Miscellaneous

This chapter covers the definition of a urogynaecologist and current training routines, including the specialty, advanced training skills modules (ATSMs), and specific subspecialty training. The composition and role of both local and regional multidisciplinary team (MDT) is described. Finally, the current controversies around the use of synthetic mesh, and the current UK suspension of all vaginal mesh use for both prolapse and incontinence, is covered.

Colorectal

This chapter covers colorectal problems. It starts with different investigations for physiology, musculature, and transit, then goes on to discuss the causes, assessment, and management of constipation. Different types of laxatives are described. Specific conditions, including obstructed defaecation syndrome, rectal prolapse, and intussusception are covered. Causes, management, and surgical interventions of faecal incontinence are described. Finally, the causes and management of rectovaginal fistula are defined.

Pelvic organ prolapse

Pelvic organ prolapse (POP) is where the pelvic organs (uterus/vaginal apex/bladder/bowel) herniate into or beyond the vagina from their normal anatomical position. This chapter provides both the classification and grading of pelvic organ prolapse, alongside assessment and examination of the patient. Management is split into conservative, pessaries, and surgery. Different types of surgery and their techniques are described, with indications and variants for various prolapses.

Laparoscopic urogynaecology

Laparoscopic surgery is well-established in the management of benign gynaecological conditions, and is increasing in use in urogynaecology. This chapter provides an overview of the advantages and disadvantages to laparoscopic surgery for both the surgeon and the patient, and then outlines key considerations in patient selection. Methods of entry are described and compared, and a list of laparoscopic procedures is included, alongside tips for training.

Age and the pelvic floor

The pelvic floor changes with age. This chapter begins by discussing daytime and nocturnal urinary incontinence in children alongside treatment strategies. Urinary tract infection in children is also described. Impact of the menopause on the urogenital tract, vulvovaginal symptoms, and lower urinary tract are all covered. Finally, the scope of the problem of incontinence in older people is discussed, with diagnostic and treatment considerations included.

Pregnancy and childbirth

This chapter covers the normal physiological changes to the renal tract, bladder, and pelvic floor that is associated with pregnancy. It then explains perineal trauma and its classification, and obstetric anal sphincter injury. The types, risk factors, and management of postpartum urinary retention is also covered.

Urology

This chapter covers various issues to do with urology in women. It begins by listing different investigation methods and what conditions they are best prepared to show. It then goes through various urological problems that may be encountered, such as ureteric stenting, haematuria, urinary tract infections and non-bacterial cystitis, and bladder pain syndrome. Urethral conditions and injuries to the urinary tract are both covered, including mechanism of injury and repair. Catheters, vesicovaginal fistulae, and urinary diversion are also described and given techniques for management.

Lower urinary tract conditions

This chapter covers conditions affecting the lower urinary tract. It begins with an overview and management strategies of overactive bladder syndrome, including both conservative and pharmacological methods. Stress urinary incontinence (SUI) is covered in detail, from an overview and risk factors, to conservative, surgical, and other interventions. The controversy surrounding synthetic mid-urethral slings is highlighted. Other types of urinary continence are defined, alongside voiding dysfunction. Finally, drugs that can affect bladder function are listed.

Anatomy and physiology

This chapter provides the anatomy of the urinary tract and pelvic floor. It covers the ureter, bladder, and urethra. It also describes the pelvic floor muscles (role and levels of vaginal support), and the control of micturition.

Neurology

This chapter describes the various neurological conditions that can have an effect on bladder function and the upper renal tract. Brain lesions and effect on continence are described, alongside spinal cord lesions, sacral cord injuries, and peripheral neuropathies like diabetes and Herpes zoster.