History taking.-
Incontinence and Frequency, Urgency, Nocturia.- The Frequency Volume Char.- How bad is the problem? – assessing severity.- Voiding difficulty.- Prolapse.- Faecal Incontinence and Obstructive Defecation.- Surgical History.- Dyspareunia in relation to urogynaecology.-
Assessment of Mesh Pain/ complications.-
Recurrent bacterial cystitis.- Interstitial Cystitis/ Painful Bladder Syndrome.- History of Drug Therapy.-
General Assessment of Precipitating Factors.- Physical examination.-
Assess the abdomen.- Inspect the vulva.- Elicit a “stress leak”.- Speculum examination needs.- POPQ Scoring system of Prolapse.- Assess Pelvic Floor Muscle Contraction Strength – Oxford Score.-
How to assess vagina/ pelvis in Mesh Pain, overview.- Do all patients need a rectal examination?.- Screening neurological examination.- How to manage the patient after history and examination.- Explaining the situation to the patient.-
Treat precipitating factors.- Get old notes of any relevant surgery.- Begin basic management plan for incontinence/ prolapse/ UTI.- How to conduct and interpret urodynamic tests.- Who needs urodynamic testing?.- Different types of urodynamics.- Practical advice about how to perform urodynamic tests.- Uroflowmetry.- Twin channel cystometry.- Urodynamic diagnoses available from the filling phase.- Videourodynamics.- “Occult” stress incontinence.-
Ultrasound .- Voiding cystometry, diagnoses available after test.- Special tests: Urethral Pressure Profilometry and Leak Point Pressures.-
3D ultrasound and/or MRI.- Examples of reports – what do they mean?.- Outcome measures in assessing response to treatment.- Tests that measure patient’s symptoms.-
The ICIQ-SF, Wexner Scale.- Tests that quantify patients symptom.- Micturition chart, Frequency Volume Chart, Urinary Diary.- The Pad Test; 1 hour and 24 hour.- Quality of Life.- Economic evaluation.- Conservative therapy of USI.- Managing chronic cough and obesity.- Treatment of constipation.-
Treating postmenopausal urogenital atrophy .- 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?.-
The efficacy of physiotherapy techniques.- What if conservative therapy fails but patient does not want surgery? Rings.- Step by step guide to treatment of overactive bladder / detrusor overactivity.- Explain the condition – basic physiology review.- Step by step guide to bladder training.-
Need section on Nocturia treatment.- How do anticholinergic drugs work, how do we use them?.-
Mirabegron mechanism, effectiveness, risks.- Are these drugs effective? – need for long term therapy?.- Role of topical oestrogens in DO.- Alternative treatments.- TENS.- Acupuncture and SANS electro-acupunctur.- Hypnotherapy.- Electrostimulation and Extracorporeal Magnetic Stimulation.- Cystodistension.-
Clam cystoplasty.- Implantation of S3 Sacral Nerve Root Stimulator.- Botox Therapy.-
Intravesical Resiniferatoxin installation.- Faecal Incontinence and Disorders of Obstructive Defecation.- Basic Physiology of Anal Continence and Defecation for the Gynaecologist.-
Overview of Anal Incontinence Tests and Treatment.- Overview of the Disorders of Obstructive Defecation.- Constipation, Outlet Obstruction.-
Overview of Treatment of Disorders of Defecation.- Surgery for US.- Bladder neck buttress.- Colposuspension, lap versus open.- Preoperative consent discussion.- Postoperative convalescence.- Technique.- Postoperative management.- Short term voiding difficulty.- Long term voiding dysfunction.-
Abdominovaginal Sling, and “Sling on a String”.- Preoperative consent discussion.- Technique.- Historical note: Stamey/ Raz/Peyreyra/ Gittes procedures, Paravaginal repair.- Laparoscopic colposuspension.-
The retropubic TVT needs total revision.-
Preoperative consent discussion, risks.- Technique.- Postoperative instructions .-
The transobturator tape;recent awareness of increased risk versus benefit.- Use of bulking agents: GAX collagen, Macroplastique, Durasphere.- Management of Prolapse.- Non surgical management options.- Surgery for cystocoele: four techniques.- Outline of controversies.- What is the value of Manchester repair- technique.- Preoperative consent discussion for anterior compartment repair.-
Overview of the rationale for previous use of vaginal mesh in cystocoele.- Surgery for Rectocoele/ Deficient Perineum.- Outline of controversies.- Surgery for enterocoele.- Vaginal Sacrospinous Fixation technique.- Preoperative consent discussion, postop instructions/ issues.- Abdomino-sacro-colpopexy techniques.- Preoperative consent discussion, postop regime.- Uterine prolapse.-
Colpocleisis.-
Management of Mesh complications- basic principles.- Recurrent bacterial cystitis in wome.- Guide to Management.-
Investigations.-
Treatment.- Interstititial cystitis?.- How to diagnosis it.- Outline of aetiology.-
Treatment.