�UroToday.com - Any urologist dealing with incontinence in the female patient must deal with pelvic organ prolapse. At a lower limit the urologist must evaluate the patient for prolapsus and relieve oneself an reserve referral to either some other urologist or a gynecologist for direction. Other degrees of interest range from evaluation and complete handling to valuation and handling of complications following prolapse surgery.
The role of the valuation 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 trouble should be elicited and a word should be had as to the treatment expectations. A variety of consideration specific questionnaires are available to financial aid in quantifying symptoms and to assess quality of life and bother. A pelvic test is performed to assess the health of the vaginal mucous membrane and to assess and grade any prolapse. A stress quiz is performed to assess for strain incontinence. The muscular integrity of the pelvic floor and the external anal sphincter should also be assessed. A post invalidate residual is checked. Further evaluation with imaging and or urodynamics is performed on a case by case footing. Once the diagnosis of prolapse is made then a decision regarding discussion should be made. Conservative treatment with pelvic muscle exercises or a pessary may serve. If surgical treatment is to performed the approach should be based on the patient's problems and her expectations for recovery and strength.
The most common complications of descensus surgery that the urologist will deal with are; persistent or de novo incontinence, new onset of recurrent infections, hematuria, painful sensation and obstruction. Incontinence should be worked up with a history and strong-arm and urodynamics. If there is whatsoever concern for foreign material in the bladder or urethra a cystoscopy should be performed. Cystoscopy should also be performed in the case of pertinacious infections or hematuria. Urodynamics may be helpful to diagnose obstruction but it is sensible to take down a sling or anterior indemnify without urodynamic proof of obstruction if there is a clear temporal relationship between the surgery and the onslaught of obstruction.
Mesh victimized in descensus repairs should be removed in the case of pain, transmission or misplacement. Mesh in the bladder can be removed endoscopically, laparoscopically or with an open technique. Mesh extrusion can be treated with partial removal and roll closure over the defect. When recurrent incontinence or prolapse occurs following a mesh doctor one behind consider placing additional mesh but if one procedure has failed it is reasonable to consider a different approach on a second repair. In drumhead the urologist who deals with self-gratification must evaluate the patient for descensus and treat or consult those patients who need surgical treatment. Urologists testament also be asked to evaluate patients with complications following descensus surgery as many of these patients may require a cystoscopy and or urodynamic testing. Treatment of complications following prolapse surgery will reckon on the nature of the complication.
Presented by: E. Ann Gormley, MD, FACS, at the Masters in Urology Meeting - July 31, 2008 - August 2, 2008, Elbow Beach Resort, Bermuda
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