{"id":4499,"date":"2022-05-03T11:47:20","date_gmt":"2022-05-03T10:47:20","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/urogynaecology\/"},"modified":"2025-04-28T10:49:18","modified_gmt":"2025-04-28T09:49:18","slug":"urogynaecology","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/gynaecology\/urogynaecology\/","title":{"rendered":"Urogynaecology"},"content":{"rendered":"\n<h4 class=\"wp-block-heading\">Services <\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">The Urogynaecology Department offers complete clinical and urodynamic assessment of female patients with pelvic floor dysfunction including lower urinary tract symptoms (LUTS) and incontinence, access to the nurse urogynaecology unit as well as surgical intervention for urinary incontinence and prolapse.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">06-07-21<\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">Who to refer:<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">Women with symptoms as above and:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Failed Conservative Management<\/li>\n\n\n\n<li>Significant (beyond introitus) and \/ or Symptomatic Prolapse<\/li>\n\n\n\n<li>Previous Incontinence \/ Prolapse Surgery<\/li>\n\n\n\n<li>Previous Pelvic Irradiation<\/li>\n\n\n\n<li>Complicated symptoms (consider referral to urology):\n<ul class=\"wp-block-list\">\n<li>Haematuria<\/li>\n\n\n\n<li>Bladder pain<\/li>\n\n\n\n<li>Recurrent UTIs<\/li>\n\n\n\n<li>Difficulty with bladder emptying \/ Urinary Retention<\/li>\n\n\n\n<li>Suspected fistula<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Women with a suspected pelvic mass should be first referred for an Ultrasound Scan to establish a diagnosis and then referred according to the findings.<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">If symptoms are of sudden onset or atypical, especially in the elderly, bladder malignancy should be considered with early referral urology.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Who not to refer:<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Women with uncomplicated symptoms who have&nbsp;<strong>not<\/strong>&nbsp;undergone initial primary care management<\/li>\n\n\n\n<li>Women with urinary symptoms due to a pelvic mass \u2013 this needs urgent investigation first (Ultrasound Scan)<\/li>\n\n\n\n<li>Women requiring input from physiotherapy \u2013 please refer directly to generic physiotherapy via SCI Gateway: this is the first line management for all those with any element of stress incontinence (SCI Gateway -AHP-Physiotherapy)<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">How to refer:<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><\/strong>Via SCI Gateway:&nbsp; Specialty Gynaecology \u2013 Urogynaecology<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Referrals&nbsp;Pathway to Women&#8217;s Health Physiotherapists in the Community across Edinburgh &amp;Lothians (West\/Mid\/East)via SCI Gateway \u2013 Options:<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">&nbsp; AHP \u2013 Physiotherapy.&nbsp;<strong>Edinburgh \u2013 Community MSK HUB (Slateford)<\/strong><br>&nbsp; AHP \u2013 Physiotherapy.&nbsp;<strong>East Lothian \u2013&nbsp;East Lothian Community&nbsp;Hospital<\/strong><a rel=\"noreferrer noopener\" href=\"\/files\/sites\/2\/Urogynaecology-East-Lothian-self-referral.doc\" target=\"_blank\">&nbsp;<\/a><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Urogynaecology-East-Lothian-self-referral.doc\" data-type=\"attachment\" data-id=\"9657\" target=\"_blank\" rel=\"noreferrer noopener\">Please note &#8211; patients can self refer using form&nbsp;<\/a><br>&nbsp; AHP \u2013 Physiotherapy.&nbsp;<strong>Midlothian&nbsp;&#8211; Bonnyrigg Health&nbsp;Centre&nbsp;Please note &#8211;&nbsp;<a rel=\"noreferrer noopener\" href=\"\/files\/sites\/2\/Midlothian-Patient-Pelvic-Health-self-referral-2020-09.doc\" target=\"_blank\">patients can self refer using form&nbsp;<\/a><\/strong><br>&nbsp; AHP \u2013 Physiotherapy.&nbsp;<strong>West Lothian -St Johns Hospital<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Referrals will be directed to one of the Community Physiotherapy Services MSK Outpatient Clinics.<\/li>\n\n\n\n<li>Referrals will be triaged appropriately to a Women&#8217;s Health Physiotherapist.<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p class=\"wp-block-paragraph\">PRESCRIBING FOR THE TREATMENT OF OVERACTIVE BLADDER IN LOTHIAN<br><br>Symptoms of overactive bladder include:<br>Urinary frequency \/ urgency \/ nocturia with or without urge incontinence<br><br>PRIOR TO PRESCRIBING MEDICATION:<br>1.