Continence outcomes following partial excision of vaginal mesh exposure after mid-urethral tape insertion.

OBJECTIVE: To assess the incidence of recurrent stress urinary incontinence (SUI) following vaginal excision of exposed mid-urethral tape (MUT). STUDY DESIGN: This was a retrospective observational study in a tertiary urogynaecology unit of an inner city teaching hospital. The population consisted of 41 consecutive women seen with a vaginal mesh exposure following MUT insertion between 2000 and 2009, which failed to resolve with conservative measures. The primary outcome measure was the presence of symptoms of stress urinary incontinence following surgical excision of exposed mesh. RESULTS: The incidence of recurrent SUI following tape excision was 34.1%. Type of mid-urethral tape, menopausal status, and the time interval between tape insertion and excision were not found to be significantly associated with the risk of recurrent SUI. CONCLUSIONS: Over a third of women experience recurrent SUI after surgical management of vaginal mesh exposure following MUT insertion. Risk factors may be more comprehensively studied using prospectively collected cohorts.

Uterine artery embolization versus myomectomy: impact on quality of life--results of the FUME (Fibroids of the Uterus: Myomectomy versus Embolization) Trial.

PURPOSE: This study was designed to compare quality of life (QoL) outcomes after uterine artery embolization (UAE) or myomectomy. METHODS: Women with symptomatic fibroids diagnosed by ultrasound who wished to preserve their uterus were randomized to myomectomy (n=81) or UAE (n=82). Endpoints at 1 year were QoL measured by a validated questionnaire, hospital stay, rates of complications, and need for reintervention. RESULTS: UAE patients had shorter hospitalization (2 vs. 6 days, p<0.001). By 1 year postintervention, significant and equal improvements in QoL scores had occurred in both groups (myomectomy n=59; UAE n=61). There had been two (2.9%) major complications among UAE versus 6 (8%) among myomectomy patients (not significant). By 2 years, among UAE patients (n=57) there were eight (14.0%) reinterventions for inadequate symptom control compared with one (2.7%) among myomectomy patients (n=37). Half of the women who required hysterectomy had concomitant adenomyosis missed by US. CONCLUSIONS: UAE and myomectomy both result in significant and equal improvements in QoL. UAE allows a shorter hospital stay and fewer major complications but with a higher rate of reintervention.