Urogynaecology

Urogynaecology is the investigation and treatment of women with bladder problems and/ or vaginal prolapse. These are problems which have enormous cost implications for the NHS consuming up to 1.5% of the total budget. One in eight women will undergo an operation for these problems during their lives. These disorders have an enormous impact on daily quality of life and can also play a role in producing poor outcomes with other co-morbidities such as hip fracture and strokes.

The Urogynaecology unit is based at St Mary’s and is led by two subspecialty trained Consultants - Vik Khullar and Ruwan Fernando. They have established a tertiary referral service for lower urinary tract dysfunction, a problem which affects 20% of all women over the age of 50 years. This is one of the few centres in the UK with investigational tools for imaging the pelvic floor and the bladder including 3 and 4D ultrasound of the pelvic floor(fig 1). The research of the unit has involved in the past assessing the receptors which lead to bladder dysfunction work carried out with Prof Anand, modelling the changes which occur to the pelvic floor during straining a collaboration with Prof Darzi (fig2).

The unit has been involved in the development of new medical and surgical treatments for bladder dysfunction.

In addition to promoting the use of nursing advisors in community care to replace prolonged in patients stays for bladder retraining, they have also developed a bench to bedside research program to investigate mechanisms underlying detrusor instability. This led to the discovery of he receptor basis for managing detruisor over activity, which affects one third of incontinent women.

Present research areas involve the use of new imaging modalities for lower urinary tract dysfunction, determining the causes of vaginal prolapse and using genetic screening techniques