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Urogynecology: Evidence-Based Clinical Practice PDF

267 Pages·2022·6.866 MB·English
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Urogynecology Evidence-Based Clinical Practice Kate H. Moore Third Edition 123 Urogynecology Kate H. Moore Urogynecology Evidence-Based Clinical Practice Third Edition Kate H. Moore Department of Urogynaecology St George Hospital, University of New South Wales Sydney, NSW, Australia ISBN 978-3-030-93366-1 ISBN 978-3-030-93367-8 (eBook) https://doi.org/10.1007/978-3-030-93367-8 © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2013, 2022 This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of pub- lication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland Contents 1 Taking the History .............................. 1 History Taking for Urinary Incontinence ........... 1 Nonincontinent Symptoms of Storage Disorders: Frequency, Urgency, and Nocturia. . . . . . . . . . . . . 3 The Bladder Chart .............................. 4 Other Types of Leakage .......................... 5 How Bad Is the Problem? ........................ 5 History of Voiding Difficulty ...................... 7 History of Prolapse .............................. 8 History Taking for Fecal Incontinence/Obstructive Defecation ................................ 8 Symptoms of Obstructive Defecation .............. 9 Assessing Previous Surgical History in Relation to Urinary Incontinence ....................... 10 Important Previous Medical History ............... 11 History Taking for Dyspareunia ................... 12 History Taking for Recurrent Cystitis .............. 12 History Taking for Painful Bladder Syndrome/ Interstitial Cystitis (IC) ..................... 13 History Taking for Mesh Pain/Complications ........ 13 History of Drug Therapy That May Facilitate Urinary Incontinence ....................... 14 General Assessment of the Patient in Relation to Urogynecology ............................. 15 2 Physical Examination ............................ 17 Examine the Abdomen .......................... 17 Inspect the Vulva ............................... 18 Elicit a “Stress Leak” ............................ 19 v vi Contents Bivalve and Sim’s Speculum Examination .......... 20 POPQ Scoring System of Prolapse ................. 21 Perform a Bimanual Examination and Palpate Vaginal Walls/Urethra ....................... 24 Assess the Pelvic Floor Muscle Contraction Strength: Oxford Score ...................... 24 Rectal Examination/Neurological Examination ...... 25 Overview of Examination for Mesh Complications/ Pain ...................................... 27 References ..................................... 27 3 How to Manage the Patient After History and Examination ................................ 29 First, Treat Precipitating Factors ................... 29 Second, Obtain All Relevant Old Notes ............ 30 Third, Begin a Basic Management Program for Urinary Incontinence .................... 30 If Prolapse Is Present ............................ 31 If Anal Incontinence Is Present ................... 31 If Recurrent Cystitis Is the Complaint. . . . . . . . . . . . . . 32 If Painful Bladder Syndrome Is Suspected .......... 32 Explaining the Situation to the Patient ............. 33 4 How to Conduct Urodynamic Studies: Essentials of a Good Urodynamic Report .................... 35 Who Needs Urodynamic Testing? ................. 35 Different Forms of Urodynamic Studies ............ 36 Practical Advice About How to Perform Urodynamic Studies ........................ 38 General Clinical Aspects ......................... 39 Explaining the Test to the Patient ................. 40 Uroflowmetry .................................. 40 Preparing the Patient for Cystometry .............. 43 Twin Channel Cystometry ........................ 45 Urodynamic Diagnoses Available from the Filling Phase ............................... 46 Videourodynamic Testing ........................ 50 “Occult” Stress Incontinence ..................... 54 Ultrasound ..................................... 54 Contents vii Voiding Cystometry ............................. 56 Diagnoses Made After Voiding Cystometry ......... 57 Special Urodynamic Tests ........................ 59 Urethral Pressure Profilometry ................. 59 Abdominal or Valsalva Leak Point Pressure Test . . . . . . . . . . . . . . . . . . . . . 61 MRI and 3-Dimensional Ultrasound tests for Urethral Diverticulum ........... 61 Note Regarding Diagnostic Test for Vesicovaginal Fistulae . . . . . . . . . . . . . . . . . . 61 Example of Case History and Full Urodynamic Report, with Management ................... 62 Urodynamic Result ............................. 63 Comments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Diagnosis: Marked Detrusor Overactivity (DO) with Mild Degree of Obstruction; Mild Stress Incontinence: Management .................. 65 Conclusions .................................... 65 References ..................................... 65 5 Outcome Measures Used to Assess Response ....... 67 Introduction .................................... 67 Tests That Measure Patient’s Symptoms ............ 69 Tests That Quantify Patients’ Symptoms ............ 71 Bladder Chart .................................. 71 The Pad Test ................................... 73 The “Cough Stress Test” ......................... 75 Tests That Measure Anatomical and Functional Observations by Doctors .................... 76 Quality of Life for Incontinence ................... 76 Quality of Life Tests for Prolapse and Sexual Function: Why Do We Need Them? ........... 76 Is There a Test That Combines Incontinence, Prolapse, Bowel, and Sexual Function? ........ 