CHAPTER 9 - Urogynaecology

Summary

Key points

1. ✓ The RCOG standards for urogynaecology provide a basic set of essentials that are necessary to provide our patients with a consistently high quality of care, irrespective of where that care is provided. Implementation with the support of national guidelines, audit and clinical governance should help to achieve this aim.

2. ✓ Clinicians, with trust support, should engage with continence advisory services, general practitioners and primary care trusts to ensure that initial management of incontinence and pelvic organ prolapse is undertaken in primary care, in line with National Institute for Health and Clinical Excellence guidelines, and that locally agreed referral pathways are in place.

3. ✓ There should be comprehensive written information about pelvic floor dysfunction to help women to make informed choices about management options.

4. ✓ Clinicians should establish dedicated urogynaecology clinics and multidisciplinary teams in secondary care, with regular multidisciplinary team meetings.

5. ✓ In selected centres, such as tertiary referral centres, more extensive multidisciplinary team meetings, with urological and coloproctology input, should be established, with appropriate investigatory and surgical skills available.

6. ✓ Appropriate training, either subspecialty or ATSM, and sufficient workload to maintain surgical competence should be available (the methods of surgical assessment need further evaluation).

7. ✓ All women undergoing prolapse or incontinence surgery should be included in national audit strategies, such as the British Society of Urogynaecology’s surgical audit database, following informed consent.

8. ✓ Clinicians should inform clinical governance leads when undertaking new surgical procedures.

Introduction

Urinary incontinence, prolapse and anal incontinence have, not surprisingly, a significant impact on quality of life, affecting relationships, social and physical activities, work and body image and thus resulting in psychological distress and the development of coping strategies. Significant advances have been made in the understanding of these symptoms and conditions, their investigation and treatment. The RCOG's clinical standards for urogynaecology have been jointly developed with the British Society of Urogynaecology (BSUG) to provide a framework that should ensure best and evidence-based practice. It is important that these standards are appropriately adopted by clinicians to improve the quality of care for our patients.