Basic clinical skills

Learning outcomes

• To understand and demonstrate appropriate knowledge, skills and attitudes in relation to history taking, examination, investigation, procedural skills and communication in obstetrics and gynaecology (O&G).

KNOWLEDGE CRITERIA	CLINICAL COMPETENCY	PROFESSIONAL SKILLS AND ATTITUDES
HISTORY TAKING, EXAMINATION, INVESTIGATIONS, PROCEDURES AND COMMUNICATION
Demonstrate an understanding of: the components of effective verbal and non-verbal communication.the importance of accurate clinical note keeping.the logical sequence of eliciting a history and physical signs in O&G.the pathophysiological basis of symptoms and physical signs in O&G.the relevant investigations used in the management of common conditions in O&G.	Elicit a history from an O&G patient. Perform an abdominal examination in women during pregnancy (early pregnancy, pregnant over 20 weeks) and recognise normal findings and common abnormalities. Perform an abdominal examination in women in the non- pregnant state and recognise normal findings and common abnormalities. Perform a vaginal examination (bimanual, bivalve speculum) and recognise normal findings and common abnormalities. Recognise the acutely unwell patient in obstetrics and gynaecology (pain, bleeding, hypovolaemia, peritonitis). Perform, interpret and explain the following relevant investigations: blood pressure, urinalysis, urinary pregnancy test, body mass index calculation, genital swabs (high vaginal swab, endocervical swab, to check for infection), cervical smear. Perform the following procedures: phlebotomy, intravenous cannulation, urinary catheterisation. Summarise and integrate the history, examination and investigation results; formulate a management plan in a clear and logical way and make a clear record in the case notes.	Conduct an intimate examination in keeping with professional guidelines (e.g. RCOG, GMC). Appreciate the need for a chaperone. Demonstrate an awareness of the importance of empathy. Acknowledge and respect cultural diversity. Demonstrate an awareness of the interaction of social factors with the patient’s illness. Maintain patient confidentiality. Provide explanations to patients in language they can understand. Be receptive to feedback on performance. Learn to be flexible and be willing to take advice and change in the light of new information.

31   Module 3: Information technology, clinical governance, research

Learning outcomes

• To understand and demonstrate appropriate knowledge, skills and attitudes in relation to information technology (IT), clinical governance and research

KNOWLEDGE CRITERIA	CLINICAL COMPETENCY	PROFESSIONAL SKILLS AND ATTITUDES
INFORMATION TECHNOLOGY
Demonstrate an understanding of: the principles of storage, retrieval, analysis and presentation of data and the effective use of computing systems.the range of uses of clinical data, its effective interpretation and associated confidentiality issues.the basic principles of the Data Protection Act.		Demonstrate appropriate use of IT for patient care and personal development (databases, word processing techniques, statistics programmes, email, web sites and health-related databases). Present data in an understandable manner.
CLINICAL GOVERNANCE
Demonstrate an understanding of: the audit cycle as applied to O&G locally and nationally (specifically related to maternal and perinatal mortality).the role of guidelines, integrated care pathways and protocols, e.g. NICE, RCOG guidelines.clinical effectiveness (evidence-based practice, types of clinical trial, evidence classification and grades of recommendation).the principles of risk management, including incident reporting.	Understand the process of complaints management.	Appropriate use of relevant evidence in discussion with patients. Demonstrate respect for patients’ views and choices.
RESEARCH
Demonstrate an understanding of: the differences between audit and research.the principles behind good research design and critical analysis of research, including statistics and ethical issues.		Be aware that plagiarism is unacceptable. Undertake a critical review of scientific literature.

32   Module 4: Ethics and legal issues

Learning outcomes

• To understand and demonstrate appropriate knowledge, skills and attitudes in relation to ethics and legal issues in obstetrics and gynaecology.

KNOWLEDGE CRITERIA	CLINICAL COMPETENCY	PROFESSIONAL SKILLS AND ATTITUDES
Demonstrate an understanding of the relevance to clinical practice of: confidentiality and consent in under 16-year-olds (Fraser competency) and vulnerable adults.the Sexual Offences Act 2003.the Abortion Act.the relative legal status of the fetus and the mother.child protection.principles and legal issues surrounding informed consent.patient confidentiality, including data protection.	Use and share clinical information appropriately. Appropriate use of interpreters and patient advocates.	Give appropriate information in a manner that patients and relatives understand and assess their comprehension. Demonstrate an awareness of the patient’s needs as an individual. Demonstrate an awareness of the importance of diversity. Maintain patient confidentiality. Be aware of the requirements of children, adolescents and patients with special needs.

