Urogynaecology

Urinary incontinence is a common problem affecting up to 35% of the female population. Initial management involves a thorough history, examination and urinalysis, following which a presumptive diagnosis can be made and initial treatment commenced; these can all be performed by trained nurses, or general paractitioners (GPs), in primary care. If these measures fail, then the patient should be referred for specialist management in secondary care. Three cases are described; stress incontinence, overactive bladder and mixed urinary incontinence, which highlight the principles of this care pathway and introduce new surgical techniques and drug treatment.