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The need for perineal repair after childbirth affects millions of women worldwide. In the United Kingdom, approximately 85% of women sustain some form of perineal trauma during vaginal delivery, and 69% of these will require stitches.
Artefacts during uroflowmetry may arise owing to several factors, which can be broadly classified into two groups: extracorporeal and intracorporeal. Recommendations to minimise uroflowmetry artefacts include ensuring privacy, checking the report and tracing immediately, correcting artefacts manually and checking that the void was representative of normal. Initial quality checks will prevent the majority of artefacts. Artefacts may arise during the voiding phase owing to displacement of the vesical or rectal pressure transducer or inadequate pressure transmission. Artefacts are spurious and inaccurate urodynamic observations. Artefacts at uroflowmetry are minimised by checking calibration regularly and asking the patient to void normally in private. Artefacts during cystometry can be minimised by zeroing transducers to atmospheric pressure, expelling air bubbles and checking for good subtraction with cough testing before filling, at 1-minute intervals during filling and before and after voiding.
This book provides a practical guide for anyone performing or training to perform urodynamic studies. Details on how to set up urodynamic equipment and perform individual urodynamic techniques are discussed, ranging from basic tests such as uroflowmetry and subtracted cystometry through to the more complex videocystometry, ambulatory monitoring and urethral function tests. Many of the chapters include case studies to place the investigations within the context of a symptom complex. This book has a place in every urodynamics laboratory as an easy reference guide and is an essential illustrative text for teaching the fundamentals of good urodynamic practice.
Urodynamic investigations are used to investigate bladder function and dysfunction in women with urinary symptoms, the most common being urinary incontinence. Guidance from the National Institute for Health and Clinical Excellence covers much of when investigations should be performed. Women are often anxious and embarrassed when they attend the tests. Recognition of the artificial test conditions and the feelings of the woman are crucial to optimising the chances of reproducing symptoms. Before cystometry, written information explaining the test should be provided with the appointment letter or when the woman attends the clinic. The information should include instructions on providing a urine sample in a sterile container, bladder chart and questionnaires and advice to come with a comfortably full bladder. Women who are using drugs to treat lower urinary tract dysfunction should normally stop using the medication for an appropriate period of time before the investigation.
This book provides concise information to help clinicians who are new to urodynamics as well as acting as an aide memoire for established practitioners. It was born out of the recognised need for a manual that can be an instant reference for practitioners. The book follows many of the key principles taught on the joint Royal College of Obstetricians and Gynaecologists and British Society of Urogynaecology Urodynamics Course and uses the Minimum Standards in Urodynamics document and the International Continence Society standards as the main underpinning documentation for the text.
We cannot overstate the importance of the expertise of the observer when attempting to obtain accurate and reliable measurements when performing urodynamics. Good urodynamic practice occurs when there is a clear urodynamic question, adequate patient preparation, appropriate technical expertise and an interactive test. In this book, we provide both a technical and clinical guide for the urodynamics observer through illustration of many of the practical steps and common clinical observations reported in the urodynamics laboratory. Several urodynamic investigations are discussed, ranging from the basic tests such as uroflowmetry and subtracted cystometry to the more complex namely videocystometry, ambulatory monitoring and urethral function tests. The key principles of measurement of physiological and pathophysiological parameters of lower urinary tract function are common, irrespective of type of investigation. This book should provide the core knowledge to undertake these measurements and an understanding of their limitations.
Anal endosonography is regarded as the gold standard investigation in patients presenting with faecal incontinence. The endosonography is also useful in the diagnosis of anal pain, anorectal tumours, fistulae, abscesses and anismus. The advent of anal endosonography has enabled considerable research into obstetric related anal sphincter trauma, the major aetiological factor in the development of anal incontinence. The internal anal sphincter is a thickened continuation of the circular smooth muscle layer of the bowel and appears homogeneously hypoechoic. The external anal sphincter usually appears hyperechoic, but has a heterogeneous appearance. Magnetic resonance imaging (MRI) defines the striated components of the sphincter with greater clarity. In 1994, Sultan et al. first described transvaginal endosonography to image the anal sphincters at rest with a rotating probe. The development of anal endosonography added a new dimension to understanding the pathogenesis of anal incontinence and the diagnosis of obstetric anal sphincter injuries.
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