Urogynaecology Core (SUI · OAB · POP · rUTI · fistula)
Clinical detail
Additional detail checked 2026-10-17 against the linked sources. This check covers the section below; the rest of the module retains its displayed verification status.
Separate stress leakage, urgency, voiding difficulty and prolapse symptoms before choosing treatment. A clear symptom pattern and baseline impact measure make follow-up more useful.
Assessment & interpretation
- Include urinalysis, pelvic examination and an assessment of pelvic-floor contraction. Use a bladder diary for at least 3 days.
- Measure post-void residual urine when voiding dysfunction or recurrent UTI is suspected. Pain, haematuria, fistula suspicion or neurological features need the appropriate referral pathway.
Decisions that change management
- For stress or mixed incontinence, offer supervised pelvic-floor muscle training for at least 3 months; NICE specifies at least 8 contractions three times daily.
- For urgency or mixed incontinence, begin bladder training for at least 6 weeks.
- Discuss conservative prolapse care, including supervised exercises and pessary options, against the patient’s symptoms and preferences.
Follow-up & safety-netting
- Use the diary and symptom impact to assess response, adherence and adverse effects.
- Consider residual urine and prolapse when symptoms persist. Investigations before surgery should be selected from the clinical pattern rather than ordered routinely for everyone.
Admission & discharge
Admission/discharge guidance checked 2026-10-18 against the linked sources. This is a clinical checklist for an individual decision, not an automatic discharge order.
When admission or continued hospital care is needed
- Urinary retention, sepsis, severe pain, obstructed/compromised prolapse, renal concern or a significant postoperative complication requires urgent assessment and admission if ongoing care is needed.
When clinic, day care or home care may be suitable
- Stable incontinence, overactive bladder or prolapse is usually assessed through outpatient pelvic-floor/urogynaecology care.
Before going home
- Bladder emptying and pain are satisfactory, or a safe catheter plan has been established with support and a named voiding-trial appointment.
- After surgery, no unresolved bleeding/infection/organ injury concern; mobility, nutrition and required home support are adequate.
Discharge medicines and treatment changes
- Reconcile bladder, bowel, analgesic and any antimicrobial medicines, reviewing side effects/retention risk rather than automatically continuing every preoperative drug.
Tests, pending results and their reviewer
- Record urine culture, residual-volume/renal or other relevant findings; assign pathology or repeat testing when indicated.
Home care and counselling
- If catheterised, teach drainage/bag care, blockage warnings and who removes/reviews it. Give the actual pelvic-floor, bowel and activity instructions for the operation or conservative treatment received.
Follow-up: when and what to review
| When | Action / responsible service |
|---|---|
At the booked catheter/voiding-trial appointment if needed | Assess emptying and decide further care. |
At specialist/pelvic-floor review | Review symptoms, treatment response and postoperative healing if applicable. |
After stress-incontinence surgery: within 6 months; after prolapse surgery: at 6 months (NICE) | Arrange the surgical review, including vaginal/mesh examination when applicable. Catheter, wound and symptomatic problems require earlier review. |
Return urgently
- Inability to void or a blocked catheter, fever, worsening pain, heavy bleeding, dyspnoea or leg swelling requires prompt assessment.
Open the complete discharge checklist →
Treatment
① Immediate stabilization — first minutes
③ First-line treatment & drug regimens
| Condition | Conservative -> escalation |
|---|---|
Stress urinary incontinence | PFMT x3 months -> midurethral sling/bulking/colposuspension |
Overactive bladder | Training+fluids -> solifenacin 5 mg OD class OR mirabegron 25-50 mg -> Botox/neuromodulation |
Pelvic organ prolapse | PFMT + pessary fitting -> native-tissue repairs/sacrocolpopexy by compartment |
Recurrent UTI | Behavioural + topical vaginal oestrogen (postmenopausal) -> prophylaxis strategies |
Vesico-vaginal fistula | Continuous drainage early; specialist repair at dedicated centres (typical 3-month rule) |
Monitoring
- ICIQ-type scores pre/post; pessary reviews q3-6 months
⑮ Complications & their management
Mesh complications
Specialist mesh clinics; regulatory guidance followed
Post-treatment care
- PFMT maintenance; caesarean planning after prolapse surgery often advised
Diagnosis & assessment
Sources (7)
2021-07 · updated 2025-12-22 (page review; guidance itself unchanged) · checked 2026-08-23 · verified-live
Open source ↗
CDC pages + wall chart: uncomplicated gonorrhoea cervix/urethra/rectum → ceftriaxone 500 mg IM single dose (<150 kg; 1 g if ≥150 kg); pharyngeal same; conjunctivitis 1 g IM; DGI 1 g IV/IM q24h; PID outpatient → ceftriaxone 500 mg IM ×1 + doxycycline 100 BD ×14 d + metronidazole 500 BD ×14 d; chlamyd…
02 April 2019 · updated 24 June 2019 · checked 2026-10-18 · verified-live
Open source ↗
Scope: additional clinical-detail explanation for urogynaecology-core. Checked the assessment, management-decision and follow-up statements in that section against this source. This does not certify all pre-existing regimens, calculations or recommendations in the module. Additional admission/discha…
· checked 2026-10-18 · verified-live
Open source ↗
Full primary patient recovery page read: pain control, wounds, activity/VTE, urinary/bowel and infection warning signs, adult support and no driving/important decisions during the first 24 hours after general anaesthesia. Used as general recovery/handover principles, not operation-specific discharge…
· checked 2026-10-18 · verified-live
Open source ↗
Maternal/newborn transfer assessment, first void and effective feeding, handover, support/safeguarding, first midwife visit within 36 hours after transfer, postnatal danger symptoms. Full recommendations page read.
· checked 2026-10-18 · verified-live
Open source ↗
Normal-delivery discharge not less than 48 hours: full primary SOP PDF normal-delivery/discharge passages read. Corroborated by NHM CEmONC 2024 Part 1, chapter 8. This does not define a universal post-caesarean or complicated-case stay.
· checked 2026-10-18 · verified-live
Open source ↗
Official WHO summary read: at least 24-hour facility care after birth; additional contacts at 48–72 hours, 7–14 days and week 6; individual assessment/support. Summary facts only, not a claim that the full 242-page PDF was reviewed.
· checked 2026-10-18 · verified-live
Open source ↗
Full primary recommendations read, focusing on critical-care-to-ward transfer: structured written handover, shared plan, monitoring, rehabilitation and receiving-team capability. Step-down is distinct from home discharge; no universal organ-support discharge cutoff is asserted.