Urogynaecology

Urogynaecological Conditions

Pelvic floor dysfunction is a common problem in Hong Kong and worldwide. The common conditions include urinary incontinence, pelvic organ prolapse and faecal incontinence. Stress urinary incontinence, urge urinary incontinence and mixed urinary incontinence are some types of urinary incontinence. Cystocele and/or uterine prolapse/vaginal vault prolapse and/or rectocele are different types of pelvic organ prolapse. Women may have concomitant problems and they may experience a wide range of symptoms with significant bothersome effects on their quality of life. Complications may arise if prolapse is left untreated including abnormal per vaginal bleeding, ulcer or even hydronephrosis.

Our team offers comprehensive evaluation and treatment for female pelvic floor dysfunction.

Evaluation

According to the symptoms of women, different types of evaluation will be offered. Facilities for evaluation of female pelvic floor dysfunction include the following:

Urodynamics Laboratory:

• Uroflowmetry

• Cystometry

• Cysto-urethroscopy

• Ano-rectal manometry

Ultrasound Imaging:

• Transperineal ultrasound

• Endoanal ultrasound

Treatment

The team provides different types of treatment for female pelvic floor dysfunction.

Urinary incontinence

Urinary symptoms and bladder diary of women will be reviewed. Continence advisors will educate and counsel women on life-style modification, if needed, and pelvic floor muscle training.
For women with overactive bladder syndrome, medical therapy may be offered.
For women confirmed urinary stress incontinence, continence surgery, in terms of tension free transvaginal tape surgery (retropubic or transobturator) or colposuspension may be offered.

Pelvic organ prolapse

A variety of therapeutic options are available, from non-surgical treatment such as pelvic floor muscle training,  to adopting supportive devices of vaginal pessaries, and surgical therapy.

Vaginal pessary: Generally, this is provided for women with mild prolapse or while women are waiting for surgery. If women are recovering well with  this treatment, self-replacement is encouraged. Women can learn the appropriate techniques.

Different surgical approaches are provided.

Vaginal surgery:

• Vaginal hysterectomy and/or pelvic floor repair surgery

• Vaginal mesh repair surgery for selected women with high risk of recurrence

Laparoscopic surgery:

• Laparoscopic sacrocolpopexy for vaginal vault prolapse

• Laparoscopic hysterocolposacropexy (uterine preserving) for uterine prolapse

Concomitant continence surgery may be performed in women with co-existing urinary stress incontinence.

Specialist continence advisors are an invaluable source of practical advice for all continence problems. Continence Advisors are nurses with expertise in providing continence care and conservative management for pelvic organ prolapse. Some of the services provided by the Continence Advisors include:

• Counseling and education

• Pelvic floor muscle training

• Behavioural modification

• Bladder training

• Clean intermittent self-catheterization

• Biofeedback

• Vaginal pessary replacement

• Teaching vaginal pessary self-replacement