Trans Vaginal Mesh Lawsuit Notification
Trans Vaginal Mesh Lawsuit : Some of the most common causes. A number of these conditions are mentioned elsewhere in this book. The group of conditions that cause bladder pain in association with frequency and urgency are considered below. This is a poorly defined collection of diseases – considered a spectrum of’painful bladder syndromes’ – that may share a common aetiology. Patients presenting with frequency-urgency need to be carefully questioned about associated urinary symptoms. Associated urge incontinence and its severity is important, as is any associated dysuria or suprapubic pain. If haematuria is reported then this must be investigated further.
As there is such a wide-ranging differential diagnosis for possible causes of urinary frequency-urgency, conditions both within the urinary tract and further afield need to be considered. Information should be sought regarding any neurological symptoms, drinking habits and concomitant medication. An abdominal examination will rule out a mass or large distended bladder. A neurological assessment is important to exclude an upper motor neurone Lesion. The S2, S3 and S4 nerve roots innervate the bladder, and particular regard should be paid to these dermatomes.
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On pelvic examination a possible large fibroid uterus, ovarian mass or pregnancy should be considered. It is important to assess the degree and site of any pelvic organ prolapse that may be present. Tenderness on bladder palpation may be found in interstitial cystitis (IC) and other painful bladder syndromes. The urethra should be carefully inspected for a LocaL cause (such as a urethral caruncle) of irritative symptoms, or signs of urethritis.
Initial investigation should always include a midstream urine sample for culture and sensitivity and urine for cytology. A completed frequency-volume chart is an invaLuable tool, providing useful information on fluid input and output, drinking habits, voided volumes and the episodes of urgency and incontinence. Where the cause for the symptoms is not revealed by the above assessment, the more specialist investigations should be considered. Ultrasound scan can be accurately used to assess urinary residual volumes, to measure bladder wall thickness and to give more information on any masses detected on pelvic examination. Once a UTI has been ruled out, subtracted cystometry may detect detrusor overactivity (DO) or sensory urgency. Cystourethroscopy should be performed for recurrent UTI if haematuria is present, if pain is a significant symptom and if IC or a urethral diverticulum is suspected.
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The latter is more common and allows far better biopsy samples to be taken for histologicaL assessment, which is important in the diagnosis of many of these conditions. Although the histological appearances of biopsies taken from patients with IC are generally non-specific, the findings at cystoscopy are more characteristic. Treatment should be directed at the underlying cause of the urinary symptoms. This intervention is supported by evidence, such as a simple course of antibiotics for a UTI, or bladder retraining and anticholinergic drug therapy for DO. With some of the less well- understood or rarer diseases, treatment may be largely empirical with less chance of success. This is often the case in women with IC.
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