33   Module 5–7: Basic surgical skills, surgical procedures and postoperative care

Learning outcomes

• To understand and demonstrate appropriate knowledge, skills and attitudes in relation to basic surgical skills, surgical procedures and postoperative care

KNOWLEDGE CRITERIA	CLINICAL COMPETENCY	PROFESSIONAL SKILLS AND ATTITUDES
BASIC SURGICAL SKILLS
Describe: the regional anatomy and histology relevant to O&G.the commonly encountered complications of surgery in O&G and their prevention. Demonstrate an understanding of: the principles of infection control.appropriate use of blood and blood products.the principles of nutrition, water, electrolyte and acid- base balance.general pathological principles.	Interpret relevant preoperative investigations. Recognise potential co-morbidity. ‘Scrub-up’ correctly in the operating theatre.	Demonstrate effective communication with patients and relevant healthcare professionals.
COMMON SURGICAL PROCEDURES
Demonstrate an understanding of the common surgical procedures in obstetrics and gynaecology (indications, contraindications, principles, and complications).*	Explain to patients using appropriate language the principles of common surgical procedures in O&G and their complications.*	Demonstrate an awareness of the principles of consent for surgical procedures.
POSTOPERATIVE CARE
Demonstrate an understanding of: general pathological principles of postoperative care.fluid–electrolyte balance.wound healing.	Interpret relevant post-op investigations Recognise normal wound healing and postoperative course Recognise symptoms and signs of common/serious postoperative complications and initiate management plan	Demonstrate effective communication with patients and relevant healthcare professionals.

• Detailed in specific modules

34   Module 8: Antenatal care

Learning outcomes

• To understand and demonstrate appropriate knowledge, skills and attitudes in relation to antenatal care in the low-risk pregnancy, recognition of the high-risk pregnancy and the appropriate modifications to antenatal care.

KNOWLEDGE CRITERIA	CLINICAL COMPETENCY	PROFESSIONAL SKILLS AND ATTITUDES
CORE LEARNING
Demonstrate an understanding of: the anatomy of the pelvis.genetic modes of inheritance and common structural abnormalities of fetuses resulting from abnormal development.the principles of safe prescribing in pregnancy.	Take and present an obstetric history. Measure blood pressure in pregnancy. Perform and interpret urinalysis in pregnancy. Assess risk in pregnancy.	Communication with a well woman and her partner. Interaction with a multidisciplinary team. Understand the use of female chaperones whenever an intimate examination is being performed. Be aware of patient autonomy (e.g. informed maternal choice).
NORMAL PREGNANCY
Demonstrate an awareness of aims and patterns of routine antenatal care. Demonstrate an understanding of screening in pregnancy.	Enquire about maternally perceived fetal movements. Examine the pregnant abdomen. Auscultate the fetal heart.	Awareness of the explanation of risk and patients’ perceptions of risk. Recognition of the midwife as the primary care-giver.
HIGH-RISK PREGNANCY
Demonstrate an understanding of: the determination, risks and monitoring of high-risk pregnancies.monitoring fetal wellbeing.the impact of social problems.	Identify a high-risk pregnancy. Interpret relevant investigations during pregnancy.	Awareness of the impact of pregnancy on daily living.
ABNORMAL PREGNANCY
Demonstrate an understanding of the aetiology. risk factors for, risks and management of the major antenatal complications of pregnancy.	Describe the management of antepartum haemorrhage and eclampsia. Identify a sick or deteriorating patient.	Recognition of normality and deviation form normality during pregnancy. Understand the ethical and legal framework for abortion and the status of the fetus.

• for details see next page

35   Details of knowledge criteria

• Preconceptual care and the use of lifestyle changes and folic acid preconception and nutritional requirements and lifestyle changes in pregnancy.
• Consideration of past obstetric history, including mode of delivery.
• The risk of drug treatment in pregnancy.
• The risk of substance abuse in pregnancy.
• Changing demographics of pregnancy.
• The booking visit and routine investigations performed.
• Screening for fetal abnormality.
• Schedules of routine antenatal care.
• The use of Anti-D.
• Be aware of the legal rights of and provisions for pregnant women.

• Diagnostic tests for fetal abnormality.
• Multiple pregnancy.
• Breech presentation.
• Prolonged pregnancy.
• Fetal monitoring.
• The use of ultrasound scanning in pregnancy.
• The antenatal causes of maternal mortality and morbidity.
• The causes of stillbirth.

• Hypertensive disorders of pregnancy.
• Gestational diabetes.
• Preterm labour/rupture of membranes.
• Rhesus isoimmunisation.
• Antepartum haemorrhage.
• Infections in pregnancy.
• Thromboembolic disease.
• The small-for-dates fetus.
• The large-for-dates fetus.

