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Gynaecological Development and Function

Gynaecological Development and Function

Gynaecological development and function is an umbrella group comprising several teams researching into different benign gynaecological conditions. These conditions may be congenital or acquired and can have a significant impact on gynaecological health and reproductive potential.

The following research teams are included:

Disorders of Sex Development

UCLH is an internationally recognised centre providing clinical care, diagnosis, information and highly specialised treatments to patients from all over the UK.  Lead clinicians within the multidisciplinary team are:

Professor Sarah CreightonGynaecology
Professor Gerard ConwayEndocrinology
Dr Lih-Mei LiaoPsychology
Mr Dan WoodUrology

Examples of conditions treated include:
Congenital adrenal hyperplasia
Complete and partial androgen insensitivity syndrome
Swyer's syndrome

All clinics are multidisciplinary with a gynaecologist, endocrinologist and psychologist, supported by a Clinical Nurse Specialist. Specialist genetics, biochemistry and imaging are also available. Monitoring of hormone replacement and bone density monitoring is offered as well as steroid maintenance for CAH. Treatment for the shortened or narrowed vagina involves vaginal dilation and vaginoplasty. Psychological support is available for all aspects of diagnosis and treatment. The service has close links with Great Ormond Street Hospital for transition of paediatric and adolescent patients to adult services.

The DSD team at UCLH is an international leader in clinical research into the long term outcomes of DSD and has numerous peer reviewed publications in this field. Past and current research projects include sexual and gynaecological function after dilation and vaginal reconstruction, endocrine and genetic diagnosis and the psychological impact of disclosure

Paediatric and Adolescent Gynaecology

UCLH is also an internationally recognised centre for paediatric and adolescent gynaecology. Clinicians in the team include

Professor Sarah CreightonLead consultant
Mr Alfred CutnerMinimal Access Surgery
Miss Melanie DaviesLate Effects and Turner Syndrome
Dr Lih-Mei LiaoClinical Psychology
Mrs Maligaye BikooClinical Nurse Specialist

Examples of conditions treated include:

  • Mullerian agenesis (Rokitansky Syndrome)
  • Mullerian obstruction and duplication e.g. transverse septae and cervical agenesis
  • Gynaecological conditions associate with complex urological conditions e.g cloacal anomaly

Treatments available include an individualised vaginal dilation programme with psychological support. The majority of surgical treatments are performed laparosopically and include the laparosopic Vecchietti procedure.  This ensured the advantages of good cosmesis and quick recovery which is essential for this young age group. The team have an excellent track record for clinical research and have published some of the first outcome data in this field.

Urogynaecology

Urogynaecology consists of the management of women with lower urinary tract dysfunction and pelvic organ prolapse. There are two separate Urogynaecology units at UCLH and below is an outline of the UCLH Urogynaecology and Pelvic Floor Unit.

The UCLH Urogynaecology and Pelvic Floor Unit is a multidisciplinary department that sees a range of women suffering with urogynaecological problems. The aims of the Unit reflect the UCLH vision of providing world class patient care safely with an excellent patient experience. The consultant team consists of two gynaecologists, Arvind Vashisht and Alfred Cutner, supported by our nurse specialists, Kate Welford and Ann Lyons,  and a team of women’s health physiotherapists led by Louise Rahmanou and Emma Tailby, all closely linking to the departments of functional gastroenterology, colorectal surgery, and urology. We also have support from our midwifery colleagues, Astrid Osbourne, Maureen McCabe and June Pembroke-Hajaj for our postpartum service. We link in with the Obstetric department to provide comprehensive antenatal and postnatal pelvic floor assessments and  delivery planning. By engaging in multidisciplinary and multiprofessional working, the unit is able to manage the whole spectrum of urogynaecological conditions from general to highly specialised.

The major strength of the unit is laparoscopic urogynaecology for which UCLH is a leader in the field and has developed several new techniques that result in tertiary referrals from all over the UK. Mr Vashisht and Mr Cutner have a particular interest in prolapse and incontinence surgery. They run a weekly integrated clinic, and some joint operating lists. All patient management is consultant-led. As well as performing laparoscopic operations including vaginal vault, uterine preservation prolapse surgery, colposuspension and paravaginal repair, we also perform a range of vaginal procedures. We have pioneered minimally invasive uterine conservation surgical techniques for the treatment of uterine prolapse, and have already published our early experiences with these techniques.

At UCLH, there have been several new developments in the management of women within Urogynaecology. We are improving the care for our patients by introducing comprehensive patient information sheets, and also improved access into the system by opening direct telephone and email contact to clinical staff.  We have implemented a telephone review system for certain medical conditions, and for early post operative surgical cases preventing delays in clinical review. 

We provide bladder assessment and care (including trials without catheter and intermittent self-catheterisation techniques) for gynaecological patients who develop bladder related problems following surgery, particularly endometriosis and gynaecology oncology. This is a central requirement to fulfil risk management and clinical governance and helps prevent long term symptoms associated with post surgical bladder problems. The increasing complexity of both these services has increased the internal referral rate.