Uro Gynaecology

Urinary incontinence is when you accidentally urinate or wet yourself. This can range from leaking a small amount of wee to completely wetting yourself.

There are different types of urinary incontinence. The most common are stress incontinence and urge incontinence.  

Stress Incontinence is triggered by pressure on your abdomen (for example when you laugh, cough, sneeze or do something physical like playing sport or lifting things).   
Urge Incontinence is triggered by an overactive bladder. It is characterised by strong ‘urges’ to go to the toilet and not making it in time. 

Urinary incontinence is very common and can affect up to one in two women (or 30-50 percent). It happens to women of all ages although it becomes more likely the older you are. it can  have a big impact on your quality of life. Many women find it so embarrassing that they don’t seek medical help but there are a range of treatments that can help. 

How is urinary incontinence treated?

The kind of treatment you have will depend on  the type of urinary incontinence you have

• How severe it is
• Your age, health and medical history.

 treatment options may be one or more of the following :

• Lifestyle changes such as losing weight, quitting smoking, eating more fibre, drinking more water or lifting less. 
• Medication to help relax the bladder muscles, which play an important role in urge incontinence. 
• Physiotherapy to strengthen the pelvic floor, which supports your bladder. A physiotherapist can design a special pelvic exercise program for you. 
• Surgery to support or ‘hold up’ your bladder or urethra (the tube that links your bladder to the outside of your body). Surgery is usually only considered if medication or physiotherapy have not been successful. 
• The success of treatment can vary. While treatment may not ‘cure’ your incontinence, it can still help you live more comfortably with it.
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• There are Two main operations provided to treat stress incontinence:
  

  Mid-urethral sling procedure installs a mesh tape under your urethra to give it support. This usually involves small cuts to your vagina and belly (key-hole surgery).  You will be given an injection of medicine to either numb the area being operated on (local anaesthetic), the whole pelvic region (regional or spinal anaesthetic) or to put you to sleep (general anaesthetic). This procedure is sometimes called a tension-free or trans-obtruator vaginal tape (TOT)operation. 

  Colposuspension uses stitches to lift up the neck of the bladder and attach it to the pubic bone. This can involve small cuts to your belly (key-hole surgery) or a longer cut along your belly. You will be given a general anaesthetic for this procedure.

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Genital Prolapse:>

Occurs when pelvic organs (uterus, bladder, rectum) slip down from their normal anatomical position and either protrude into the vagina or press against the wall of the vagina. The pelvic organs are usually supported by ligaments and the muscles, connective tissue and fascia which are collectively known as the pelvic floor. Weakening of or damage to these support structures allows the pelvic organs to slip down.

The condition is most common in postmenopausal women who have had children, but can also occur in younger women and women who have not had children. It is estimated that at least half the women who have had more than one child have some degree of genital prolapse (although only 10-20% complain of symptoms).

Normal (no prolapse)

Uterine prolapse

Cystocele

Rectocele

Treatment

There are a range of treatment options available for prolapse. The most appropriate treatment will depend upon the type of prolapse or prolapses, their severity, the age of the woman, her state of health and her plans regarding children. Treatments can be divided into three types, conservative, mechanical and surgical. Conservative and mechanical treatments are generally considered for those with a mild prolapse, women whose childbearing is not complete and for those who do not wish to have surgery or who are unsuitable candidates for surgery (eg., elderly women).

Prevention of Genital Prolapse:

While women have little control over some contributing factors to prolapse (eg., having a long labour or giving birth to a large infant), there are a number of other steps they can take to reduce their risk:

• Perform pelvic floor exercises regularly, particularly during pregnancy after childbirth and into menopause.
• Avoid constipation and straining during a bladder and bowel movement. A physiotherapist or continence nurse can provide information on toileting positions to minimise risk to the pelvic floor and assist in the complete emptying of the bladder and bowel.
• Treat the cause of any chronic cough (if it is smoking-related seek assistance in quitting).
• Maintain a healthy weight.
• Avoid lifting heavy objects frequently. If lifting heavy objects, make sure to bend at the knees and keep the back straight.