36   Module 9: Maternal medicine

Learning outcomes

• To understand and demonstrate appropriate knowledge, skills and attitudes in relation to the effect of pre-existing medical conditions on pregnancy and the effect of pregnancy on these conditions.

KNOWLEDGE CRITERIA	CLINICAL COMPETENCY	PROFESSIONAL SKILLS AND ATTITUDES
Demonstrate an understanding of the role of preconception counselling of women with pre-existing illness. Demonstrate an understanding of the effects on pregnancy, basic management and the risks of pre-existing medical conditions on the woman and fetus. Demonstrate an understanding of the risks and modifications required to continuing drug treatment during pregnancy.	Observe the formulation of a multidisciplinary management plan. Interpret relevant blood tests taken during pregnancy. Perform a general physical examination.	Awareness of the effect of pregnancy on disability. The use of multidisciplinary clinics.

Details of knowledge criteria

• Diabetes mellitus.
• Obesity.
• HIV and pregnancy.
• Thrombophilia.
• Pre-existing hypertension.
• Epilepsy.
• Relevance of cardiac disease.

37   Module 10: Management of Labour

Learning outcomes

• To understand and demonstrate appropriate knowledge, skills and attitudes in relation to labour.

KNOWLEDGE CRITERIA	CLINICAL COMPETENCY	PROFESSIONAL SKILLS AND ATTITUDES
Demonstrate an understanding of: mechanisms of normal labour and delivery.induction and augmentation of labour.monitoring maternal and fetal wellbeing including the partogram.pain relief in labour.deviations from normal.the principles of management of the collapsed obstetric patient.	Participate in the management of labour. Observe task prioritisation on the labour ward. Demonstrate the skills required in the immediate resuscitation of the collapsed obstetric patient.	Respect for cultural and religious differences in attitudes to childbirth. Empathy and decision making. Awareness of multiprofessional working.

Details of knowledge criteria

• Mechanisms, diagnosis and management of normal and abnormal labour.
• Methods of induction and augmentation of labour; indications, contraindications and complications.
• Structure and use of partograms.
• Analgesia and anaesthesia in labour.
• Assessment of fetal wellbeing (e.g. meconium, fetal heart rate monitoring and fetal scalp blood sampling).
• Causes and management of maternal collapse (e.g. massive haemorrhage, cardiac problems, pulmonary and amniotic embolism, drug reactions, trauma).
• Intrapartum haemorrhage (e.g. placenta praevia, placental abruption).
• Preterm labour: impact and management.
• Pre-eclampsia and eclampsia.

38   Module 11: Management of delivery

Learning outcomes

• To understand and demonstrate appropriate knowledge, skills and attitudes relating to the management of delivery.

KNOWLEDGE CRITERIA	CLINICAL COMPETENCY	PROFESSIONAL SKILLS AND ATTITUDES
Demonstrate an understanding of: normal vaginal deliveryoperative vaginal delivery: indications, methods and complicationscaesarean section: indications, procedures and complications.	Participate in and ideally assist or conduct a normal vaginal delivery. Observe and ideally assist an operative vaginal delivery. Observe and ideally assist a caesarean section.	Awareness of the principles for the choice of mode of delivery in partnership with the mother and respect the views of other healthcare workers (midwives). Awareness of emotional implications for woman, family and staff. Respect cultural diversity. Respect individual dignity and privacy. Respect confidentiality. Communicate clearly and effectively at times of stress. Understand and empathise with the needs of mothers in labour.

Details of knowledge criteria

• Anatomy, physiology and mechanism of normal delivery.                                                     • Indications and complications.
  • Types (e.g. elective, emergency).

• Indications and methods, e.g. twin delivery, ventouse, forceps.
• Episiotomy, perineal trauma.

• Indications.
• Options/methods.
• Complications/effects on woman and fetus.

39   Module 12: Postpartum problems (the puerperium)

Learning outcomes

• To understand and demonstrate appropriate knowledge, skills and attitudes in relation to postpartum problems
• To understand and demonstrate appropriate knowledge, skills and attitudes in relation to neonatal problems

