Sheffield, United Kingdom
Sheffield, United Kingdom

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Lashen H.,University of Sheffield | Jones G.L.,University of Sheffield | Duru C.,University of Sheffield | Pitsillides C.,York District Hospital | And 3 more authors.
European Journal of Gastroenterology and Hepatology | Year: 2013

BACKGROUND AND AIM: On the basis of retrospective studies, hysterectomy has been considered a risk factor for functional bowel disorders. The aim of this study was to prospectively evaluate the patients' bowel function and general health-related quality of life (QoL) before and after hysterectomy. Our hypothesis was that hysterectomy in properly selected patients can impact positively on the patients' self-reporting of their general health and bowel function. MATERIALS AND METHODS: A prospective longitudinal observational study was conducted in a university-based teaching hospital. Eighty-five patients who were scheduled for total abdominal hysterectomy for a nonmalignant cause completed the study. The main outcome measure was the patient's perception of her bowel function, which was assessed preoperatively and at 6, 12, 26 and 52 weeks postoperatively using the gastrointestinal quality of life questionnaire. The patient's general health was also assessed using a generic general health questionnaire (EQ5D and EQVAS). The effect of time on change in questionnaire score was assessed using mixed model repeated measures at a significance level of 0.05. RESULTS: The scores in the three questionnaires declined significantly at 6 weeks postoperatively as compared with those obtained preoperatively. However, there was a subsequent increase in the scores up to 12 months postoperatively. Smoking and use of laxative were identified as potential confounding variables. CONCLUSION: Apart from a transient negative effect, total abdominal hysterectomy improves the patient's gastrointestinal-related QoL, probably as part of general improvement in their QoL. © 2013 Wolters Kluwer Health | Lippincott Williams and Wilkins.


Jha S.,Sheffield Teaching Hospitals NHS Foundation Trust | Jha S.,Sheffield Teaching Hospitals NHSFT | Strelley K.,Sheffield Teaching Hospitals NHS Foundation Trust | Radley S.,Sheffield Teaching Hospitals NHS Foundation Trust
International Urogynecology Journal and Pelvic Floor Dysfunction | Year: 2012

Introduction and hypothesis: This study aimed to establish the prevalence of urinary leakage during intercourse, the extent to which urinary leakage impacts on sex life and the correlation between different urodynamic diagnosis and coital leakage. Methods: Four hundred eighty women attending between 1 January 2006 and December 2010 with urinary incontinence and subsequently undergoing urodynamic assessment were included. Data were collected as part of routine clinical care using the electronic Pelvic floor Assessment Questionnaire and correlated with urodynamic findings. Results: Sixty percent of women with urinary incontinence reported leakage during intercourse. Overall quality of life in women with urinary incontinence was strongly correlated to the impact of urinary symptoms on sex life. Parameters of sexual function were no different in women with different urodynamic diagnosis. Conclusion: Worsening urinary incontinence has a deleterious effect on sexual function. Urodynamic diagnosis does not correlate with the nature of underlying sexual problems, orgasm or penetration incontinence. © The International Urogynecological Association 2012.


Lobo M.D.,British Hypertension Society | Lobo M.D.,Queen Mary, University of London | Lobo M.D.,Barts Health NHS Trust | De Belder M.A.,James Cook University | And 26 more authors.
Heart | Year: 2015

Resistant hypertension continues to pose a major challenge to clinicians worldwide and has serious implications for patients who are at increased risk of cardiovascular morbidity and mortality with this diagnosis. Pharmacological therapy for resistant hypertension follows guidelines-based regimens although there is surprisingly scant evidence for beneficial outcomes using additional drug treatment after three antihypertensives have failed to achieve target blood pressure. Recently there has been considerable interest in the use of endoluminal renal denervation as an interventional technique to achieve renal nerve ablation and lower blood pressure. Although initial clinical trials of renal denervation in patients with resistant hypertension demonstrated encouraging office blood pressure reduction, a large randomised control trial (Symplicity HTN-3) with a sham-control limb, failed to meet its primary efficacy end point. The trial however was subject to a number of flaws which must be taken into consideration in interpreting the final results. Moreover a substantial body of evidence from non-randomised smaller trials does suggest that renal denervation may have an important role in the management of hypertension and other disease states characterised by overactivation of the sympathetic nervous system. The Joint UK Societies does not recommend the use of renal denervation for treatment of resistant hypertension in routine clinical practice but remains committed to supporting research activity in this field. A number of research strategies are identified and much that can be improved upon to ensure better design and conduct of future randomised studies.


Ammembal M.K.,Sheffield Teaching Hospitals NHSFT | Radley S.C.,Sheffield Teaching Hospitals NHSFT
Obstetrics, Gynaecology and Reproductive Medicine | Year: 2010

Traditional surgical repair for pelvic organ prolapse may be associated with a high recurrence rate. Mesh is being used increasingly to replace damaged endo-pelvic fascia, in an attempt to reduce recurrence. Polypropylene mesh is currently preferred over biological and synthetic absorbable meshes, aiming to reduce failure. Mesh may be placed abdominally (sacro-colpopexy) or vaginally to correct prolapse. Whilst sacro-colpopexy is a well-established procedure for the correction of vault prolapse, there is a lack of strong evidence of safety and efficacy for vaginal placement of mesh. The majority of reported complications related to mesh are minor though occasionally severe complications arise. The management of complications can be difficult, particularly when experience and evidence are lacking. Guidelines suggest that vaginal mesh repairs should only be performed by surgeons with training and expertise, with special arrangements for clinical governance, consent, audit and research. © 2010.

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