Urogynecology: Evidence-Based Clinical Practice

Transcription

1 Urogynecology: Evidence-Based Clinical Practice

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3 Kate H. Moore Urogynecology: Evidence-Based Clinical Practice Second Edition

4 Kate H. Moore, MBBS, FRCOG, FRANZCOG, MD, CU Department Obstetrics & Gynaecology St George Hospital Kogarah New South Wales Australia ISBN ISBN (ebook) DOI / Springer London Heidelberg New York Dordrecht Library of Congress Control Number: Springer-Verlag London 2013 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, speci fi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on micro fi lms 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. Exempted from this legal reservation are brief excerpts in connection with reviews or scholarly analysis or material supplied speci fi cally for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work. Duplication of this publication or parts thereof is permitted only under the provisions of the Copyright Law of the Publisher s location, in its current version, and permission for use must always be obtained from Springer. Permissions for use may be obtained through RightsLink at the Copyright Clearance Center. Violations are liable to prosecution under the respective Copyright Law. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a speci fi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper Springer is part of Springer Science+Business Media (

5 Contents 1 Taking the History History Taking for Incontinent Women Incontinence Symptoms Nonincontinent Symptoms of Storage Disorders: Frequency, Urgency, and Nocturia The Frequency Volume Chart (FVC) Other Types of Leakage How Bad Is the Problem? History Taking for Voiding Difficulty History Taking for Prolapse History Taking for Fecal Incontinence Symptoms of Obstructive Defecation Assessing Previous Surgical History in Relation to Urinary Incontinence History Taking for Dyspareunia History Taking for Recurrent Bacterial Cystitis History Taking for Painful Bladder Syndrome/Interstitial Cystitis (IC) History of Drug Therapy That May Facilitate Urinary Incontinence General Assessment of the Patient in Relation to Urogynecology Physical Examination Examine the Abdomen Inspect the Vulva Elicit a Stress Leak v

6 vi Contents Speculum Examination Pass a Bivalve Speculum Pass a Sims Speculum POPQ Scoring System of Prolapse Perform a Bimanual Examination Assess the Pelvic Floor Muscle Contraction Strength: Oxford Score Do All Urogynecology Patients Need a Rectal Examination? Screening Neurological Examination References 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 Fourth, if Anal Incontinence Is Present Fifth, if Prolapse Symptoms Are Present If Associated Recurrent Bacterial Cystitis (Urinary Tract Infection, UTI) Is Present If Suprapubic Pain, with Severe Frequency, Urgency, and Nocturia, Is Present A Few Words About Explaining the Situation to the Patient Urinary Incontinence Anal Incontinence Prolapse 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 Calibration of the Equipment

7 Contents vii General Clinical Guidelines Explaining the Test to the Patient Uroflowmetry Performance of Cystometry Passing the Rectal Catheter Twin Channel Cystometry Urodynamic Diagnoses Available from the Filling Phase What Is Sensory Urgency, Now Termed Bladder Oversensitivity? Features of the Atonic Bladder During the Filling Phase Videourodynamics Videourodynamic Testing Value of VCU in Cystocele Occult Stress Incontinence Ultrasound Voiding Cystometry Diagnoses Made After Voiding Cystometry Special Urodynamic Tests Urethral Pressure Profilometry Abdominal or Valsalva Leak Point Pressure Test.. 57 Triple Lumen (Trantner) Catheter Test for Urethral Diverticulum, Now Replaced by MRI. 59 Note Regarding Diagnostic Tests for Vesicovaginal Fistulae Example of Report Case History, with Example of a Full Urodynamic Report, Illustrating Contribution of Urodynamic Studies to Management Urodynamic Result Comments Diagnosis: Marked Detrusor Overactivity (DO) with Mild Degree of Obstruction; Mild Stress Incontinence Management Conclusions References

8 viii Contents 5 Outcome Measures Used to Assess Response Introduction Tests That Measure Patient s Symptoms The Wexner Score for Fecal Incontinence Tests That Quantify Patients Symptoms Bladder Chart The Pad Test The One-Hour Pad Test The 24-Hour Pad 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 QOL Tests for Prolapse? Why Do We Need QOL Tests for Sexual Function? Socioeconomic Evaluation Conclusions References Conservative Therapy of Urodynamic Stress Incontinence Managing Chronic Cough and Obesity Treatment of Constipation Treatment of Postmenopausal Urogenital Atrophy Practical Advice for Patients 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

9 Contents ix 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 Drugs Effective? Role of Topical Estrogens Alternative Therapies for Detrusor Overactivity TENS (Transcutaneous Electrostimulation Therapy) Acupuncture SANS Electro-Acupuncture (Stoller Afferent Nerve Stimulator) Hypnotherapy Electrostimulation Extracorporeal Electromagnetic Stimulation Therapy Cystodistention Botox Therapy (Botulinum Toxin A Injections) Intravesical Resiniferatoxin (RTX) Installation Clam Cystoplasty Partial Detrusor Myomectomy Implantation of S3 Sacral Nerve Root Stimulator Conclusions References 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

10 x Contents A Note Regarding Obstetric Trauma as a Cause of Anal Incontinence References Surgery for Urodynamic Stress Incontinence Introduction Bladder Neck Buttress Colposuspension Preoperative Consent Discussion Postoperative Convalescence The Technique of Colposuspension Immediate Complications of Colposuspension Long-Term Complications of Colposuspension Postoperative Management for Colposuspension Double Voiding Technique How to Manage Short-Term Voiding Difficulty How to Manage Long-Term Voiding Dysfunction The Abdomino-Vaginal Sling Preoperative Consent Discussion Historical Note: Stamey Needle Suspension and Raz/Pereyra/Gittes Procedures Paravaginal Repair Laparoscopic Colposuspension The TVT and Transobturator Tape Preoperative Consent Advice Is the Cough Test Necessary? Postoperative Instructions Outcome Data for the TVT The Transobturator Tape The Use of Bulking Agents for USI GAX Collagen (Contigen) Macroplastique Durasphere Conclusions References Management of Prolapse Nonsurgical Management Options Use of Ring Pessary

11 Contents xi Surgery for Cystocele Anterior Colporrhaphy The Anterior Repair with Extensive Plication (Ultralateral Anterior Colporrhaphy) Paravaginal Defect Repair Use of Mesh for Cystocele Repair What Is the Value of Manchester Repair/ Retention of a Nonprolapsed Uterus? Preoperative Consent Discussion for Anterior Compartment Repairs Surgery for Rectocele/Deficient Perineum A Repair for Mid Low Rectocele and Deficient Perineum Surgery for Enterocele Vaginal Sacrospinous Fixation Preoperative Consent Discussion for Vaginal Sacrospinous Fixation Abdominal Sacrocolpopexy Preoperative Consent Discussion for Abdominal Sacrocolpopexy Conclusions References Recurrent Bacterial Cystitis in Women Guide to Management of Recurrent UTI During Examination Investigations for Recurrent UTI Treatment At Second Visit What to Look for on Cystoscopy References Interstitial Cystitis How to Diagnose It Etiology Treatment References Erratum E1 Index