Urogynaecology in West Hertfordshire - Getting the best outcomes for your patient’s Mr Andrew...
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Transcript of Urogynaecology in West Hertfordshire - Getting the best outcomes for your patient’s Mr Andrew...
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