Urogynecology: Evidence-Based Clinical Practice

267 Pages·2022·6.866 MB·English

by  Kate H. Moore

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
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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