Ambulatory Urology and Urogynaecology
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Группа авторов. Ambulatory Urology and Urogynaecology
Table of Contents
List of Tables
List of Illustrations
Guide
Pages
Ambulatory Urology and Urogynaecology
List of Contributors
1 Principles of an Ambulatory Surgery Service
Infrastructure
Pre‐operative Assessment
Social Selection Criteria
Physical Selection Criteria
Preparation for Surgery
Anaesthesia
Early Recovery: Emergence from Anaesthesia
Intermediate Recovery: Discharge Criteria
Late Recovery: Care After Discharge
Setting Up an Ambulatory Centre
Economics of Ambulatory Surgery
Complication Rates
Conclusion
Further Reading
2 Introduction and Epidemiology of Pelvic Floor Dysfunction
Introduction
Types of Pelvic Floor Dysfunction. Pelvic Organ Prolapse (POP)
Urinary Incontinence
Anal Incontinence
Paradoxical Puborectalis Contraction
Levator Syndrome
Coccygodynia
Proctalgia Fugax
Pudendal Neuralgia
Epidemiology
Pelvic Organ Prolapse
Urinary Incontinence
Anal Incontinence
Predisposing Factors
Pelvic Organ Support. Pelvic Floor
Muscular Support
Fascial Support
Level I Support
Level II Support
Level III Support
Conclusion
Further Reading
3 Ambulatory Evaluation of Pelvic Organ Prolapse and Urinary Incontinence
History. Presenting Symptoms
Urological History
Pelvic Organ Prolapse (POP)
Bulge Symptoms
Urinary Symptoms
Bowel Symptoms
Pain
Sexual Symptoms
Bowel Habits
General Medical History
Obstetric History
Gynaecological History
Family History
Quality of Life
Sexual Dysfunction
Physical Examination. General Examination
Neurological Examination
Abdominal Examination
External Gynaecological Examination
Internal Gynaecological Examination
Assessment of Pelvic Muscle Function
Investigations
Urinary Diary
Urine Analysis
Cough Stress Test
Urethro‐Vesical Mobility
Pad Test
Urogynaecological Ultrasound
Uroflowmetry
Urodynamic Testing (UDS)
Urethral Pressure Profile
Cystoscopy
Conclusion
Further Reading
4 Role of Cystoscopy
Instrument
Pre‐procedure
Indications
Technique
Bladder Pain Syndrome (BPS)
Intra‐operative Cystoscopy
Cystoscopy as Surgical Tool
Side Effects and Complications
Conclusion
Further Reading
5 Role of Nurse Practitioners in Ambulatory Urogynaecological Care
Introduction
Who is a Nurse Practitioner (NP)?
What Can a Urogynaecology Nurse Practitioner Do?
Educational/Training Requirements
Documentation
Managing Risks and Governance Requirements
Conclusions
Further Reading
6 Non‐Surgical Management of Pelvic Floor Disorders
General Life‐Style Interventions
Pelvic Floor Exercises
Supervised PFMT and Biofeedback
Bladder Re‐training
Pessaries
Pharmacotherapy
Percutaneous Posterior Tibial Nerve Stimulation (PTNS)
Conclusion
Further Reading
7 Ambulatory Surgical Procedures in Stress Urinary Incontinence
Introduction
Epidemiology
Pathophysiology
Ambulatory Procedures for Stress Urinary Incontinence
Urethral Bulking Agents
Macroplastique
Bulkamid
Coaptite
Durasphere
Urolastic
Urolon
Single Incision Mini‐Slings (SIMS)
Synthetic Mid‐urethral Slings
Thermomodulation
Laser
Radiofrequency
Conclusion
Further Reading
8 Pelvic Organ Prolapse Surgery as an Ambulatory Procedure
General Requirements
Enhanced Recovery Protocols
The First Stage for ERAS is Pre‐admission
The Second Stage of ERAS is Pre‐operative
The Third Stage of ERAS is Intra‐operative
The Fourth Stage of ERAS is Post‐operative
Urogynaecological Procedures
Vaginal Hysterectomy
Anterior and Posterior Vaginal Repair (Colporrhaphy)
Vault Suspension Procedures
Obliterative Colpocleisis
Fistulae
