Urogynaecology is the area of Gynaecology and Female Urology that involves the assessment and treatment of lower urinary tract (bladder and urethra) and pelvic floor problems including uterine and vaginal prolapse.
The prevalence of urogynaecological problems overall is high; 30-40% of Australian women suffer urinary incontinence and uterovaginal prolapse. One third of these women will have severe symptoms.
Common Urogynaecological conditions That Dr Musa Manages :
Anterior and posterior vaginal prolapse
Although not life-threatening, it has a signiﬁcant impact on the quality of life and is associated with signiﬁcant functional disturbances including bladder, bowel and sexual function.
Uterine prolapse occurs when there is weakening or damaged pelvic floor muscles and ligaments.
Common causes include pregnancy, childbirth, hormonal changes after menopause, obesity, severe coughing and straining on the toilet.
Treatment options include
Dr Musa will assess the degree of prolapse, order investigation to rule out other causes and then discuss either surgical or non-surgical treatment. If required, surgery will be performed by Dr Musa at either Greenslopes or Sunnybank Private Hospitals.
Bladder and bowel control problems are common.
Although Urinary incontinence have a considerable impact on a person’s quality of life, many people do not seek help. Embarrassment often prevents people talking about their bladder and bowel problems. Some people restrict going out and have little social contact outside their home.
There is no need to become a recluse. The good news is that for most people, these problems can either be cured or at least better managed. You can lead a normal life without needing to plan your activities around the toilet.
Incontinence and continence problems affect people of all ages, gender, cultures and backgrounds. Despite popular beliefs, older people are not the only ones affected.
Involuntary loss of urine with coughing, running, jumping, sneezing and other exercise activities.
Involuntary loss of urine associated with a compelling desire to void which is difficult to defer (urgency).
More than 7 episodes of passing urine a day may be excessive. This comment depends on fluid intake to a degree.
Getting up to pass urine more than once per night is probably excessive. Excess fluids before bed may contribute.
A compelling desire to void which is difficult to defer.
This is commonly due to is a lack of support to the bladder neck (urethral hypermobility), causing urinary leakage.
Urinary stress incontinence has many possible causes including:
Generally believed the prevalence of incontinence increases with age but others believe stress incontinence may be most common in women in the 40’s.
Stress incontinence is seen more frequently in women who have had children than in those who have not. Increasing number of children and larger birth weight of children may be a risk factor.
Is not thought to be a significant risk factor for urinary stress incontinence. Some studies suggest incontinence is greater in premenopausal than in postmenopausal women.
Is more common in incontinent women than continent women. The surgical correction of incontinence is difficult and the long-term efficacy of surgery may be reduced in obese women
Women who smoked are 2-3 times more likely to develop stress incontinence than nonsmokers.
Women with stress incontinence have increased number of enzymes that break down the connective tissue. The common enzymes that are increased include collagenases and elastases. They may be related to increased incidence of “stretch marks”, hernias and increased joint flexibility seen in women with pelvic floor dysfunction.
Many medications may affect the bladder. Best researched are fluid tablets (diuretics) and some bladder pressure medications such as Minipress.
Weight Loss: can lead to a reduction of the symptom of stress incontinence
Reduced Caffeine Intake (less coffee, tea or chocolate intake) may see a reduction in irritable bladder symptoms such as frequency and urgency
Optimize Chest Conditions: ie chronic coughing management. Reduce smoking
Physiotherapy: Works best if the incontinence is mild to moderate in severity and stress incontinence is the main symptom
Vaginal Oestrogens: May improve the symptoms of frequency, nocturia, urgency and the condition of the vaginal skin (mucosa).
Treat bladder infection, minimize excessive fluid intake, change medications (minipress used in hypertension may cause stress incontinence), treat constipation.
TVT sling procedure is the most commonly performed procedure for Sling but currently Dr Musa does not do any procedures that has mesh in it due to current controversies.
Macroplastique has been used safely and effectively in over 70,000 patients since 1991. Many clinical studies have reported Macroplastique to be clinically effective with a low rate of side-effects (individual results may vary depending on your type of urinary incontinence). So, you can be assured of its safety and effectiveness. Macroplastique is an injectable soft-tissue bulking agent for treating stress urinary incontinence and vesicoureteral reflux. Macroplastique is made up of two parts – the water-soluble gel (polyvinylpyrrolidone) that is absorbed and removed from the body in urine and the man-made, rubber-like, silicone elastomer implant material (cross-linked polydimethylsiloxane) that is permanent and not absorbed by the body. It is this permanent material that causes the bulking effect after implantation.
Macroplastique adds volume to the tissue surrounding the urethra. This extra volume increases the urethral closure pressure to prevent urine leakage during normal, everyday activities such as standing, coughing and physical exercise.
This is usually performed by Dr Musa as a day only procedure at the hospital.
This procedure is performed under anaesthesia. A permanent tape is introduced via the vagina to sit under the mid urethra. The tape used is a permanent mesh, which will not be dissolved by your body.
The colposuspension uses vaginal tissue to elevate the bladder neck. Stitches link the vagina to the strong ligaments overlying the pubis. This is a different way of curing incontinence from the tapes which are a sling to support the middle of the urethra.
Usually described as Overactive Bladder. This condition affects 15% – 30 % of adults and the incidence increases with advancing age. It is the Involuntary bladder contraction resulting in urgency or incontinence.
Some causes include infection, inflammation, foreign bodies or tumours and neurological disorders.
Dr Musa will take a thorough history, examination and organize relevant investigations to rule out these conditions.
Bladder retraining and pelvic floor exercises.
Limit Caffeine intake.
Minimise water intake after 5 pm if nocturia is aconcern.
Most commonly used is Ditropan which is cheaper but has more side effects.
Betmiga is a new medications and is better tolerated but costs a bit more.
BOTOX INJECTIONS IN THE BLADDER
Only indicated if medical and behavioural management have not worked or are not tolerated.
Botox is injected into the bladder and last approximately 6-12 months. For more information clink on the link
Some women may have trouble emptying there bladder following botox and use of a temporary catheter would then be required.
NEUROMODULATION: S3 SNS
Sacral Neuromodulation is a alternate treatment option for bladder control, delivered via a implanted neurostimulator .
The leads electrically stimulate the sacral nerve which is thought to normalize neural communication between the bladder and brain.
Unlike oral medications that target the muscular component of bladder control,
Sacral Neuromodulation offers control of symptoms. through direct modulation of the nerve activity.
Neuromodulation is considered in those who have failed to respond to medical treatments.