&nbsp;&nbsp;&nbsp; Exclusion of the following:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Haematuria<\/li>\n\n\n\n<li>Recurrent urinary tract infection<\/li>\n\n\n\n<li>Difficulty with bladder emptying<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Any of the above and previous surgery for incontinence warrant early referral<br>2.&nbsp;&nbsp;&nbsp; Conservative management:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Advice regarding fluid intake<\/li>\n\n\n\n<li>Bladder retraining<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">MEDICATION FOR THE OVERACTIVE BLADDER:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Medication should be commenced at the lowest dose and titrated up as required and tolerated.&nbsp;<\/li>\n\n\n\n<li>If medication is not effective or not tolerated, the formulation should be changed.&nbsp;<\/li>\n\n\n\n<li>The use of medication for overactive bladder may be limited by side effects. These may be reduced by adjusting the dose or changing the formulation \/ application.<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Generic antimuscarinic formulations:<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Tolterodine tartrate&nbsp;<\/strong>(Tablets 1mg, 2mg)<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Dose:&nbsp;&nbsp;2mg twice daily. Reduced if not tolerated to 1mg twice dailyModified release tablets 4mg once&nbsp;daily<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Oxybutynin hydrochloride is no longer on the Lothian Formulary but is the only formulation available for transdermal application if oral application is not tolerated; it should not be used in patients aged over 65 due to increased risk of cognitive impairment<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">M3 selective antimuscarinic formulations:<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Solifenacin<\/strong>&nbsp;(Tablets 5mg, 10mg)<br>Dose:&nbsp;&nbsp;5mg once&nbsp;daily.&nbsp;Increase to 10mg daily if required<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Fesoterodine<\/strong>&nbsp;&nbsp;(Tablets 4mg, 8mg)&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Dose:&nbsp;&nbsp;&nbsp;4mg once&nbsp;daily. Increase to 8mg daily if required<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">b3 Receptor agonist:<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Mirabegron&nbsp;<\/strong>(Tablets 50mg)<br>Dose:&nbsp;50mg once&nbsp;daily<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>If antimuscarinic formulations are contra-indicated, not effective in controlling symptoms or not tolerated, the b3-receptor agonist is an alternative option.<\/li>\n\n\n\n<li>In patients who are already on medication with a high anticholinergic load, the b3-receptor agonist may be considered as a first line option.<\/li>\n\n\n\n<li>The lower dose of Mirabegron 25mg is available for patients with renal or hepatic impairment.<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image\"><div class=\"wpcp-wp-lightbox-host wpcp-advanced-image-lightbox-icon-hover\"><a class=\"wpcp-wp-lightbox-image-link\" href=\"\/files\/sites\/2\/Urogynae-Treatrment-of-Overactive-Bladder.png\" data-wpcp-wp-lb-image=\"1\"><img decoding=\"async\" src=\"\/files\/sites\/2\/Urogynae-Treatrment-of-Overactive-Bladder.png\" alt=\"Urogynae Treatrment of Overactive Bladder\" \/><\/a><a href=\"\/files\/sites\/2\/Urogynae-Treatrment-of-Overactive-Bladder.png\" data-fancybox=\"wpcp-wp-wpcp-wp-1\" class=\"wpcp-lightbox-trigger wpcp-advanced-image-lightbox-icon wpcp-position-top-right wpcp-advanced-image-lightbox-icon-hover wpcp-global-lightbox-icon wpcp-lightbox-icon--global wpcp-lb-icon-style-default\" data-wpcp-lb-icon-source=\"global\" aria-label=\"Open image in lightbox\" data-thumb-src=\"\/files\/sites\/2\/Urogynae-Treatrment-of-Overactive-Bladder.png\" data-wpcp-lb-single=\"1\"><span class=\"wpcp-icon-container\"><svg viewBox=\"0 0 20 20\"><path d=\"M17.6585 16.025L14.2437 12.6198C15.1716 11.3338 15.6121 9.7613 15.4871 8.1819C15.362 6.60251 14.6795 5.11847 13.5607 3.99351C12.936 3.36206 12.1916 2.86066 11.3709 2.51845C10.5502 2.17623 9.66952 2 8.77995 2C7.89039 2 7.00969 2.17623 6.18899 2.51845C5.36829 2.86066 4.62395 3.36206 3.99919 3.99351C3.36594 4.61649 2.86312 5.35871 2.51992 6.17708C2.17673 6.99545 2 7.87365 2 8.76068C2 9.64772 2.17673 10.5259 2.51992 11.3443C2.86312 12.1627 3.36594 12.9049 3.99919 13.5279C5.11957 14.6901 6.62279 15.4103 8.23285 15.5562C9.84291 15.7022 11.4517 15.2641 12.7639 14.3224L16.1788 17.7275C16.3849 17.9034 16.6473 18 16.9186 18C17.1899 18 17.4523 17.9034 17.6585 17.7275C18.1138 17.16 18.1138 16.5925 17.6585 16.025ZM5.59278 12.0523C5.16258 11.6298 4.82094 11.1263 4.58774 10.5709C4.35455 10.0156 4.23446 9.41951 4.23446 8.81744C4.23446 8.21536 4.35455 7.6193 4.58774 7.06394C4.82094 