78 Socioeconomic Evaluation ....................... 78 Conclusions .................................... 79 References ..................................... 79 viii Contents 6 Conservative Therapy of Stress Incontinence ....... 83 Managing Chronic Cough and Obesity ............ 83 Treatment of Constipation ...................... 85 Treatment of Postmenopausal Urogenital Atrophy: Benefit for Stress Incontinence .............. 86 Starting a Home-Based Pelvic Floor Muscle Training Program .......................... 87 The Role of the Nurse Continence Advisor ........ 89 Who Should Be Referred for Physiotherapy? ...... 91 What Does the Physiotherapist Do That Increases Efficacy? ........................ 93 The Efficacy of Physiotherapy Techniques ......... 96 Extracorporeal Electromagnetic Chair Stimulation Therapy .................................. 97 What to Do if Conservative Therapy Fails but Patient Does Not Want Surgery? ............ 98 Conclusions ................................... 100 References .................................... 101 7 Step-by-Step Guide to Treatment of Overactive Bladder (OAB)/Detrusor Overactivity ............ 105 Explain the Condition .......................... 105 Step-by-Step Guide to Bladder Training ........... 108 How Do Anticholinergic Drugs Work? ............ 112 Are Anticholinergic/Beta Mimetic Drugs Effective? .......................... 114 Role of Topical Estrogens ....................... 117 Alternative Therapies for Detrusor Overactivity .... 118 Electrostimulation ........................... 118 Transcutaneous Electro Stimulation .............. 118 Acupuncture .................................. 119 Electro-Acupuncture and Posterior Tibial Nerve Stimulation ............................... 119 Hypnotherapy ................................. 121 Extracorporeal Electromagnetic Stimulation Therapy .................................. 122 Cystodistention ................................ 122 What Is “Refractory” Detrusor Overactivity? ...... 123 Contents ix Botox Therapy (Botulinum Toxin A Injections). . . . . 124 Implantation of S3 Sacral Nerve Root Stimulator ... 125 Conclusions ................................... 126 References .................................... 127 8 Anal Incontinence and Disorders of Obstructive Defecation .................................... 133 Basic Physiology of Anal Continence and Defecation for the Gynecologist ......... 133 The Act of Defecation .......................... 137 Overview of Anal Incontinence .................. 138 Treatment of Anal Incontinence .................. 140 Overview of the Disorders of Obstructive Defecation ............................... 143 Constipation .................................. 143 Assessing the Causes of Constipation ............. 144 Overview of Treatment of Disorders of Defecation ............................. 147 Conclusions ................................... 148 A Note Regarding Obstetric Trauma as a Cause of Anal Incontinence ...................... 148 References .................................... 150 9 Surgery for Urodynamic Stress Incontinence ....... 153 Introduction ................................... 153 Bladder Neck Buttress .......................... 154 The Open Burch Colposuspension ................ 155 The Technique of Colposuspension ............... 157 Complications of Colposuspension ............... 159 Postoperative Management for Colposuspension ... 159 How to Manage Short-Term Voiding Difficulty ..... 160 How to Manage Long-Term Voiding Dysfunction ... 162 The Pubovaginal Sling .......................... 162 The Technique of Pubovaginal Sling .............. 164 Historical Note: Stamey Needle Suspension and Raz/Pereyra/Gittes Procedures .......... 165 Modified PuboVaginal Sling; The “Sling on a String” ................................. 167 Paravaginal Repair ............................. 167 x Contents Laparoscopic Colposuspension ................... 168 Overview of Mid-Urethral Polypropylene “Tape” Slings: TVT and TVTO ..................... 168 The Tension-Free Vaginal Tape (TVT) ............ 171 The Technique of TVT .......................... 171 Postoperative Instructions for Simple TVT ........ 173 Outcome Data for the TVT. . . . . . . . . . . . . . . . . . . . . . 174 The Transobturator Tape ........................ 175 TOT Groin Pain/Other Complications ............ 177 Overview re Mesh Complications after Mid Urethral Slings ............................ 178 A Word About “Mini-slings” ..................... 178 The Use of Bulking Agents for USI. . . . . . . . . . . . . . . 179 Conclusions ................................... 182 References .................................... 182 10 Management of Prolapse ........................ 187 Does the Patient with Prolapse “Need” Surgery? ... 187 Use of Ring Pessaries ........................... 188 Preoperative Evaluation of Risk Factors for Recurrence After Surgery .................. 192 Note re the POPQ “Stages” ..................... 192 Surgery for Cystocele ........................... 193 Paravaginal Defect Repair ....................... 196 Use of Mesh for Cystocele Repair ................ 196 What Is the Value of Manchester Repair/Retention of a Nonprolapsed Uterus? ................. 199 Further concepts re Uterine Preservation: Vaginal Sacrohysteropexy and Abdominal Hysteropexy .............................. 202 Preoperative Consent Discussion for Anterior Compartment Repairs ..................... 202 Surgery for Rectocele/Deficient Perineum ......... 203 Technique of Repair for Isolated Mid–Low Rectocele and Deficient Perineum ........... 204 Surgery for Enterocele .......................... 204 Vaginal Sacrospinous Fixation ................... 207

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