Practical Considerations to Grow an Ambulatory Urogynaecological Surgery Practice
Further Reading
9 Common Urethral and Vaginal Lesions in Ambulatory Urogynaecology
Introduction
Embryology and Anatomy of Urethra
Benign Urethral Lesions. Urethral Caruncle
Urethral Prolapse
Urethral Diverticulum
Management
Transvaginal Diverticulectomy
Marsupialisation of Diverticulum
Transurethral Saucerisation of Diverticulum
Urethral Fistula
Pathogenesis
Classification of Fistula
Urethral Length
Fistula Size
Scarring
Vaginal Lesions. Bartholin's Cyst
Management
Gartner's and Müllerian Duct Cysts
Skene's Duct Cyst
Other Vaginal and Periurethral Lesions. Epithelial Inclusion Cysts
Leiomyomas
Urothelial Cyst
Conclusion
Further Reading
10 Ambulatory Management of Childbirth Pelvic Floor Trauma
Introduction
Perineal Wound Complications
Perineal Wound Infection
Dehiscence
Granulation Tissue
Superficial Dyspareunia Following Childbirth
Obstetric Anal Sphincter Injuries
OASI Primary Repair and Follow‐Up
Ultrasonography
Box 10.1 Technique of TPUS for the Assessment of the Anal Sphincters
Anorectal Manometry
Mode of Birth in Pregnancies Subsequent to OASIs
Levator Ani Muscle Avulsion
Conclusion
Further Reading
11 Teaching and Training in Urogynaecology
Role of the Generalist Gynaecologist in Urogynaecology
Australia
United Kingdom (UK)
United States of America (USA)
Formal Urogynaecological Training by Country. Australia
United Kingdom
Eligibility
Training Requirements
United States of America
Eligibility
Training Requirements
Low‐Resource Countries – FIGO Recommendations
Emerging Nations/Low‐Resource Settings
Dr Stephen Jeffrey – South Africa
Use of Technology and Simulation in Training
Research
The Mesh Saga
Training Status
Further Reading
Foreword
12 Ambulatory Penile and Inguino‐Scrotal Surgery
Background
Individual Conditions and Procedures. Hydrocele
Varicocele
Testicular Cancer + Radical Inguinal Orchidectomy
Phimosis and Circumcision
Peyronie's Disease and Penile Straightening Surgery
Vasectomy
Further Reading
13 Ambulatory Management of Renal Stone Disease
Epidemiology
Aetiology
Types of Stones
Risk Factors
Symptoms
Signs
Investigation
Emergency Management of the Infected Obstructed System
Treatment. Conservative
Extracorporeal Shock Wave Lithotripsy
Uretero‐renoscopy
PCNL
Long‐Term Management and Prevention
Further Reading
14 The Management of Recurrent Urinary Tract Infections
History
Definitions
Risk Factors and Patient Discussion
Personal Hygiene
Genetics
Fluid Intake
Intercourse
Menopause
Biofilms and QIRs
Further Advice to the Patient
Investigation
Management Strategies
Continuous Antimicrobials
Self‐Directed Prophylaxis
D‐Mannose
Methenamine Hippurate
Vaccines
GAG Layer Treatments
Further Reading
15 An Ambulatory Approach to Benign Prostatic Obstruction
Further Assessment and Investigations. History
Urine Dipstick Testing
Prostate Examination and PSA
Uroflowmetry
Urodynamic Studies
Flexible Cystoscopy
Ultrasound and Post Void Residual Volume Measurement
International Prostate Symptom Score
Medical Management
Surgical Management
Transurethral Resection of Prostate (TURP)
Urolift
Rezūm
Laser Procedures: Holmium Laser Enucleation of Prostate (HoLEP)
Other
Choice of Surgery
Further Reading
16 Urethral Catheters and Ambulatory Management of Urinary Retention
Risk Factors
Definition of Acute Urinary Retention
Definition of Chronic Urinary Retention
Definition of Acute‐on‐Chronic Retention
Causes of Urinary Retention. Prostatic Enlargement
Urethral Strictures
Constipation
Infection
Haematuria leading to Clot Retention
