The urogynaecology department provides both a general gynaecology, subspecialist urogynaecology service and minimally invasive gynaecology services.
Scope of service
This service is operated through the Urogynaecology Firm, one of the three gynaecology units. The general service includes both a busy emergency and elective gynaecology component. The emergencies include a broad range of pathology. We also manage the post-partum surgical complications as part of the general gynaecology service. The three gynaecology firms share the general gynaecology workload.
Minimally invasive gynaecology
Aspects of the general gynaecology service that are unique to our unit is that we perform a significant portion the minimally invasive surgical procedures including both outpatient and in-patient hysteroscopy.
This is the main focus of the unit. We provide a service for women with pelvic floor dysfunction, which includes urinary and faecal incontinence, pelvic organ prolapse and post –partum perineal trauma.
Details of the patient profile which the Unit manages.
- Stress urinary incontinence (SUI)
- Urgency and urgency incontinence of varying aetiology.
- Women with voiding difficulties i.e. hesitancy, poor stream, double voiding, incomplete emptying, post-micturition dribbling
- Women with a suspected neurological cause of urinary incontinence
- Painful bladder syndrome / interstitial cystitis
- Women with all grades of pelvic organ prolapse.
- Women with pelvic floor pathology involving all compartments with components relating to colo-rectal, urological, and gynaecological issues.
- Persistent or worsening urinary symptoms after surgery for stress urinary incontinence
- Symptoms of voiding dysfunction after surgery for SUI.
- Symptoms of voiding dysfunction, SUI and detrusor overactivity.
- Other complicated urinary symptoms.
- Women who have sustained a third or fourth degree vaginal tear.
- Severe perineal trauma where there are concerns regarding healing
- Perineal pain following delivery, post-partum voiding dysfunction and defaecatory dysfunction.
- Post-partum dyspareunia.
- Pregnant women who have a history of a third or fourth degree tears for advice regarding mode of delivery following clinical assessment and endo-anal ultrasound.
- We perform a broad range of gynaecological procedures. The bulk of our operating comprises surgery for pelvic organ prolapse and incontinence. This includes anterior repair, sacrospinous fixation, vaginal mesh insertion, vaginal hysterectomy for prolapse, laparoscopic sacrocolpopexy and colpocleisis. We also performed a number of rectovaginal fistula repairs and we excised a few urethral diverticula. We performed approximately 40 stress incontinence sling procedures.
Available facilities and equipment include the following:
- A fully equipped urodynamics suite with facilities for urethral pressure profilometry testing.
- Endo-anal ultrasound equipment
- Facilities to perform advanced laparoscopic procedures including access to: High definition camera system, all necessary endoscopic instruments, bipolar, monopolar, ultrasonic (Harmonic) and advanced bipolar systems (Ligasure).
- Fully equipped cystoscopic assessment instruments including a flexible scope for use in an outpatients setting
- Full access to modern disposable vaginal surgery devices including retropubic TVT, TVT-O, TOT, sacrocolpopexy mesh and Capio devises.
- Fully equipped to provide laparoscopic sacrocolpopexy with access to Y-mesh, V-loc suturing devices and Protack Helical Suturing device.
- Ready access to a level 3 ultrasound service for assistance in scanning of more complex pathology.
- One ward for in-patient care (15 beds) at Groote Schuur Hospital
- Cooperative arrangements for training with Prof John Lazarus in Urology.
- Facilities for radiological imaging techniques and collaboration with the Department of Radiology of radiological interventions including and CT scans.