterine fibroids with predominant large posterior pedunculated fibroid. She was scheduled for total laparoscopic hysterectomy and bilateral salpingectomy. Intraoperatively, she was found to have multiple parasitic leiomyomas throughout the abdomen and pelvis which included the abdominal wall, small bowel mesentery, and colon. Complete laparoscopic excision of all leiomyomas was performed without complication. Histopathology confirmed diagnosis of benign leiomyomata uteri. Parasitic leiomyomas are a rare, late sequelae of laparoscopic myomectomy with power morcellation. Initial diagnostic imaging may be misleading; therefore, surgical excision is warranted for diagnosis and treatment. Laparoscopic excision of multiple parasitic myomas can be performed safely and is considered definitive treatment.

A Stepwise Approach to Broad Ligament Fibroids

Study Objective To demonstrate a stepwise laparoscopic approach to patients with broad ligament fibroids. Design N/A Setting Patient with a broad ligament fibroid undergoing total laparoscopic hysterectomy in a community hospital. Patients or Participants The patient is a 48-year-old female with a symptomatic fibroid uterus undergoing definitive surgical management with laparoscopic hysterectomy. Interventions The anatomically normal side of the hysterectomy was completed first. On the affected side, the uterine artery was ligated at its origin. The ureter was mobilized to allow safe dissection of the fibroid out of the pelvic side wall and completion of the hysterectomy. Measurements and Main Results N/A Conclusion Having a framework approach for patients with broad ligament fibroids enhances the safety and success of managing uncommon anatomic variants.

A Case of Benign Extrauterine Leiomyomatosis

Study Objective: To demonstrate the use of laparoscopy in a complex case of benign extrauterine leiomyomatosis. Design: Case report. Setting: Operating room at an academic hospital. Patient in dorsal lithotomy position. Patients or Participants: 46yo G0 with symptomatic fibroid uterus presenting for definitive management after failed laparoscopic myomectomy and uterine fibroid embolization. Interventions: Laparoscopic total hysterectomy, bilateral salpingectomy, removal of extrauterine fibroids. Measurements and Main Results: Outcomes evaluated included surgical time, EBL, length of stay in hospital, surgical complications, intraoperative and postoperative complications, pathology. EBL for the case was 50cc. Operative time was 5 hours. Final pathology was benign smooth muscle with degenerative changes. Total stay in the hospital was zero days. There were no intraoperative or postoperative complications. Conclusion: Laparoscopic removal of benign extrauterine leiomyomatosis resulted in improved outcomes as laparoscopy proved essential for adequate visualization. Additionally, patient was discharged on day of surgery without intraoperative or postoperative complications.

Primary Biphasic Peritoneal Mesothelioma Encountered During Myomectomy for Symptomatic Fibroid Uterus

Abstract Background: Malignant mesothelioma (MM) is an aggressive neoplasm whose pathogenesis is conventionally associated with occupational and environmental respiratory exposure to asbestos. MM a...

The impact of uterine artery embolisation on fibroid volume at 43.6 months in women with symptomatic fibroids at a tertiary-level hospital

Background. Symptomatic uterine fibroids have a significant impact on women’s health. Surgical intervention (myomectomy and hysterectomy) has been the mainstay of treatment. Women living with symptomatic uterine fibroids contribute significantly to a growing waiting list for surgery in South African public hospitals. Uterine artery embolisation (UAE) is a newer treatment option and has shown to be a minimally invasive, safe and effective alternative to surgery for such women. Objective. To evaluate the efficacy of UAE in women with symptomatic fibroid uterus. Methods. A prospective, observational, single-centre study of 51 women with symptomatic fibroid uterus who underwent UAE at Steve Biko Academic Hospital from February 2007 to November 2012. Results. A total of 51 women underwent UAE, 3 of whom were lost to follow-up. The remaining 48 women were followed for a mean duration of 43.6 months. There was a statistically significant reduction in the mean uterine and dominant myoma volumes, as well as improvement in the haemoglobin levels ( p =0.001). The mean uterine and dominant fibroid volume reductions were 38% and 58%, respectively. Minor complications were reported in 19% of the women (fever, post-embolisation syndrome and vaginal fibroid passage were frequently reported complications). Reintervention (hysterectomy and gonadotropin-releasing hormone analogue use) was required in 35% of women. Conclusion. UAE has a good clinical effect on fibroid volume reduction. It is a treatment option that can be considered prior to major surgery in a select group of women with symptomatic fibroid uterus.

Bipolar vessel-sealing devices in laparoscopic hysterectomies: a multicenter randomized controlled clinical trial.

To compare operating time and blood loss in patients undergoing total laparoscopic hysterectomies (TLH) for benign conditions with either the Marseal™ IQ 5mm (MS) or the Ligasure™ 5mm (LS) vessel-sealing device. A randomized controlled clinical trial (RCT) in two German gynecology departments. 74 patients scheduled to undergo TLH for a symptomatic fibroid uterus, adenomyosis or severe meno-metrorrhagia. Patients were randomized to receive a TLH with either the MS or the LS device. 27 variables were prospectively collected to address potential confounding issues. Operating time, defined as the time period between the first (round ligament dissection) and the last (uterine vessels sealing) use of the device, estimated and calculated intraoperative blood loss. The mean operating time (95% confidence interval, CI) was 22.7min (95% CI 17.6-27.7) for LS and 26.4min (95% CI 20-32.8) for the MS device (p=.89). The estimated intraoperative blood loss was 164ml (95% CI 110-217) for LS and 160ml (95% CI 116-203) for the MS device (p=.36). The multivariate analyses accounting for BMI, endometriosis, uterine weight and appearance of fibroids did not reveal any significant effect of the type of device used on operating time and estimated blood loss. In this RCT, both devices provided reliable and effective sealing and dissection. The reusable MS showed non-inferiority against the disposable LS device with regard to operating time and estimated intraoperative blood loss.

