Urogynae TOG articles

Question 1

Proportion of women affected by stress UI?

Answer 1

1 in 3

Question 2

What is colposuspension used to treat and how is it performed?

Answer 2

Surgical treatment for stress incontinence
Open or laparoscopically
Paravaginal fascia is attached to coopers ligament (iliopectineal ligament)

Question 3

What is the continence rate after 1 year following colposuspension?

Answer 3

85-90%

Question 4

5 years after colposuspension what is the continence rate?

Answer 4

65-70%

Question 5

What are the rates of enterocele and rectocele following colposuspension at 5 year follow up?

Answer 5

49% - enterocele

42% - rectocele

Question 6

Risk of prolapse surgery following colposuspension

Answer 6

7 in 100 women

Question 7

Risk of de novo overactive bladder following colposuspension

Answer 7

3-8 in 100 women

Question 8

Risk of colposuspension causing bleeding requiring a blood transfusion or forming a haematoma

Answer 8

2 in 100 women

Question 9

Risk of colposuspension causing bladder or ureteric injury?

Answer 9

Bladder - 0.4 - 9%

Ureter - 0.2 - 2%

Question 10

Risk of colposuspension causing dysparaneuia or pelvic pain?

Answer 10

2-6%

Question 11

Risk of colposuspension causing urinary retention

Answer 11

25% directly after surgery, 0.7% at month post surgery

Question 12

What proportion of postmenopausal women are affected by uterine prolapse?

Answer 12

14%

Question 13

Which patients might Manchester repair be appropriate for?

Answer 13

1) Patients with cervical elongation
2) stage 2 or 3 prolapse who wish to retain their uterus +/- want to retain reproductive function
3) previous pelvic surgery
4) Adverse to mesh surgery

Question 14

Specific risks of Manchester repair

Answer 14

1) Cervical stenosis leading to haematometra/pyometra
2) Cervical incompetence leading to preterm labour and miscarriage
3) Dyspareunia

Question 15

Contraindications to Manchester repair

Answer 15

** Inherent risk of developing endometrial cancer as uterus retained**
Endometrial cancer
HNPCC
Cervical cancer
Tamoxifen
Familial BRCA1 and BRCA2

Question 16

Which patients might urethral bulking agents be appropriate for?

Answer 16

Stress incontinence

1) Does not want major surgery or mesh
2) Have not completed their family
3) Recurrent SUI after previous surgery
4) Medical co-morb making major surgery risky

Question 17

Common complications of urethral bulking agents

Answer 17

Pain, urinary tract infection

usually transient symptoms