Urogynaecology

Urogynaecology is a sub speciality of gynaecology, treating patients with urinary incontinence, vaginal prolapse, recurrent urinary tract infections, bladder pain and pelvic floor injury after childbirth including faecal incontinence, along with many other conditions.

Women are offered a comprehensive range of treatment options from conservative treatments to advanced surgical procedures if appropriate (including keyhole surgery).

Treatments are delivered by a dedicated team of doctors (surgeons), specialist nurses and pelvic health physiotherapists.

There is a dedicated nurse led pessary service for women requiring fitting, insertion, or changes and for those encountering pessary problems. The clinics are held in Ysbyty Cwm Cynon, Ysbyty Cwm Rhondda, Keir Hardie Health Park and Princess of Wales Hospital.

Meet the Team

Mohamed Elnasharty
Mr M Elnasharty FRCOG, MD MSC Obstetrics and Gynaecology
Consultant Gynaecologist with special interest in Urogynaecology Minimal Access Surgery
Children and Family Care Group Medical Directory

Sanjay Chawathe
Obstetrics Gynaecology and Sexual Health

Sreevidya Govindapillai Ambika
Obstetrics Gynaecology and Sexual Health

Nadia Z Hikary-Bhal
Obstetrics Gynaecology and Sexual Health

Andrew Allman
Consultant

Karin Bisseling
Consultant

Angharad Carroll
Senior Nurse in Urogynaecology

Victoria Atkins
Pelvic Health co-ordinator

Victoria Collins
HCSW in Urodynaecology

Laura Carter
Health Care Support Worker

Conditions treated include:

Female Urinary Incontinence

There are several types of urinary incontinence, including:

Stress incontinence - when urine leaks out at times when your bladder is under pressure; for example, when you cough or laugh.
Urge (urgency) incontinence - when urine leaks as you feel a sudden, intense urge to pee, or soon afterwards.
Overflow incontinence (chronic urinary retention) - when you're unable to fully empty your bladder, which causes frequent leaking.
Total incontinence - when your bladder cannot store any urine at all, which causes you to pass urine constantly or have frequent leaking.
It's also possible to have a mixture of both stress and urge urinary incontinence.

Find out more about the Urinary incontinence symptoms on the main NHS website.

Utero-Vaginal Prolapse

Cystocele: Prolapse of the front wall of the vagina.
Rectocele: Prolapse of the back wall of the vagina.
Uterus: Prolapse of the womb.
Vault: Prolapse of the top of the vagina after a hysterectomy.

Find out more about more about Pelvic organ prolapse - NHS https://www.nhs.uk

The British Society of Urogynaecology (BSUG) and the Pelvic organ prolapse NHS website have further information about treatment offered.

Referrals: The urogynaecology team works closely with a variety of specialised teams to ensure comprehensive care throughout your journey. As part of your treatment plan, you may be referred to a pelvic health physiotherapist for targeted exercises, the bladder and bowel team for symptom management and support, the colorectal team for addressing related concerns and the urology team for specialised expertise in urinary tract issues. This multidisciplinary approach is designed to provide holistic and tailored care, addressing all aspects of pelvic health.

Physiotherapy

Physiotherapy can be helpful in many ways. If your prolapse can be managed without the need for a pessary or surgery, you may be referred to a physiotherapist in order to strengthen the pelvic floor muscles.

If you do have any other treatments, you will still need to complete the physiotherapy sessions prior to any surgical intervention as it can help by improving control over bladder and bowel function, improving existing prolapse or reducing the risk of prolapse, and improved recovery from childbirth and surgery.

Bladder and Bowel Team: The Bladder and Bowel health service are a team specialising in the care of patients with bladder and bowel symptoms. Offering an open referral system we offer assessment, management and advice on many aspects of bladder and bowel care. Within Cwm Taf Morgannwg the bladder and bowel team offer Nurse led clinics (for lower urinary tract symptoms – LUTS and Pelvic Floor exercises) and Urinary Catheterisation – held at HCHP, DSH, YCC & RGH. Education – multidisciplinary & multiagency (Urinary Catheterisation, Bowel Care & Continence Assessment & Management – all can be accessed via SharePoint). Residual urine ultrasound scans, Flow studies, Assessment and fitting of urinary appliances and symptom management/coping strategies.

Bladder Diary

Bladder Training

Squeezy

Colorectal Team

Urogynaecology and colorectal teams work closely together to provide coordinated care for patients with complex pelvic floor disorders that affect both the urinary and bowel systems. The teams combine their expertise to ensure accurate diagnosis and comprehensive management. This collaborative approach allows for integrated surgical and non-surgical treatments and ensures that patient care is holistic, efficient, and centred on improving overall pelvic floor function and quality of life.

Treatments
Urogynaecology offer several treatments to women with pelvic organ prolapse, incontinence, as well as bladder pain syndrome, please see below all treatments our service offers.

Vaginal Pessaries

Vaginal pessaries are used to alleviate symptoms of pelvic prolapse and support the vaginal walls. Pessaries come in all different shapes and sizes used on a trial-and-error basis to find the patients correct fit depending on their prolapse and lifestyle. Pessaries are either PVC or silicone and are placed into the vagina. This device should be comfortable and help improve quality of life.

Vaginal estrogen is offered during pessary management to keep vaginal tissues well moisturised.

Urodynamics

At the start of the urodynamic investigation, a fine sensor, catheter tube/wire (sterile) will be put into your bladder through the urethra (the tube through which urine is passed). Another sensor will be placed into the rectum (back passage) or vagina (used occasionally for women). Placing these tubes/wires should not be painful as a lubrication gel is used to reduce any discomfort. Some patients may find this part of the investigation slightly uncomfortable or a little embarrassing. The nurse specialist will try to reduce this as much as possible. When the sensor tubes/wires are in place, they are attached to a computer and your bladder activity will be measured as it fills and empties.

Your bladder will be filled with sterile saline (salt water) through the fine tube until you feel the need to pass urine. You will be asked to cough at various stages during the investigation; this is to show if the sensors are recording correctly. The nurse specialist will try to reproduce the bladder symptoms that you are currently having by getting you to cough, laugh or listen to running water. You will also be asked a series of questions such as your first desire to pass urine or whether you experience any urgency. When the nurse specialist feels that enough information has been collected, you will be allowed to empty your bladder into the specially adapted urodynamic toilet (in private). This toilet will measure the flow rate and volume of urine passed. Once this is done, the sensor tubes/wires will be gently taken out and you will be offered some wet wipes and dry wipes so you can have a wash and make yourself comfortable and get dressed in privacy.

Urodynamics