Vaginal Mesh Lawsuit News- 1/24/2012 : The female pelvic organs consist of the vagina, uterus, bladder, urethra, and rectum (Fig. 2.1). All these organs are enclosed in a protective cage called the bony pelvis. The vagina is the birth canal, which the baby passes through during delivery. It is also the organ used during sexual intercourse, where the male’s penis enters the vagina to deposit semen during ejaculation. The uterus is also called the womb, where a baby develops during pregnancy, and awaits labour to occur. The bladder is the organ that stores urine, which is continually produced by our kidneys. At suitable occasions where there is privacy, like in the toilet, the bladder expels the stored urine.
Urogynaecology is a branch of medicine that deals specifically with female bladder disorders and pelvic floor dysfunction. The common symptoms are abnormal frequency of urination, urinary leakage, vaginal and pelvic heaviness or pain, and prolapse of the female pelvic organs. As part of the evaluation of a patient, a detailed history and clinical examination is performed to assess the general medical status of the patient, and decide whether certain medical conditions may affect urinary symptoms. For example, a patient with poorly controlled diabetes mellitus may have troublesome thirst, urinary frequency, disruption of sleep due to frequent urination (nocturia), an overwhelming sensation to pass urine (urgency) and so on.
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A detailed urogynaecological examination would involve the assessment of atrophic vaginitis which affects the quality and condition of the vaginal skin. A supine cough test is used to assess stress urinary incontinence, and an erect stress test (EST) can be used as a semi-quantitative test to assess the severity of urinary leakage. An assessment for prolapse of the female pelvic organs is also made. The degree of prolapse of the bladder (cystocoele), rectum (rectocoele), uterus (uterovaginal prolapse), vaginal vault (vault prolapse), or combinations of pelvic organ prolapse should be made, to decide whether conservative treatment or surgery is needed.
A urine dipstick test is a rapid screening test that detects blood (haematuria), sugar (glycosuria) or protein (proteinuria) in the urine and other signs of a urine infection. A urine microscopy is a test that detects white blood cells, red blood cells, sldn cells, nitrites, proteins, micro-organisms, casts and crystals. It is frequendy combined with a urine culture for the diagnosis of urinary tract infection. A urine culture is used to grow and detect the specific type of bacteria that may be causing a UTI. It also identifies which specific antibiotic can be used to best treat the UTI. A urine cytology is used to identify suspicious-looking or cancerous cells, which may come from anywhere along the urinary tract. A positive cytology requires urgent assessment with a cystoscopy or other tests, for example, a CT scan. An ultrasound pelvis is performed to assess the uterus, the fallopian tubes, and the ovaries of the patient. This is to diagnose any masses, such as uterine fibroids or ovarian cysts and tumours, which may cause pressure effects leading to problematic urinary symptoms or prolapse symptoms.
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An abdominal X-ray (AXR) is done to detect stones along the urinary tract. Large staghorn calculi, which look like branches of coral, can occur in the kidneys, whereas smaller stones can occur in the ureters or the bladder. Cystoscopy involves a specialised endoscopic camera which can be inserted into the bladder to detect chronic infection, bladder stones, foreign bodies, and most importantly, cancerous tumours. Biopsies are samples of tissues taken for definitive diagnosis of chronically inflamed bladder (like painful bladder syndrome) or cancerous tumours (like bladder cancer). A CT scan is a specialised X-ray test that examines in detail the entire urinary tract after the injection of a dye into a vein. It can diagnose stones, cysts, masses (benign or malignant) and any other abnormalities of the urinary tract; such as extra kidneys, extra ureters, abnormal connections (fistulae) of the urinary tract to other organs, or even an abnormally located kidney (pelvic kidney).
Also referred to as a MCU or cystogram, this diagnostic X-ray test helps determine the bladder capacity and the emptying ability of the patient. It also detects abnormalities of the urethra and the bladder. Apart from that, this test can detect a narrowing of the urethra (stricture) secondary to infection or physical trauma, reflux (back-flow) of urine up the ureters during voiding, as well as bladder fistula (an abnormal connection between bladder and another organ).
A MCU is usually performed at the hospitals radiology department. There is no special preparation required of the patient prior to the test. During the procedure, the patient is asked to lie on her back and remain still. A preliminary film of the abdomen area and pelvis is initially done without contrast (dye). This helps the radiologist determine the proper radiographic technique to be used and the positioning of the patient. A catheter is inserted through the urethra into the bladder so that dye can be injected. As the bladder is filled with dye, X-rays of the area in various positions and time intervals are taken. Then, the catheter is removed and additional X-rays are taken as the patient urinates into a container. Once the bladder is emptied, a final X-ray is taken. The entire test takes approximately an hour to complete.
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With recent major advances in medical care, many chronic diseases can now be managed successfully, and women’s healthcare has greatly improved. However, in our longer-living but rapidly ageing population, the problems associated with ageing are also becoming more common. One common problem that affects a womans quality of life is pelvic organ prolapse (POP). POP is common, nearly 45% of menopausal women suffer from some degree of the condition. Fortunately, POP can be treated with a variety of methods. A prolapse is the protrusion of an organ beyond its normal position. The protrusion of the uterus (womb) along the axis of the vagina, or out of it is called utero-vaginal prolapse (UVP). The commonest form of prolapse in women is a prolapse of the bladder and the urethra, which presents as a protrusion of the anterior vaginal wall (cystourethrocoele). Other types of prolapse include a protrusion of the rectum from the posterior vaginal wall (rectocoele).
Uterine prolapse is when the womb drops down the vagina. It is the second most common type of prolapse. The severity of the prolapse is described in three degrees: a first- degree uterine prolapse being very mild and asymptomatic and, a third-degree uterine prolapse being the most severe . It is also called a procidentia. In this case, part of the small intestine in the pouch of Douglas may slip down between the rectum and the back wall of the vagina. This often occurs at the same time as a rectocoele or uterine prolapse.
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The symptoms and severity of the prolapse usually depends on the degree of prolapse. Symptoms include feeling a sense of heaviness in the vagina, pelvic discomfort, feeling or seeing a protrusion at the vaginal opening, difficulty having sexual intercourse, or feeling low back pain. In severe cases, women may have difficulty passing urine or motion. Some sufferers experience chronic vaginal discharge or bleeding resulting from repeated injury to the prolapsed organ. The patients symptoms usually improve when she lies down but worsen when she stands for prolonged periods of time.
A 60-year-old woman went to see the doctor because she experienced the feeling of vaginal heaviness for a year. One week before her consultation, she felt and discovered a lump in her vagina. She had previously delivered five children, all through natural childbirth and was being treated for asthma and chronic constipation for many years. The doctor performed a speculum examination of her vagina and a pelvic examination. She was diagnosed with a prolapse of the bladder and the womb.
Generally, when women suffer from prolapse, it is impossible for them to recover on their own. The most popular non- surgical treatment is pelvic floor exercise (PFE) or Kegel exercises. This exercise strengthens the pelvic floor muscles and slows down the progression of die prolapse. The success of PFE depends on how regularly the exercise is carried out. PFE may improve the condition in the short-run but does not cure it, as the prolapse will worsen once PFE is stopped. It is only suitable for milder degrees of prolapse. The definitive form of management of POP is surgery. There are many types of operation depending on the patients condition, the type and severity of POP, and the preference of the patient. A urogynaecologist is best able to discuss with the patient the type of surgery, the risks and complications involved, the anaesthesia required, and the post-operative management.
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