Pubertal Menorrhagia: Evaluation and Management

Background: Puberty menorrhagia is a common gynecological problem. Polycystic Ovary Syndrome (PCOS) is one of the most common endocrine disorders in adolescent and adult women and importantly has both reproductive and metabolic consequences. . It is challenging to make a diagnosis during the 1-2 years following menarche because normal pubertal changes can mimic features of PCOS. Aims: To determine the cause of puberty menorrhagia and evaluate the efficacy of medical management. Materials and Methods This is a prospective observational study included 48 patients who presented with menorrhagic cycles in the pubertal age group to Princess Esra Hospital, DCMS from January 2013 to December 2013. Each case was assessed by thorough history, physical examination and relevant laboratory investigations. Results: In 28 patients immaturity of hypothalamic pituitary ovarian endometrial axis was considered to be the cause as their ultrasound and hormonal assays were normal. 10 had PCOS, 3 had hypothyroidism, 4 had tuberculosis, 1 patient had thrombocytopenia, 2 patients had symptomatic fibroid uterus. Blood and its components were given to 8 patients. Conclusions: Puberty menorrhagia is a distressing condition which can lead to severe complications and may require blood transfusion. Most of the cases are due to anovulatory cycles with immaturity of the hypothalamo-pitutuary-ovarian-endometrial axis. The current epidemic of childhood obesity may increase the symptoms of polycystic ovarian disease and underscores the importance of its early and accurate diagnosis with emphasis on lifestyle modification. Key-words: Pubertal Menorrhagia, Medical Management, Prospective study

English

OBJECTIVES: To determine the causes of puberty menorrhagia and to evaluate the efficacy of medical management. MATERIALS AND METHODS: This is a prospective observational study included 48 patients who presented with menorrhagic cycles in the pubertal age group to Princess Esra Hospital, DCMS from January 2013 to December 2013.Each case was assessed by thorogh history, physical examination and relevant laboratory investigations. RESULTS: In 28 patients immaturity of hypothalamic pitutuary ovarian endometrial axis was considered to be the cause as their ultrasound and hormonal assays were normal. 10 had PCOS, 3 had hypothyroidsm, 4 had tuberculosis, 1 patient had thrombocytopenia, 2 patients had symptomatic fibroid uterus. Blood and its components were given to 8 patients. CONCLUSION: Puberty menorrhagia is a distressing condition which can lead to severe complications and may require blood transfusion. Most of the cases are due to anovulatory cycles with immaturity of the hypothalamo - pitutuary - ovarian - endometrial axis. The current epidemic of childhood obesity may increase the symptoms of polycystic ovarian disease and underscores the importance of its early and accurate diagnosis with emphasis on lifestyle modification.

An audit of indications, complications, and justification of hysterectomies at a teaching hospital in India.

Objective. Aim of this audit was to analyze indications, complications, and correlation of preoperative diagnosis with final histopathology report of all hysterectomies, performed in a premier teaching hospital. Methods. Present study involved all patients who underwent hysterectomy at a premier university hospital in Southern India, in one year (from 1 January, 2012, to 31 December, 2012). Results. Most common surgical approach was abdominal (74.7%), followed by vaginal (17.8%), and laparoscopic (6.6%) hysterectomy. Most common indication for hysterectomy was symptomatic fibroid uterus (39.9%), followed by uterovaginal prolapse (16.3%). Overall complication rate was 8.5%. Around 84% had the same pathology as suspected preoperatively. Only 6 (5 with preoperative diagnosis of abnormal uterine bleeding and one with high grade premalignant cervical lesion) had no significant pathology in their hysterectomy specimen. Conclusion. Hysterectomy is used commonly to improve the quality of life; however at times it is a lifesaving procedure. As any surgical procedure is associated with a risk of complications, the indication should be carefully evaluated. With the emergence of many conservative approaches to deal with benign gynecological conditions, it is prudent to discuss available options with the patient before taking a direct decision of surgically removing her uterus.

Perforation of Transverse Colon: A Catastrophic Complication of Uterine Artery Embolization for Fibroids

We report a case of a 43-year-old woman who underwent uterine artery embolization (UAE) for a symptomatic large fibroid uterus and had spontaneous perforation of the transverse colon 3months after embolisation with near-fatal consequences. We believe this is the first reported case in the literature of this serious complication of UAE. We briefly review the literature on bowel complications after UAE and discuss lessons to be learned regarding patient selection and postprocedure follow-up.

Meet Editorial Board Member Mina Karamshi

100 My name is Mina Karamshi and I work at the Royal Free Hospital in Hampstead, London (United Kingdom), as a Specialist Sister within the radiology department. My job comprises of two roles. My first and predominant role (for 3 days a week) is specializing in the role of uterine artery embolization for patients with a symptomatic fibroid uterus. I work independently and autonomously in carrying out their consultations, organizing their blood tests, their magnetic resonance imaging scans, hysteroscopies and all other necessary investigations (all under the supervision of my consultant radiologist). Therefore overall coordinating and planning their procedure from start to finish and being the key point of contact for these patients. I scrub for their procedure and jointly discharge them from