Urogynaecology in West Hertfordshire

- Getting the best outcomes for your patient’s

Mr Andrew Hextall MD FRCOGConsultant Gynaecologist /

UrogynaecologistWest Herts Hospitals NHS Trust

Spire Harpenden / Bushey

Urogynaecology in West Herts

Aims

Changes in SACH

Continence team + services

What can you do prior to referral?

Physiotherapy

TVT results

ST ALBANS CITY HOSPITAL

MAJOR GYNAE SURGERY IS BACK!

Vaginal Repair

Vaginal Hysterectomy

Tension-Free Vaginal Tape (TVT)

Laparoscopic BSO

Laser to endometriosis..........

Urogynaecology in West Herts

Team Approach

Continence advisors

Physiotherapists

UG nurse specialists

GP specialist

Consultants

Incontinence In General Practice

Initial Assessment

Predominant symptom

– Stress / Urge / Mixed

Examination

Basic investigation

– Urinalysis /MSU

– Bladder diary

Urinary IncontinenceSimple measures Lifestyle modification

– Fluid management (volume / type)– Good bladder habits– Stop smoking– Weight loss?– Avoid high impact exercises

Alter medication

Treat chronic conditions (e.g.) cough

Pelvic floor exercises

–

– Alter medication Treat chronic conditions (e.g.) cough (Weight reduction ?) Lifestyle modification Pelvic floor exercises

Drugs for Detrusor Overactivity

Treatment options

Physiotherapy

Medication?

Surgery

Urinary Stress Incontinence

Primary Care

PHYSIOTHERAPY

Local Services Judith Pearson Clare Downie Sandra Watkin (Berkhamstead)

Conservative treatments also offered by UG Nurse specialists and Continence Advisors

Tension-Free Vaginal Tape (TVT)

Age distribution for women undergoing Tension-Free vaginal tape (TVT) since 2007 ( n = 225)

0

5

10

15

20

25

30

35

40

0-39 40-49 50-59 60-69 70-79 80-89 Not answered

Age

Percentage

Urinary stress incontinence only: change in Stress incontinence following TVT (n = 170)

010

20304050

607080

90100

Worse No change Improved Cured

Percentage

Choice

Changes in incontinence for patients with mixed incontinence (Urinary stress incontinence and detrusor muscle over-activity) n = 29

Percentage

Choices

0

10

20

30

40

50

60

70

80

90

100

Worse No Change Improved Cured |Not present

StressIncontinenceUrgeIncontinence

Global Impression for improvement of incontinence - Urinary Stress Incontinence (n = 170) - Mixed incontinence (DOA and USI) (n=29)

0102030405060708090

100

Verymuchworse

Muchworse

A littleworse

NoChange

Alittlebetter

Muchbetter

Verymuchbetter

USI

Mixed

Percentage

Choices

Urogynaecology in West Herts

Conclusions Improved services at SACH

– Laser for endometriosis– Vaginal Surgery

Team approach in UG TVT has good success rates (for all age groups)

WEST HERTS & WATFORD MEDICAL SOCIETY

(founded 1849)

GP – CONSULTANT FORUM THURSDAY 21st May 2009

Medical Education Centre WGH

Programme – please feel free to join us at anytime

6.30-7.00pm Registration and Buffet

7.00pm Start of the meetingOBSTRUCTIVE SLEEP APNOEADr Andy Barlow Consultant Respiratory Physcian(Runner up President’s meeting in 2008)

MEET SOME NEW CONSULTANTSHave you still to meet the new Consultants working in the local area? Here is an opportunity. Each will give a brief outline of their practice.

Dr Julia Ostberg Consultant EndocrinologistMiss Caroline Hing Consultant Orthopaedic Surgeon

UPDATE ON BOWEL CANCER SCREENING IN WEST HERTFORDSHIRE- THE FIRST 12 MONTHSDr Alistair KingConsultant GastroenterollogistWest Hertfordshire Hospitals NHS Trust

8.30pm Close

Andrew Hextall MD FRCOG Hannah Cowling MRCGP

Detrusor Overactivity

Cost of Anti-cholinergics / day

Oxybutynin – IR 5mg bd £0.10– ER 10mg od £0.82

Tolterodine– IR 2mg bd £1.09– ER 4mg od £1.04

Solifenacin– 5mg od £0.92– 10mg od £1.20

Trospium chloride– 20mg bd £0.87