1. Urogynaecology in West Hertfordshire - Getting the best outcomes for your patient’s Mr Andrew Hextall MD FRCOG Consultant Gynaecologist / Urogynaecologist West Herts Hospitals NHS Trust Spire Harpenden / Bushey

2. Urogynaecology in West Herts Aims Changes in SACH Continence team + services What can you do prior to referral? Physiotherapy TVT results

4. ST ALBANS CITY HOSPITAL MAJOR GYNAE SURGERY IS BACK! Vaginal Repair Vaginal Hysterectomy Tension-Free Vaginal Tape (TVT) Laparoscopic BSO Laser to endometriosis..........

6. Urogynaecology in West Herts Team Approach Continence advisors Physiotherapists UG nurse specialists GP specialist Consultants

10. Incontinence In General Practice Initial Assessment Predominant symptom –Stress / Urge / Mixed Examination Basic investigation –Urinalysis /MSU –Bladder diary

11. Urinary Incontinence Simple measures Lifestyle modification –Fluid management (volume / type) –Good bladder habits –Stop smoking –Weight loss? –Avoid high impact exercises Alter medication Treat chronic conditions (e.g.) cough Pelvic floor exercises – –Alter medication Treat chronic conditions (e.g.) cough (Weight reduction ?) Lifestyle modification Pelvic floor exercises

12. Drugs for Detrusor Overactivity

13. Treatment options Physiotherapy Medication? Surgery Urinary Stress Incontinence Primary Care

14. PHYSIOTHERAPY Local Services Judith Pearson Clare Downie Sandra Watkin (Berkhamstead) Conservative treatments also offered by UG Nurse specialists and Continence Advisors

15. Tension-Free Vaginal Tape (TVT)

18. Age distribution for women undergoing Tension- Free vaginal tape (TVT) since 2007 ( n = 225) Age Percentage

19. Urinary stress incontinence only: change in Stress incontinence following TVT (n = 170) Percentage Choice

20. Changes in incontinence for patients with mixed incontinence (Urinary stress incontinence and detrusor muscle over-activity) n = 29 Percentage Choices

21. Global Impression for improvement of incontinence - Urinary Stress Incontinence (n = 170) - Mixed incontinence (DOA and USI) (n=29) Percentage Choices

22. Urogynaecology in West Herts Conclusions Improved services at SACH –Laser for endometriosis –Vaginal Surgery Team approach in UG TVT has good success rates (for all age groups)

23. WEST HERTS & WATFORD MEDICAL SOCIETY (founded 1849) GP – CONSULTANT FORUM THURSDAY 21 st May 2009 Medical Education Centre WGH Programme – please feel free to join us at anytime 6.30-7.00pmRegistration and Buffet 7.00pmStart of the meeting OBSTRUCTIVE SLEEP APNOEA Dr Andy Barlow Consultant Respiratory Physcian (Runner up President ’ s meeting in 2008) MEET SOME NEW CONSULTANTS Have you still to meet the new Consultants working in the local area? Here is an opportunity. Each will give a brief outline of their practice. Dr Julia OstbergConsultant Endocrinologist Miss Caroline HingConsultant Orthopaedic Surgeon UPDATE ON BOWEL CANCER SCREENING IN WEST HERTFORDSHIRE - THE FIRST 12 MONTHS Dr Alistair King Consultant Gastroenterollogist West Hertfordshire Hospitals NHS Trust 8.30pmClose Andrew Hextall MD FRCOGHannah Cowling MRCGP

24. Detrusor Overactivity Cost of Anti-cholinergics / day Oxybutynin –IR 5mg bd£0.10 –ER 10mg od£0.82 Tolterodine –IR 2mg bd £1.09 –ER 4mg od£1.04 Solifenacin –5mg od£0.92 –10mg od£1.20 Trospium chloride –20mg bd£0.87