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Knowledge Area 15: Urogynaecology and Pelvic Floor Problems
Published in Rekha Wuntakal, Ziena Abdullah, Tony Hollingworth, Get Through MRCOG Part 1, 2020
Rekha Wuntakal, Ziena Abdullah, Tony Hollingworth
You are the in the urogynaecology clinic, and you are about to see a 56-year-old woman who complains of urge incontinence, frequency and nocturia. She does not complain of any haematuria and has no other symptoms. What is your initial investigation?CystoscopyPost-void residual measurementUltrasound of the kidneys, urinary tract and bladderUrine dipstickUrodynamics
Chronic Perineal Pain
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Giuseppe Chiarioni, William E. Whitehead
Epidemiology of pudendal neuralgia in the general population is unknown. The diagnosis is usually entertained in highly focused pelvic floor units or in specialised urogynaecology practices. It is considered a rare entity, but it may be over-diagnosed due to the co-morbidities associated with pudendal nerve dysfunction.16 Particularly controversial is its association with rectal pain, which will lead to a differential diagnosis of chronic proctalgia.16 In some clinics, all forms of pain accentuated by sitting may be considered as pudendal neuralgia.
Gynaecological history, examination and investigations
Published in Helen Bickerstaff, Louise C Kenny, Gynaecology, 2017
The external genitalia and surrounding skin, including the perianal area, are first inspected under a good light with the patient in the dorsal position, the hips flexed and abducted and knees flexed (Figure 2.2). The patient is asked to cough or bear down to enable signs of a prolapse or stress incontinence. Abnormal signs such as skin discolouration, lumps, scars from previous episiotomy, deficient perineum or prolapse (see Chapter 10, Urogynaecology and pelvic floor problems) are noted. Female genital mutilation (FGM) (see Chapter 13, Benign conditions of the vulva and vagina, psychosexual disorders and female genital mutilation) should be described.
Patient-reported goal achievements after pelvic floor muscle training versus pessary in women with pelvic organ prolapse. A randomised controlled trial
Published in Journal of Obstetrics and Gynaecology, 2023
Wongsakorn Limbutara, Suvit Bunyavejchevin, Purim Ruanphoo, Keerati Chiengthong
Studies with both short and long-term follow-ups have investigated the use of GAS to evaluate the success of pelvic floor treatment. Based on previously published work, GAS is well suited to evaluate pelvic organ prolapses treatment such as vaginal pessary treatment and surgical treatment in the urogynecology field (Elkadry et al.2003; Komesu et al.2008). Women who attain self-determined goals are likely to continue pessary use (Komesu et al.2008). Nevertheless, a direct comparison of patient-reported goal achievement between pelvic floor muscle training (PFMT) and vaginal pessary in a randomised controlled trial study is still lacking. As a result, the aim of the study was to assess the achievement of patient-reported goal achievements in POP participants receiving pelvic floor muscle training compared to vaginal pessary as a treatment of POP, to understand what patients genuinely hoped to achieve from both treatments. The patient-reported goal achievement results from this study might be useful for patient counselling and contribute additional information to the current literature.
The effects of gestational diabetes on lower urinary tract symptoms of pregnant women: a case-control study
Published in Journal of Obstetrics and Gynaecology, 2022
Adem Yavuz, Semra Kocaöz, Pınar Kara, Emre Destegül
Pregnant women who came to our hospital for routine prenatal follow-up and were at 28–42 weeks of gestation were included in the study. Women with (i) neurological disorders such as stroke, Parkinson’s disease, spinal cord injury and multiple sclerosis, (ii) urogynaecological malformation, (iii) urogynaecology surgery, (iv) renal disease, (v) urinary infection at the time of the study, and those that were (vi) unable to understand and answer questions and (vii) subjects who were unwilling to participate voluntarily in the study were excluded. Pregnant women with GDM were included in the case group of the study (n = 44). The control group consisted of pregnant women without GDM (n = 44). Pregnant women in case and control groups were recruited to the study consecutively, using convenience sampling. Case and control groups were matched in terms of age, working in an income-earning job, gestational week, caffeine-containing beverage consumption (cola, coffee, etc.), smoking, constipation, presence of chronic cough, and urinary complaints (defined as applying to a physician with urinary symptoms).
A rapid systematic review of postpartum bladder care guidelines and recommendations in the context of the COVID-19 pandemic
Published in Journal of Obstetrics and Gynaecology, 2022
Olga Divakova, Demetri Panayi, Zainab Khan, Stergios K. Doumouchtsis
This systematic rapid review was undertaken by a working group of CHORUS: An International Collaboration for Harmonising Outcomes, Research and Standards in Urogynaecology and Women’s Health (https://i-chorus.org/), aiming to identify national and international guidelines, and summarise available recommendations on postpartum bladder care that are relevant to women’s care and management that may be affected by practice challenges at the time of the COVID-19 pandemic. We reviewed postpartum bladder care guidelines and recommendations with a view to highlighting and proposing principles of safe clinical practice. CHORUS working groups have evaluated research as well as clinical practice standards (Durnea et al. 2018; Pergialiotis et al. 2018; Doumouchtsis et al. 2019; Ghai et al. 2019, 2020; Pape et al. 2019; de Mattos Lourenço et al. 2019a, 2019b, 2020; Nygaard et al. 2020; Rada et al. 2020) and more recently CHORUS has published a rapid systematic review on urogynecology care during the COVID-19 pandemic (Loganathan and Doumouchtsis 2021). Using a similar methodology we aimed to identify and evaluate current evidence related to bladder care in the postpartum period, given the gaps in evidence on optimal management in this field of clinical practice at a time of highly challenged practices and evolving adaptations.