Urogynaecology

Lead: Ms Suzy El-Neil

The Urogynaecology unit at The University College Hospital London Hospitals NHS Foundation trust is based at The Elizabeth Garrett Anderson Hospital (EGA) and The National Hospital for Neurology and Neurosurgery (NHNN). The unit consists of two Gynaecologists, 1 Physician, a Clinical nurse specialist and two dedicated women’s health physiotherapists. The unit works in close affiliation with the Departments of Urology, Functional Gastroenterology, and Colorectal surgery. The Department of Uro-neurology with associated neurologists and neurophysiologists is an integral part of the Urogynaecology unit.

The patients are referred to the unit with a history of incontinence, prolapse and bladder dysfunction including neurological causes. The unit is able to offer assessment, diagnosis, investigations and surgery. Routine and complex procedures are offered as well as new techniques that are unique to our unit.

Specialist Expertise in the Urogynaecology Unit

The unit has experts with different areas of specialist expertise. Apart from the management of general urinary and prolapse problems, each specialist has specific expertise in certain aspects of complex Urogynaecology.

Ms Suzy Elneil's interest lies in fistula surgery and surgery for urethral diverticula. Her other area of interest is in Uro-neurology, incorporating the surgical treatment of intractable detrusor overactivity and bladder pain. This work is carried out at the NHNN, both in the Department of Uro-neurology (chaired by Professor Clare Fowler) and in the Pain Management Unit (with Dr Andrew Baranowski). The surgical techniques employed include intra-detrusor botulinum toxin treatment (in detrusor overactivity), neurostimulation (in chronic urinary retention, intractable detrusor overactivity, painful bladder syndrome, and chronic pelvic pain) and pudendal nerve blocks.

Dr Adrian Wagg has an interest in patients with multiple medical problems and the medical treatment of resistant overactive bladder syndrome and those with recurrent urinary tract infections, helping to improve their quality of life. He runs a multidisciplinary team between the Physicians and the Surgeons looking after patients requiring medical support whilst undergoing surgery. He has an interest is in the coordination of national and international drug trials for the treatment of the overactive bladder.

Mr Alfred Cutner's area of interest lies in laparoscopic vault prolapse surgery and uterine preservation prolapse surgery. The former offers laparoscopic surgery for procidentia with vault support techniques, and laparoscopic vault prolapse surgery and paravaginal repair surgery for recurrent anterior vaginal wall prolapse. The latter, which is unique to this unit, enables women in their reproductive years to keep their uterus and still have their prolapse symptoms treated. This is now an important consideration for many women, as it enables them to maintain fertility for much longer, whilst at the same time treating their symptoms.

Our close affiliation with the Urologists (Mr Julian Shah and Ms Tamsin Greenwell), the Functional Gastroenterologist (Dr Anton Emmanuel) and the colorectal surgeons is essential, given the complex nature of some of the patients that are referred. The patients vary in complexity from routine urogynaecological condition to patients with failed previous surgery. Some of these have had mesh inserted and other complex procedures performed and therefore require a tertiary referral base to deal with the challenges of their condition.

These areas of interest are relatively unique and we have become a centre of national and international excellence in these fields. The number of referrals is therefore ever increasing. About 30% of referrals are from national sources.