Pessaries In Clinical Practice

This book provides a comprehensive review of the evidence concerning pessaries and the practicalities of using them. It is a valuable resource for health care practitioners treating patients with incontinence and prolapse. It includes a brief history of pessaries and provides profiles of the inventors of some of the more commonly used pessaries, along with a description of their original purposes. There are illustrations to guide selection, fitting and care, as well as providing materials which can be photocopied and handed out to patients. This work is an essential handbook for all urogynecologists, urologists, gynecologists, family physicians and specialty nurses.

With mesh surgery for prolapse sometimes proving problematic, there has been a resurgence of professional medical interest in more traditional methods for the management of prolapse and of stress urinary incontinence. This concise guide to the practical aspects of pessary use will be of interest to all gynecologists involved in the clinical management of the patient with these problems. Contents: Historical review * Pessaries for pelvic organ prolapse * Incontinence pessaries * Pessary fitting * Pessary care * Outcomes of pessary use * Current clinical studies on vaginal pessaries Cover image of vaginal pessaries © 2019 Rick Hicaro, Jr., Chicago, IL 60647, USA

Background: Pelvic organ prolapse (POP) can be treated surgically or, more conservatively, with use of a pessary. Objective: To determine if the population of women treated for POP with the use of a pessary in one Nurse Practitioner's (NP) practice demonstrated health outcomes as better, same, or needing improvement through use of a data-based practice model from encounter data extracted from the electronic health record (EHR). Design: The project design was a quality improvement (QI) project, descriptive in nature. One Plan Do Study Act (PDSA) cycle was conducted for this QI project. Setting: NP managed specialty clinic in urban Southwestern Arizona that provides services to women with POP. Patients: Ten randomly selected women who had been treated conservatively for POP with use of a pessary were identified as two subpopulations and evaluated: women who received professional management of the pessary and women who were patient managed. Intervention: The intervention was the development of a data-based practice model, using patient profile data elements derived from the documented EHR encounters of the 10 women. Measurements: Twelve scales were developed to evaluate the patient profile data elements, generating numeric scores for each encounter. Two Decision Rules were then used to evaluate numeric scores by encounter, creating primary and secondary health outcomes. Limitations: Two limitations were identified. The QI project was limited by the small sample size of 10 patients. This is however, true to PDSA guidelines that recommend small scale cycles. The data were limited as only documented data were used. Conclusions: In general, the expected outcome was the outcome observed; the provider was unaware of any women in this QI Project who were not successfully treated with use of a pessary for treatment of POP. The value of this data-based practice model is that outcomes can be aggregated across populations rather than relying on recall of individual outcomes and therefore has potential to be used regularly and systematically as a quality feedback loop, as well as on a larger scale in future PDSA cycles to determine other outcomes beyond a single provider in this or other similar clinical populations.

Presents almost 100 common and uncommon gynecologic problems encountered in urgent and emergency settings with an emphasis on practical management.

Bridging the gap between evidence-based research and clinical practice, Physical Therapy for the Pelvic Floor has become an invaluable resource to practitioners treating patients with disorders of the pelvic floor. The second edition is now presented in a full colour, hardback format, encompassing the wealth of new research in this area which has emerged in recent years. Kari Bø and her team focus on the evidence, from basic studies (theories or rationales for treatment) and RCTs (appraisal of effectiveness) to the implications of these for clinical practice, while also covering pelvic floor dysfunction in specific groups, including men, children, elite athletes, the elderly, pregnant women and those with neurological diseases. Crucially, recommendations on how to start, continue and progress treatment are also given with detailed treatment strategies around pelvic floor muscle training, biofeedback and electrical stimulation. aligns scientific research with clinical practice detailed treatment strategies innovative practice guidelines supported by a sound evidence base colour illustrations of pelvic floor anatomy and related neuroanatomy/ neurophysiology MRIs and ultrasounds showing normal and dysfunctional pelvic floor incorporates vital new research and material uses key summary boxes throughout new edition to highlight quick reference points now in full colour throughout and a hardback format

This excellent textbook provides up-to-date information on all aspects of pelvic floor disorders. After an opening section on anatomy and physiology, it explains the methodology, role and application of the integrated imaging approach in detail, including the most advanced 3D, 4D, and dynamic ultrasound techniques, illustrated with hundreds of images. It then discusses in depth the epidemiology, etiology, assessment, and management of the full range of pelvic floor disorders from multidisciplinary and practical perspectives. The book also provides information on the various forms of obstetric perineal trauma, urinary incontinence and voiding dysfunction, anal incontinence, pelvic organ prolapse, constipation and obstructed defecation, pelvic pain and sexual dysfunction, and fistulas, and includes treatment algorithms as well as helpful guidance on what to do when surgical treatment goes wrong. The authors are leading experts in the field from around the globe. Since the first edition from 2010 (more than 200,000 chapter downloads), the book has been extensively rewritten and features numerous additional topics. The result is a comprehensive textbook that is invaluable for gynecologists, colorectal surgeons, urologists, radiologists, and gastroenterologists, beginners and veterans alike.

A unique combination medical reference and full-color surgical atlas on female pelvic medicine and reconstructive surgery An essential clinical companion and an outstanding practical review, Female Pelvic Medicine & Reconstructive Surgery is the most comprehensive single-volume resource available on urogynecology. It delivers a solid introduction to this growing subspecialty and thoroughly covers its underlying principles with an emphasis on diagnostic techniques and management strategies. Authored by a team of international experts, the book is enhanced by hundreds of original full-color photographs and illustrations that provide step-by-step guidance on key surgical procedures. Female Pelvic Medicine & Reconstructive Surgery is logically divided into four sections: Fundamental Topics--Includes essentials such as epidemiology, anatomy of the pelvic floor, mechanisms of disease, and evaluation of the patient with pelvic floor dysfunction Disease States--Covers lower urinary tract dysfunction, functional anorectal disorders, pelvic organ prolapse, and other pelvic floor disorders Clinical Management--Details pessaries, physical therapy, behavioral therapy, the use of graft materials in reconstructive surgery, peri-operative and post-operative medical evaluation and care, and incorporating new treatments into clinical practice Surgical Atlas--Reviews surgical instrumentation and illustrates surgery for stress urinary incontinence, pelvic organ prolapse, fistula repair, anal incontinence, and covers the management of surgical complications

Urogynecology: Evidence-Based Clinical Practice 2nd Edition is a fully revised and updated text providing an evidence based approach to the treatment of urinary incontinence and prolapse. This updated version incorporates new evidence in the areas of continence procedures, prolapse management, mesh usage and complications; in addition to new insights into Sacral Nerve Stimulation for refractory detrusor overactivity. Written by a leading expert in the field, Urogynecology: Evidence-Based Clinical Practice 2nd Edition is a handy how-to guide, valuable for the junior registrar assigned to work in a urogynecology department, as well as for those with no previous formal urogynecological training who wish to know more about the subject.