1. NEW CONCEPTS AND TECHNIQUES and pursuing a career in urogynaecology
N J Nwabineli
Consultant in Obstetrics, Gynaecology and Urogynaecology
South Tyneside NHS Foundation Trust

2. Greetings from Tyneside

3. Urogynaecology is all about the pelvic floor

4. Urogynaecology is all about the pelvic floor
Colorectal
Gynaecologist
Urologist

5. Female Pelvic Medicine Female Urology
Urogynaecology
Female Pelvic Medicine
Female Urology

6. Pelvic Floor Muscles

7. Pelvic Floor Fascia

9. THE PELVIC FLOOR MUSCLES - An extraordinary multi-tasker!

10. Pelvic Floor Dysfunction
Gynaecologist
Urologist
Colorectal
Can affect anyone or combination of all 3 organs passing through it.
Dysfunction can be caused by the muscles and nerves of the pelvic floor.

11. Pelvic Floor Dysfunction Anterior compartment
Too active Urinary Retention
Under active Urinary Incontinence

12. Pelvic Floor Dysfunction Middle compartment
Too active Vaginsmus
Under active Pelvic Organ Prolapse

13. Pelvic Floor Dysfunction Posterior compartment
Too active Constipation – obstructed defaecation
Under active Flatus – Fecal incontinence

14. Pelvic Floor Dysfunction Chronic pelvic pain
Muscles in spasms
Hyperaesthesia of nerves – PBS, etc.

15. Urinary Problems Definitions
PAST
PRESENT
Urinary Retention
Symptoms, signs
Catheterisation
Bladder Ultrasound
Incontinence
Symptoms and signs only
Symptoms, signs and Urodynamics

16. Urodynamics

17. Urodynamics

18. Treatment of True or Urodynamic Stress Incontinence
Anterior Repair
MMK (1949)
Burch Colposuspension (1970’s)
Stamey’s and similar procedures
Mid urethral tapes/slings (mid 1990’s)
Bulking agents (mid 1990’s)

19. Tension Free Vaginal Tape
Down up
Side to side

20. Tension Free Vaginal Tape
Down up

21. Tension Free Vaginal Tape
Side to side (TVT-O, TOT)

22. Bulking agents

23. Treatment of Urge Urinary Incontinence
Life style modification
Anti-cholinergics
Beta sympathomimetics (Mirabegron)
Botox
Neuro-modulation (PTNS, SNS)
Complex surgery

24. Neuro-modulation
PTNS
SNS

25. Anal Incontinence and Obstructed defaecation
Anal Manometry

26. Anal Incontinence and Obstructed defaecation
Trans-anal ultrasound

27. Dynamic coloproctography

28. Bulking of anal supports

29. Pelvic Organ Prolapse
Treatment

30. Pelvic Organ Prolapse
Treatment – Traditional repair

31. Pelvic Organ Prolapse
Treatment – Mesh repair

32. Pelvic Organ Prolapse
Hystero sacro-colpopexy

33. Pelvic Floor Dysfunction The Future
Shift in paradigm of our approach
Anatomy of supports
Fresh cadaveric dissections
Trans perineal ultrasound
MRI – static
Supports in action
Dynamic MRI
Bio mechanical modelling

34. Fresh cadaveric specimens

35. Perineal Ultrasound

36. Static MRI

37. Dynamic MRI

38. John De Lancey

39. Must pelvic floor dysfunction occur? Can we prevent it?
Inherited collagen
Aging
Childbirth
Other trauma

40. If we can not prevent PFD – can we mitigate the effects?
How are tissues damaged?
What changes occur in structure and function?
How can we adapt treatments that take these
factors into consideration?
Comparison with car accidents

41. Pursuing a career in Urogynaecology
What to consider? – Is there a demand?
(Population will get older)
What are the demographics of PFD in Nigeria
compared to UK?

42. Pursuing a career in Urogynaecology
Personal recommendations
Start where you are and build your skills into urogynaeecology incrementally without switching off obstetrics
Be prepared to learn and to change as you go along
Ensure you are first of all a good doctor
before aspiring to be a good Uro-gynaecologist

43. Pursuing a career in Urogynaecology
You will be dealing with women whose problems
are not life threatening but of Quality of Life -
Therefore be prepared to negotiate
Be patient and thorough in the learning of your anatomy as your chosen area involves risks to several organs.
Maintain an enquiring mind as the specialty evolves
Remain humble – we do not know it all yet and because we are mending broken parts, we have to sometimes accept that we have not gotten it right.