Urogynecology: Evidence-Based Clinical Practice

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