Spire Clinic, Cheltenham Spa

Now Operating out of the Spire Clinic, Cheltenham Spa.

Mr Philip Kaloo has been invited by the Spire Private Hospital to join this new and innovative multi-speciality clinic in central Cheltenham. Clinic appointments are available during lunchtimes and out-of-hours.

the-spire-clinic-cheltenham-front-entrance

The Spire Clinic Cheltenham (Central Cheltenham -1 minute walk from Cavendish House)

Hysterectomy Safety

Laparoscopic hysterectomy safer than Open (Abdominal) hysterectomy

Abdominal versus laparoscopic hysterectomies for benign diseases: evaluation of morbidity and mortality among 465,798 cases
Wiser A, Holcroft C, Tulandi T, Abenhaim H
Gynaecological Surgery (2013) 10:117-122

A very large Canadian study looked at 465,798 women having an open (Abdominal) or laparoscopic hysterectomy over the period 2002-2008. The study showed significantly fewer bowel and bladder injuries, fewer blood transfusions, DVTs and PE’s and a lower risk of death in the laparoscopic hysterectomy.

Ovarian Masses in Premenopause

Management of Suspected Ovarian Masses in Premenopausal Women

Royal College of Obstetricians and Gynaecologists Guidelines for the “Management of Suspected Ovarian Masses in Premenopausal Women”

Mr Kaloo is the primary author of this National Guideline produced by the Royal College of Obstetricians and Gynaecologists.

Implications for practice:
The underlying management rationale is to minimise patient morbidity by:

  • conservative management where possible
  • use of laparoscopic techniques where appropriate, thus avoiding laparotomy where possible
  • referral to a gynaecological oncologist where appropriate.

Laparoscopic management of presumed benign ovarian cysts should be undertaken by a surgeon with suitable experience and appropriate equipment, whenever local facilities permit.

If surgery is indicated, a laparoscopic approach is generally considered to be the gold standard for the management of benign ovarian masses. Laparoscopic management is also cost-effective because of the associated earlier discharge from hospital and less pain.

Women who are symptom free with small (less than 50 mm diameter) simple ovarian cysts generally do not require follow-up as these cysts are very likely to be physiological and almost always resolve within 3 menstrual cycles. Women with simple ovarian cysts of 50–70 mm in diameter should have yearly ultrasound follow-up and those with larger simple cysts should be considered for either further imaging (MRI) or surgical intervention.

Publications:

Management of Suspected Ovarian Masses in Premenopausal Women

Cervical Cancer Screening

Cervical cancer screening fears delay testing, says trust

Confusion and fear about cervical cancer and testing is putting women’s lives at risk, research has found. A survey found 36% of women aged 25-29 questioned had failed to attend a test in 2012-13, with some citing worries about pain or embarrassment as factors.

Jo’s Cervical Cancer Trust chief executive Robert Music said “Currently just under 3,000 UK women are diagnosed each year and if those who are delaying their screening continue to misunderstand the disease and how it can be prevented, then we are concerned that screening uptake will continue to fall and incidence will start to rise.”

Further resources

www.bbc.co.uk/news/uk-wales-25802641

www.jostrust.org.uk/

Endometriosis doubles risk of ovarian cancer

A large study has for the first time shown an increased risk of the commonest type of ovarian cancer (low grade serous type) in women with a history of endometriosis.

13 226 controls and 7911 women with invasive ovarian cancer were included in this analysis. The risk of having had a diagnosis of endometriosis in the past doubled the risk of having low grade serous ovarian cancer and tripled the risk of clear cell ovarian cancer.

Implications for practice: Women with a history of endometriosis should be monitored more closely for ovarian cancer.

Reference: Pearce CL, Templeman C, Rossing MA, et al. on behalf of the Ovarian Cancer Association Consortium. Association between endometriosis and risk of histological subtypes of ovarian cancer: a pooled analysis of case-control studies. Lancet Oncol 2012;13:385-94.