Urodynamics

The Urogynaecology Department is a purpose built unit within the Women’s Hospital. The department is located on the ground floor, has its own entrance, reception and waiting areas, an exercise room and twin rooms for urodynamic investigation. There are 4 consulting rooms, 4 separate WC’s including one with disabled access. The staffing compliment includes 2 permanent medical staff: Mr D Richmond, Mr J Sutherst, a Continence Advisor/Stoma Care Nurse, a senior Nursing Sister, a Staff Nurse and an auxiliary. Three physiotherapists share 5 sessions of physiotherapy to the department. Junior Doctors compliment permanent medical staff as part of their training. The department sees between 700 and 800 new patients each year, most women attending the clinic suffer with incontinence or some sort of bladder or bowel problem, Medical staff perform the majority of the cystometric testing as well as the urogynaecology clinics. A standard urogynaecological "work-up" comprises: history and quality of life questionnaire, physical examination, urinalysis, documentation of a frequency/volume chart, followed by a 2 hour pad test, free uroflowmetry and measurement of residual urine. The "work-up" is completed by supine, erect and voiding cystometry. Treatment will vary according to the problem but often conservative help is given in the unit before surgical Intervention is used. Investigations performed within the Department include uroflow measurement transvaginal ultrasound for measurement of post void residual urine volumes, filling and voiding cystometries, urethral pressure profiles and ambulatory urodynamics.

The continence advisor is responsible for managing the unit as well as some cystometric testing. She has her own continence clinic, which provides advice, teaches clean intermittent self-catheterisation, and provides assessment and treatment of pelvic floor. She is available to provide advice on urinary and faecal problems to the Gynaecology and Obstetric wards. She is also a qualified stomatherapist and is able to provide a full stoma service including pre and post-operative counselling, siting of the stoma, advice on stoma products and follow-up care both in the community and in the hospital.

The other nursing staff supervise pad-testing and flow rate measurements, take urogynaecology histories which are input on to a computerised urodynamic database (in use since 1995), and provide help and support to patients about available continence devises. All staff are very aware of the embarrassment factor associated with incontinence and treats each women with sensitivity they need. The staff nurse has recently set up a weight reduction clinic in response to many patients needing to loose weight, either prior to surgery or to assist in their treatment of incontinence, it is proving to be very popular and we have seen some good outcomes.

There has been an increase in referral of patients with ano-rectal dysfunction. This has prompted the development of a combined surgical/Gynaecological clinic with a Consultant Colo-rectal Surgeon held every three months at the University Hospital in Liverpool and a Perineal Clinic, for follow-up care, will take place in the Urodynamics Department. This will provide postnatal advice for patients with perineal, urinary and bowel dysfunction. The clinic will undertake ano-rectal ultra sound and endo-anal measurements.

There are strong research links with the University and collaborations with the Departments of Rheumatology, Immunology, Cell Biology, Veterinary Medicine and Manchester University. The research is carried out by Nursing and Medical staff.