Drugs
Pain
Post‐operative Retention
Pelvic Fracture and Urethral Injury
Neurological Conditions (Parkinson's Disease, Multiple Sclerosis, Fowler's Syndrome)
Cauda Equina
Prolapse in Women
Pelvic Masses
Post‐surgery for Stress Incontinence
Post‐obstructive Diuresis
Clinical Assessment of a Patient with Urinary Retention
Catheter Insertion. Types of Urethral Catheters
Catheter Insertion Technique
Flexible Cystoscopy Guided Catheter Insertion
Suprapubic Catheter Insertion
Patients with Urinary Retention requiring Admission
Ambulatory Urology and Urinary Retention
Further Reading
17 Paediatric Urology
Recurrent Urinary Tract Infections
Reflux
Undescended Testes
Phimosis
Enuresis
Further Reading
18 Urothelial Bladder Cancer: Diagnosis and Management in the Outpatient Clinic
Bladder Cancer Investigation
Clinical Assessment
Cystoscopy
Further Steps
Transurethral Resection of a Bladder Tumour. Surgery
Risk Stratification and Further Treatment and Follow‐Up for Non‐muscle Invasive Disease
Low Risk
Intermediate Risk
High Risk
Muscle Invasive Disease
Further Reading
19 Prostate Cancer: Diagnosis and Management in the Outpatient Clinic
Pathology
Tumour Grading
History
Risk Factors
Symptoms of the Disease
Examination and Investigation
Multiparametric MRI
Biopsy
Techniques
Risk Categorisation
Treatment. Non‐metastatic Disease
Advanced or Metastatic Disease
Key Points
Further Reading
20 Renal Cancer: Diagnosis and Management in the Outpatient Clinic
Incidence
Aetiology
Subtypes
Signs and Symptoms
Investigation
Staging
Role of Biopsy
Management
Enhanced Recovery After Renal Surgery
Further Reading
21 Penile Cancer: Diagnosis and Management in the Outpatient Clinic
Pathology
Risk Factors
Presentation
History
Examination
Primary Lesion (May Be Hidden Under Phimosis)
Lymph Nodes
Investigation. Role of Penile Biopsy
Imaging. Penis
Regional Lymph Nodes
Impalpable Lymph Nodes
Palpable Lymph Nodes
Distant Metastases
Management
Management of the Primary Lesion
Superficial Non‐invasive Disease
Partial or Total Glans Resurfacing
Invasive Disease
Lymph Node Management
Follow‐Up after Treatment
Summary of Key Points
Further Reading
22 Testis Cancer: Diagnosis and Management in the Outpatient Clinic
Aetiology
Symptoms and Signs
Pathology and Subtypes
Investigation
Management of Seminomatous Germ Cell Tumours (SGCTs)
Management of Non‐seminomatous Germ Cell Tumours (NSGCTs)
Management of Metastatic Testicular Cancer
Further Reading
23 Plain X‐Ray, Computed Tomography Scanning, and Nuclear Imaging in Urology
X‐ray
Intravenous Pyelogram (IVP) or Intravenous Urogram (IVU)
CT KUB
CT Urogram (CTU)
Renal Protocol CT Scan
Staging CT Scans
Percutaneous Procedures
Renal Biopsy
Renal Cyst Aspiration
Nephrostomy and Antegrade Procedures
Nuclear Medicine Scans
MAG3 Renogram
DMSA
Bone Scan
Positron Emitting Tomography (PET)/PET CT
Further Reading
24 Magnetic Resonance Imaging in Urology
Basic Principles
Clinical Applications. Multi‐Parametric MRI in Prostate Cancer
Evaluation of Renal Masses
Staging Investigations
Advantages and Disadvantages
Further Reading
Index
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Edited by
Abhay Rane, OBE, MS, FRCS, FRCS(Urol)
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Mark Salmon, MBBS, FRCA, DipIMC Department of Anaesthesia East Surrey Hospital Surrey and Sussex Healthcare NHS Trust United Kingdom
Marcella Zanzarini Sanson Department of Obstetrics and Gynecology Medical School of Ribeirão Preto University of São Paulo Brazil
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