6.50859 5.16258 6.00503 5.59278 5.58257C6.01644 5.15359 6.52144 4.81292 7.07838 4.58039C7.63532 4.34786 8.23308 4.22811 8.83687 4.22811C9.44066 4.22811 10.0384 4.34786 10.5954 4.58039C11.1523 4.81292 11.6573 5.15359 12.081 5.58257C12.5112 6.00503 12.8528 6.50859 13.086 7.06394C13.3192 7.6193 13.4393 8.21536 13.4393 8.81744C13.4393 9.41951 13.3192 10.0156 13.086 10.5709C12.8528 11.1263 12.5112 11.6298 12.081 12.0523C11.6573 12.4813 11.1523 12.822 10.5954 13.0545C10.0384 13.287 9.44066 13.4068 8.83687 13.4068C8.23308 13.4068 7.63532 13.287 7.07838 13.0545C6.52144 12.822 6.01644 12.4813 5.59278 12.0523Z\" \/><\/svg><\/span><\/a><\/div><\/figure>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p class=\"wp-block-paragraph\">\u200bPelvic health, Continence and Prolapse education video:&nbsp;<a rel=\"noreferrer noopener\" href=\"https:\/\/vimeo.com\/428502146\" target=\"_blank\">https:\/\/vimeo.com\/428502146<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a rel=\"noreferrer noopener\" href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/POGP-PelvicFloor-Exercises-for-women.pdf\" target=\"_blank\">POGP-PelvicFloor Exercises for women<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a rel=\"noreferrer noopener\" href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/UK-Pessary-Guideline-final-April21.pdf\" target=\"_blank\">UK Pessary Guideline final April21<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Gynae-Urogynaecology-Mgt-Female-Urinary-Symptoms-Printable-08Jan20.pdf\" data-type=\"URL\" data-id=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Gynae-Urogynaecology-Mgt-Female-Urinary-Symptoms-Printable-08Jan20.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Management of Female Urinary Symptoms Printable Jan2020<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a rel=\"noreferrer noopener\" href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Guidance-on-use-of-BASICS-community-1.pdf\" target=\"_blank\">Guidance on use of BASICS community <\/a>assessment of bladder function<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/UroGynaecology-Physiotherapy-Pelvic-Floor-Urinary-incontinence-Prolapse.pdf\" data-type=\"URL\" data-id=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/UroGynaecology-Physiotherapy-Pelvic-Floor-Urinary-incontinence-Prolapse.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Physiotherapy Pelvic Floor Urinary incontinence Prolapse<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a rel=\"noreferrer noopener\" href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Uro-Gynae-Keeping-your-bladder-healthy-leaflet-Sept-18.pdf\" data-type=\"URL\" data-id=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Uro-Gynae-Keeping-your-bladder-healthy-leaflet-Sept-18.pdf\" target=\"_blank\">Keeping your bladder healthy leaflet Sept 18<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Prescribing-for-the-Treatment-of-Overactive-Bladder.pdf\" data-type=\"attachment\" data-id=\"11027\" target=\"_blank\" rel=\"noreferrer noopener\">Prescribing for the Treatment of Overactive Bladder<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Services The Urogynaecology Department offers complete clinical and urodynamic assessment of female patients with pelvic floor dysfunction including lower urinary tract symptoms (LUTS) and incontinence, access to the nurse urogynaecology unit as well as surgical intervention for urinary incontinence and prolapse. 06-07-21<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":3976,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_searchwp_excluded":"","footnotes":""},"categories":[238],"class_list":["post-4499","page","type-page","status-publish","hentry","category-urogynaecology"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/nhs-lothian\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/gynaecology\/urogynaecology\/\" rel=\"tag\">Urogynaecology<\/a>","rttpg_excerpt":"Services The Urogynaecology Department offers complete clinical and urodynamic assessment of female patients with pelvic floor dysfunction including lower urinary tract symptoms (LUTS) and incontinence, access to the nurse urogynaecology unit as well as surgical intervention for urinary incontinence and prolapse. 06-07-21","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4499","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=4499"}],"version-history":[{"count":0,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4499\/revisions"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3976"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=4499"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=4499"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}