About the Urodynamics Department
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This is a purpose built unit within the Women’s Hospital and can be found on the ground floor. It has it’s own entrance, reception and waiting area, along with three clinic rooms for urodynamic investigations. There are 4 consulting rooms, 5 separate WC’s including one with disabled access. We also perform weekly clinics for urodynamic investigations in the Aintree Centre for Women’s Health, which is located in the assessment unit on Ward 4.
Staff in the Department
Mr D. Richmond Consultant
Miss E. Adams Consultant
Dr K. Ward Consultant
Mr G. Rowland Consultant
Mrs K. Taylor Urogynaecology Nurse Specialist/ Department Manager
Mrs C. Caddick Urogynaecology Nurse
There is also a urogynaecology sub-speciality registrar, a urogynaecology research doctor, two staff nurse’s (one based at Aintree Centre for Women’s Health) an urogynaecology link midwife and a health care assistant who form an important part of the team in the department. Physiotherapy plays a large part in treating patients with continence problems and the physiotherapists in the Women’s and at Aintree provide assessment and treatment of the pelvic floor.
Junior medical staff, medical students, nursing and midwifery students also attend clinics as part of their training.
The department can see more than 1000 new patients each year; many of the patients are referred by other Consultants, both at the Women’s Hospital and from around the Mersey region. Most women attending the clinic suffer with incontinence or some sort of bladder or bowel problem and the unit deals with patients with more complex urogynaecological problems. Medical staff perform the majority of the cystometric testing, although we are developing nurse led cystometric testing performed by the 2 nurse specialists. Medical staff also perform the urogynaecology review clinics.
What is Urodynamics?
Urodynamics is the investigation of the way in which the lower urinary tract works. It involves the use of a series of diagnostic tests, which help to identify the cause of continence problems.
What will happen in the clinic?
A standard urogynaecological consultation consists of:
- A full medical history and quality of life questionnaire
- Physical examination
- Urine test
- Completion of a fluid input/output chart
This is followed by a 2-hour pad test, free uroflowmetry and measurement of residual urine volume. A filling and voiding Cystometry complete the consultation. Treatment will vary according to the problem but often non-surgical help is given in the unit before surgical intervention is used.
Investigations performed in the Department Include:
- Uroflow measurement
- Transvaginal ultrasound for measurement of post residual urine volumes
- Filling and voiding cystometries (subtracted dual channel)
- Urethral pressure profiles and ambulatory urodynamics
- Endo-anal ultrasound scan
- Rectal manometry studies
Nursing Staff
The other nursing staff supervise pad-testing and flow rate measurements, take urogynaecology histories, assist the medical staff to perform Cystometry tests and provide help and support to patients about available continence products.
All the staff are very aware of the embarrassment associated with incontinence and they treat each patient with the sensitivity they need./newimg_061.jpg)
Ano-rectal dysfunction
There has been an increase in the referral of patients with ano-rectal dysfunction. This has prompted the development of a multi-professional clinic, which is currently held every 3 months. These combine the expertise of a consultant urogynaecologist from the Women’s and a consultant colo-rectal surgeon from the Royal Liverpool and Broadgreen University trust. The clinics are held in the Urodynamic Department.
Perineal Clinic
The perineal clinic provides follow-up, advice and investigation for new mothers who have had a third or fourth degree tear during their delivery. It also sees and manages women with chronic perineal problems caused through delivery.
Miss Adams and Dr Ward, the nurse specialist and the link midwife work together to perform this clinic, which is held every Thursday in the Urodynamic Department.
Prolapse Clinic
Miss Adams and Dr Ward, who have a special interest in this area of women’s health, provides assessment, investigation and advice for women with prolapse. The clinic is currently held every fortnight in the department. Patients can be referred directly by their GP.
Research
There is considerable research undertaken within the department by both the medical and nursing staff. There are also strong research links with Liverpool University through collaboration with the Departments of Rheumatology, Immunology, Cell Biology, and also Manchester University.
New developments within the Urodynamic department
We have been fortunate to be able to recently employ an urogynaecology link- midwife. She will be working closely with the clinical nurse specialist and the consultants to improve care for ante and post natal women with bladder and perineal problems. We also hope to develop nurse led Cystometry clinics, which will help to improve the service by increasing the availability for these tests to be performed.
Some useful websites for further information are;
www.continence-foundation.org.uk
www.incontact.org
http://www.interstitialcystitis.co.uk
http://www.2womenshealth.co.uk
http://www.bowelcontrol.org.uk
