Urogynecology: Evidence-Based Clinical Practice

Description

This heavily revised third edition concisely covers the latest evidence-based treatment strategies for urinary incontinence and prolapse. Chapters cover methodologies relevant to continence procedures, prolapse management, and potential complications. New topics discussed include Colpocleisis, principles associated with managing Mesh complications and the Mirabegron mechanism. Urogynecology: Evidence-Based Clinical Practice 3rd Edition is a vital how-to guide, which is ideal for junior registrars assigned to work in a urogynecology department, as well as for those with no previous formal urogynecological training seeking to develop their understanding of the subject. Contents Chapter 1: Taking the History History Taking for Urinary Incontinence Nonincontinent Symptoms of Storage Disorders: Frequency, Urgency, and Nocturia The Bladder Chart Other Types of Leakage How Bad Is the Problem? History of Voiding Difficulty History of Prolapse History Taking for Fecal Incontinence/Obstructive Defecation Symptoms of Obstructive Defecation Assessing Previous Surgical History in Relation to Urinary Incontinence Important Previous Medical History History Taking for Dyspareunia History Taking for Recurrent Cystitis History Taking for Painful Bladder Syndrome/Interstitial Cystitis (IC) History Taking for Mesh Pain/Complications History of Drug Therapy That May Facilitate Urinary Incontinence General Assessment of the Patient in Relation to Urogynecology (Fig. 1.5) Chapter 2: Physical Examination Examine the Abdomen Inspect the Vulva Elicit a “Stress Leak” Bivalve and Sim’s Speculum Examination POPQ Scoring System of Prolapse Perform a Bimanual Examination and Palpate Vaginal Walls/Urethra Assess the Pelvic Floor Muscle Contraction Strength: Oxford Score Rectal Examination/Neurological Examination Overview of Examination for Mesh Complications/Pain References Chapter 3: How to Manage the Patient After History and Examination First, Treat Precipitating Factors Second, Obtain All Relevant Old Notes Third, Begin a Basic Management Program for Urinary Incontinence If Prolapse Is Present If Anal Incontinence Is Present If Recurrent Cystitis Is the Complaint If Painful Bladder Syndrome Is Suspected Explaining the Situation to the Patient Chapter 4: How to Conduct Urodynamic Studies: Essentials of a Good Urodynamic Report Who Needs Urodynamic Testing? Different Forms of Urodynamic Studies Practical Advice About How to Perform Urodynamic Studies General Clinical Aspects Explaining the Test to the Patient Uroflowmetry Preparing the Patient for Cystometry Twin Channel Cystometry Urodynamic Diagnoses Available from the Filling Phase Videourodynamic Testing “Occult” Stress Incontinence Ultrasound Voiding Cystometry Diagnoses Made After Voiding Cystometry Special Urodynamic Tests Urethral Pressure Profilometry Abdominal or Valsalva Leak Point Pressure Test MRI and 3-Dimensional Ultrasound tests for Urethral Diverticulum Note Regarding Diagnostic Test for Vesicovaginal Fistulae Example of Case History and Full Urodynamic Report, with Management Urodynamic Result Comments Diagnosis: Marked Detrusor Overactivity (DO) with Mild Degree of Obstruction; Mild Stress Incontinence: Management Conclusions References Chapter 5: Outcome Measures Used to Assess Response Introduction Tests That Measure Patient’s Symptoms Tests That Quantify Patients’ Symptoms Bladder Chart The Pad Test The “Cough Stress Test” Tests That Measure Anatomical and Functional Observations by Doctors Quality of Life for Incontinence Quality of Life Tests for Prolapse and Sexual Function: Why Do We Need Them? Is There a Test That Combines Incontinence, Prolapse, Bowel, and Sexual Function? Socioeconomic Evaluation Conclusions References Chapter 6: Conservative Therapy of Stress Incontinence Managing Chronic Cough and Obesity Treatment of Constipation Treatment of Postmenopausal Urogenital Atrophy: Benefit for Stress Incontinence Starting a Home-Based Pelvic Floor Muscle Training Program The Role of the Nurse Continence Advisor Who Should Be Referred for Physiotherapy? What Does the Physiotherapist Do That Increases