Surgical Gynaecology
Two minimally-invasive methods have been developed at St Mary’s for treating uterine fibroids, the commonest tumour in women and responsible for numerous gynaecological consultations and admissions. The first study of MR-guided percutaneous laser ablation demonstrated the technique was safe, effective, preserves fertility, reduces operative morbidity, and can be offered as a day case, thereby avoiding lengthy admissions and prolonged convalescence. As the only UK site with MR-compatible thermo-ablation equipment, we subsequently pioneered completely non-invasive MR-guided focussed ultrasound. Over the next five years we will continue to investigate GnRH agonist pre-treatment, which potentiates the thermo-ablation effect, to allow treatment of large fibroids. International interest has led to training and research collaborations with leading US (Harvard) and European centres.
At St Mary’s, Dr Vic Khullar established a tertiary referral service for lower urinary tract dysfunction, which affects 20% of women over 50-years-old and consumes 1-2% of the NHS budget. In addition to evaluating nursing advisors in community care to replace prolonged in-patient stays for bladder training, they established a “bench-to-bedside” research unit investigating mechanisms underlying detrusor instability; this led to discovery of the receptor basis for pathogenesis and treatment of detrusor over-activity, which affects one third of incontinent women. To pursue this, they will continue multicentre randomised studies to determine best practice for mixed incontinence.
