�UroToday.com - Any urologist dealing with incontinence in the female patient must deal with pelvic organ prolapse. At a minimum the urologist must valuate the affected role for prolapsus and make an reserve referral to either another urologist or a gynecologist for direction. Other degrees of involvement range from evaluation and complete treatment to evaluation and treatment of complications following prolapse surgery.
The role of the evaluation is to diagnose the extent of the problem and to implement management. During the history symptoms pertaining to prolapse should be sought. An assessment of disoblige should be elicited and a discussion should be had as to the treatment expectations. A variety of status specific questionnaires are useable to care in quantifying symptoms and to assess quality of life and bother. A pelvic exam is performed to assess the health of the vaginal mucosa and to assess and grade whatever prolapse. A stress test is performed to assess for focus incontinence. The muscular integrity of the pelvic floor and the external anal sphincter should also be assessed. A post void residual is checked. Further evaluation with imaging and or urodynamics is performed on a case by case groundwork. Once the diagnosis of prolapse is made then a determination regarding treatment should be made. Conservative treatment with pelvic muscle exercises or a contraceptive diaphragm may do. If surgical treatment is to performed the approach should be based on the patient's problems and her expectations for convalescence and enduringness.
The most common complications of prolapsus surgery that the urologist will deal with are; persistent or de novo incontinence, new onset of recurrent infections, hematuria, hurting and obstruction. Incontinence should be worked up with a history and physical and urodynamics. If there is whatever concern for foreign material in the bladder or urethra a cystoscopy should be performed. Cystoscopy should also be performed in the pillowcase of dogged infections or hematuria. Urodynamics may be helpful to diagnose obstruction but it is sane to take down a sling or anterior repair without urodynamic proof of obstruction if there is a clear temporal relationship between the surgery and the oncoming of impediment.
Mesh used in descensus repairs should be remote in the case of pain, contagion or misplacement. Mesh in the bladder can be removed endoscopically, laparoscopically or with an open proficiency. Mesh extrusion can be treated with partial removal and dither closure over the defect. When perennial incontinence or prolapse occurs following a mesh fix one can consider placing additional mesh but if one procedure has failed it is reasonable to consider a different approaching on a second repair. In drumhead the urologist who deals with dissoluteness must value the patient for prolapsus and care for or bring up those patients who indigence surgical intervention. Urologists will also be asked to evaluate patients with complications following descensus surgery as many of these patients may ask a cystoscopy and or urodynamic testing. Treatment of complications next prolapse surgical procedure will reckon on the nature of the knottiness.
Presented by: E. Ann Gormley, MD, FACS, at the Masters in Urology Meeting - July 31, 2008 - August 2, 2008, Elbow Beach Resort, Bermuda
UroToday - the only urology web site with original content scripted by world urology key opinion leaders actively engaged in clinical practice.
To access the in vogue urology news releases from UroToday, go to:
www.urotoday.com
Copyright � 2008 - UroToday
More information