Laparoscopic Surgery

Laparoscopy is a keyhole surgery: Is one of the surgeries which is designed to reduce the post operative hospitlisation facilitating early discharge and recovery, it is performed at fully equiped hospitals.

if you have had laparoscopic surgery with early discharge it is expected that you will improve day by day following this procedure.

Should symptoms of increasing pain, abdominal swelling and/or fever occur you will have been advised post operatively to contact your surgeon  or to present at the closest Emergency Department  to identify any possible complications from the procedure.

Pelvic Pain

Chronic pelvic pain is common, affecting approximately one in six of adult females. Much remains unclear about its aetiology, with a number of possible contributory factors. The development of a management plan in partnership with the woman is required.

Pelvic Pain, a chronic and complex condition  it is often classified under the following headings:

Painful Bladder Syndrome (PBS)

Painful Vaginal Syndrome (PVS)

Painful Irritable Bowel Syndrome (PIBS)

Pelvic floor dysfunction might cause chronic Myofascial Pelvic Pain, these symptoms can be further exacerbated by Psychological and social issues.

There are two recommended treatments for the Pelvic Pain; conservative and surgical treatment. The approach is often mutlidisciplinary with involvement of physiotherapist as well as a psychologist in the ttreatment.

Private Obstetrics

Is offered to all woman for: Antenatal care of the pregnant woman

Management of her labour.

Post Natal Care of mother and baby.

Cervical Screening:

In Australia cervical cytology remains a cost effective test for reducing incidence and mortality of cervical cancer by the detection and subsequent treatment of its precursors. General practitioner have a great role in recruitment of women who has never been screened or under screened.

Renewal of the National Cervical Screening Program:

2017 cervical screening program changes from every 2 years pap smear for women aged 18-69 to a 5 yearly  Human Papilloma Virus (HPV) test for women aged 25-74 years.Screening will be for oncogenic virus rather than cytology.

The new test is more sensitive and less frequent with high negative predictive value.

there will be 2 different types of testing

1. Cervical screening test (CST) to detect for oncogenic Viruses type16,18 and other High Risk Viruses.

2. Co Test which will detect both the oncogenic Virus +LBC , also this test will be used for test of cure.

women are divided in to 3 groups

1. Low Risk / woman with Negative CST and those will be reminded to repeat the test in 5 years.

2. Intermediate Risk / women with positive Other High Risk Viruses (non 16/18 HPV) with LBC showing Low Grade or Possible Low Grade Squamous Intra epithelial Lesion(LGSIL, PLGSIL) would be invited to do a cotest in a year , if negative for the Virus then to be referred to 5 yearly screening program.

3. High Risk groups / are  three sub groups who needs to be referred for  a Colposcopy

a. All positive HPV 16/18  needs colposcopy  what ever the results of LBC

b. All positive (HPV non 16/18) with LBC showing High or possible high grade squamous intra epithelial Lesion (HGSIL, PHGSIL) also persistent HPV infection for a year + LGSIL or PLGSIL

c. All Adeno Carcinoma Insitue AIS

Women with HPV 16 & 18 positive with Liquid base Cytology (LBC) showing invasive squamous cell carcinoma or glandular lesion should be referred to Gynaecology Oncology ideally in 2 weeks.

Women who have had a total hysterectomy with no evidence of cervical pathology, have previously been successfully treated for histologically confirmed High Grade Squamous Intraepithelial Lesion (HSIL) and have completed Test of Cure, do not require further follow-up. These women should be considered as having the same risk for vaginal neoplasia as the general population who have never had histologically confirmed HSIL and have a total hysterectomy.

Treatment:

Conservative Management Followup.

Diathermy of the cervix. 

Surgical management

Large LOOP Excision of Transformation Zone (LLETZ) or Cone biopsy,usually used for Glandular Lesion. 

Find out more about cervical screening test at cancerscreening.gov.au/cervical  or call 131556