RESEARCH
01.04.95-30.09.96 WellBeing Research fellow to Professor L. Cardozo Kings College Hospital, London.
REGISTRAR ROTATION IN OBSTETRICS AND GYNAECOLOGY
01.02.94-31.01.95 Chelsea and Westminster Hospital, London.
01.02.93-31.01.94 Hillingdon Hospital, Middlesex.
CLINICAL EXPERIENCE
GYNAECOLOGY
I have a broad training in gynaecology and currently have a general gynaecology clinic once a week. In addition I have a weekly continence clinic. I have 3 regular operating sessions and perform regular video urodynamics.
UROGYNAECOLOGICAL TRAINING & RESEARCH
I gained experience of urogynaecology prior to being appointed as research fellow to Professor Cardozo and subsequently as her year 4/5 SpR. at Kings College Hospital. I am the lead clinician for Urogynaecology at BWH. This is a large stand alone trust catering for Women's health and maternity services. I now run an expanding service covering the south of Birmingham with the facilities to investigate and treat patients at a tertiary level.
The current service provides
- The ongoing evaluation of investigation and treatment of urinary incontinence and pelvic floor dysfunction.
- Transperineal & transvaginal ultrasound scans
- Laboratory urodynamics
- Video Urodynamics
- Ambulatory Urodynamics
- Complimentary investigations (urethral pressure profile and pad testing).
- " Specialist combined clinics with a Colorectal surgeon with an interest in functional bowel disease, a Urologist with an interest in female urology and a Geriatrician to allow the assessment of women with complex medical disorders.
- Development of an interest in sensory urgency (see publications)
I currently offer a full range of conservative and surgical treatments including:
- In patient bladder drill
- Out patient bladder instillations
- Nurse led continence clinics
- Basic pelvic floor surgery and hysterectomy
- Laparoscopic sacrocolopexy
- Posterior IVS
- Sacrospinous ligament fixation
- Continence surgery
- TVT
- TVTO
- colposuspension
- bladder neck injections
I established my major research interest on the changes in the female pelvis due to childbirth which is the basis of my MD thesis. I was awarded a research fellowship on a grant for £72,000 from WellBeing. This project is continued until March 1998. (see publications)
As the senior SpR on the urogynaecological service I continued from my research post I consolidated my research base and developed further skills including
- Undertaking a dedicated period of training within urogynaecology
- Helping develop a "one stop" and combined conservative management incontinence
- Evaluating new conservative and surgical techniques for treatment of urinary incontinence
- Training in the surgical management of recurrent and severe utero-vaginal prolapse
- Developing nurse led and specialist interest GP services to improve services in South Birmingham
My current research interests include
- Obstetric anal sphincter injury
My first research Fellow Samantha Pretlove has spent 2 years investigating occult anal sphincter injury. Her thesis has developed themes relating to the diagnosis and follow up of women sustaining injury in childbirth.
In addition we are following up women in subsequent pregnancies and evaluating the risk of subsequent injury or symptoms
- Assessment of prolapse
My second research fellow Amit Majundar is currently engaged in evaluating urodynamics
- My third research fellow Katharine Robb studied psychological effects of incontinence patients within urogynaecology this work is now being used to develop a cognitive behavioural therapy
- My current research fellow Richard Foon is evaluating the effects of various anaesthetics on bladder sensation in childbirth
- I have worked with several pharmaceutical companies and undertake 2-3 drug trials each year
- My current clinical studies include
- a randomized placebo study of the effect of Botulinum toxin A in the overactive bladder
- comparative study of colposuspension with TVT & anterior repair for prolapae and stress incontinence
- efficacy of Bulkamid as a bladder neck injectable
- use of SIS mesh in recurrent prolapse
Since taking up post as a consultant I have published 3 peer reviewed papers and over 15 peer reviewed abstracts at National and International meetings. I have written invited articles & book chapters in over 6 publications. I have supervised 2 audits (on outcomes of TVT and infection after urodynamics) and a national survey (of current practice in UDA and compliance with a MDA directive).