Efficacy? The Efficacy of Physiotherapy Techniques Extracorporeal Electromagnetic Chair Stimulation Therapy What to Do if Conservative Therapy Fails but Patient Does Not Want Surgery? Conclusions References Chapter 7: Step-by-Step Guide to Treatment of Overactive Bladder (OAB)/Detrusor Overactivity Explain the Condition Step-by-Step Guide to Bladder Training How Do Anticholinergic Drugs Work? Are Anticholinergic/Beta Mimetic Drugs Effective? Role of Topical Estrogens Alternative Therapies for Detrusor Overactivity Electrostimulation Transcutaneous Electro Stimulation Acupuncture Electro-Acupuncture and Posterior Tibial Nerve Stimulation Hypnotherapy Extracorporeal Electromagnetic Stimulation Therapy Cystodistention What Is “Refractory” Detrusor Overactivity? Botox Therapy (Botulinum Toxin A Injections) Implantation of S3 Sacral Nerve Root Stimulator Conclusions References Chapter 8: Anal Incontinence and Disorders of Obstructive Defecation Basic Physiology of Anal Continence and Defecation for the Gynecologist The Act of Defecation Overview of Anal Incontinence Treatment of Anal Incontinence Overview of the Disorders of Obstructive Defecation Constipation Assessing the Causes of Constipation Overview of Treatment of Disorders of Defecation Conclusions A Note Regarding Obstetric Trauma as a Cause of Anal Incontinence References Chapter 9: Surgery for Urodynamic Stress Incontinence Introduction Bladder Neck Buttress The Open Burch Colposuspension The Technique of Colposuspension Complications of Colposuspension Postoperative Management for Colposuspension How to Manage Short-Term Voiding Difficulty How to Manage Long-Term Voiding Dysfunction The Pubovaginal Sling The Technique of Pubovaginal Sling Historical Note: Stamey Needle Suspension and Raz/Pereyra/Gittes Procedures Modified PuboVaginal Sling; The “Sling on a String” Paravaginal Repair Laparoscopic Colposuspension Overview of Mid-Urethral Polypropylene “Tape” Slings: TVT and TVTO The Tension-Free Vaginal Tape (TVT) The Technique of TVT Postoperative Instructions for Simple TVT Outcome Data for the TVT The Transobturator Tape TOT Groin Pain/Other Complications Overview re Mesh Complications after Mid Urethral Slings A Word About “Mini-slings” The Use of Bulking Agents for USI Conclusions References Chapter 10: Management of Prolapse Does the Patient with Prolapse “Need” Surgery? Use of Ring Pessaries Preoperative Evaluation of Risk Factors for Recurrence After Surgery Note re the POPQ “Stages” Surgery for Cystocele Paravaginal Defect Repair Use of Mesh for Cystocele Repair What Is the Value of Manchester Repair/Retention of a Nonprolapsed Uterus? Further concepts re Uterine Preservation: Vaginal Sacrohysteropexy and Abdominal Hysteropexy Preoperative Consent Discussion for Anterior Compartment Repairs Surgery for Rectocele/Deficient Perineum Technique of Repair for Isolated Mid–Low Rectocele and Deficient Perineum Surgery for Enterocele Vaginal Sacrospinous Fixation Preoperative Consent Discussion for Vaginal Sacrospinous Fixation A Note re McCall’s Culdoplasty/Uterosacral Ligament Plication Abdominal Sacrocolpopexy Preoperative Consent Discussion for Abdominal Sacrocolpopexy Colpocleisis Conclusions References Chapter 11: Recurrent Bacterial Cystitis in Women Guide to Management of Recurrent UTI: Start with a Proper History and Exam Investigations for Recurrent UTI Initial Treatment At the Second Visit The Problem of Multidrug Resistance, Need for Antibiotic Stewardship, and the Possible Benefits of Nonantibiotic Prophylaxis What to Look for on Cystoscopy? References Chapter 12: Interstitial Cystitis How to Diagnose Interstitial Cystitis (IC) Prevalence/Epidemiology Etiology Treatment Bladder Pain Syndrome References Chapter 13: Overview of Management of Mesh ­Pain/Complications Introduction History Taking for Mesh Pain/Complications Physical Examination for Mesh Complications/Pain Investigations Explain Findings to the Patient Understanding the Mesh Problem: Vaginal Mesh for Prolapse Vs. Midurethral Slings Management of Mesh Problems Controversy Surrounding Partial Versus Complete Mesh Removal Risk of Recurrent Stress Incontinence Conclusions References Index