KNOWLEDGE CRITERIA	CLINICAL COMPETENCY	PROFESSIONAL SKILLS AND ATTITUDES
POSTPARTUM PROBLEMS
Demonstrate an understanding of a normal postpartum period. Describe the common abnormalities of the postpartum period. Describe the techniques for prevention and management of postpartum haemorrhage. Describe the management of anaemia. Demonstrate an understanding of common postnatal psychiatric illness and its management. Describe the importance of breastfeeding. Appropriate use of blood and blood products.	Advise regarding postpartum contraception. Observe, where possible, or be aware of the key issues in the management of: perineal trauma.postpartum sepsis.postpartum haemorrhage.breastfeeding-related pathology.	Awareness of the roles of other healthcare professionals (e.g. social workers, psychiatrists, physiotherapists). Awareness of breastfeeding initiatives. Display empathy with women with puerperal problems and their families. Awareness of long-term implications of pregnancy and postpartum problems. Respect cultural diversity.
NEONATAL PROBLEMS
Demonstrate an understanding of: recognition of normality.sequelae of obstetric complications (e.g. preterm delivery).the principles of resuscitation of the newborn.common neonatal problems and their management.	Observe the immediate assessment and resuscitation of the neonate.	Awareness of the importance of liaison with the paediatric/neonatal team.

40   Details of knowledge criteria

• Postnatal clinical review.
• Contraception.
• Aetiology, recognition and management of:
  • primary and secondary postpartum haemorrhage.
  • maternal collapse, including massive haemorrhage, cardiac problems, pulmonary and amniotic embolism, drug reactions, trauma.
  • thromboembolism.
  • care of the perineum.
  • lactation.
  • medical disorders.
  • psychiatric disorders.
• Puerperal pyrexia.

41   Module 13: Gynaecological problems

Learning outcomes

• To understand and demonstrate appropriate knowledge, skills and attitudes in relation common gynaecological problems.

KNOWLEDGE CRITERIA	CLINICAL COMPETENCY	PROFESSIONAL SKILLS AND ATTITUDES
Physiology of menstrual cycle. To understand the significance of benign gynaecological problems and their management. These should include: menstrual disorders.menarche.menstruation.menopause. Vaginal discharge. Drug treatments.	Take a gynaecological history. Formulate a management plan. Observe the following: a pelvic ultrasound scan.hysteroscopy.diagnostic laparoscopy.endometrial sampling.	Observe communication between doctor and patient, including explanation of the condition, treatment options and complications of treatment. Suggest a management plan for the patient, Note referral between primary, secondary and tertiary care. Be aware of guidelines and pathways of care.

Details of knowledge criteria

• Menstrual disorders.
• Understand the particular significance and investigation of:
  • intermenstrual, postcoital and postmenopausal bleeding.
  • menstrual irregularity.
  • heavy menstrual bleeding.
  • dysmenorrhoea.
• Problems of the climacteric:
  • abnormal bleeding
  • symptoms.
  • osteoporosis.
  • hormone replacement therapy.
• Amenorrhoea:
  • primary.
  • secondary.

• Advantages and disadvantages of medical and surgical therapies.
• Benign conditions of the lower genital tract:
  • vulva (pruritus)
  • vagina (vaginal discharge, physiological vs pathological).
  • pelvic pain (endometriosis, adhesions, uncertain origin).
• Emergency gynaecology:
  • pelvic Infection.
  • ovarian cysts.
  • Bartholin’s abscess/cyst.
  • abdominal pain of uncertain origin.
  • acute unscheduled vaginal bleeding.

42   Module 14: Subfertility

Learning outcomes

• To understand and demonstrate appropriate knowledge, skills and attitudes in relation common gynaecological problems.

KNOWLEDGE CRITERIA	CLINICAL COMPETENCY	PROFESSIONAL SKILLS AND ATTITUDES
Significance of failure to conceive. Demonstrates a basic understanding of the common causes and investigation of subfertility. Understand the principles of: ovulation induction.artificial reproduction techniques.gamete donation.reproductive surgery. Social and ethical issues.	Take a subfertility history. Formulate a management plan. Interpret basic investigations and explain to the patient.	Shows an appreciation of the importance of psychological factors. Has an understanding of the issues relating to NHS funding and rationing of treatment.

Details of knowledge criteria

• Diagnosis and management of common causes of subfertility:
  • ovulatory dysfunction
  • male factor
  • tubal disease
  • endometriosis
  • coital dysfunction
  • unexplained infertility.
• Understand the following investigations:
  • semen analysis.
  • endocrine evaluation.
  • tubal patency.
  • ultrasound screening of pelvic organs.

• Operative investigative procedures:
  • diagnostic laparoscopy.
  • hysteroscopy.
  • tubal patency.
• Advantages and disadvantages of surgical interventions for subfertility, including:
  • adhesiolysis.
  • surgical management of endometriosis.
  • myomectomy.
• Complications of ovulation induction, e.g:
  • ovarian hyperstimulation syndrome.
  • multiple pregnancy.

• Legal and ethical issues:
  • Human Fertilisation and Embryology Act.
  • gamete donation.
  • surrogacy.
• Importance of the multidisciplinary team.

43   Module 15: Sexual and reproductive health

(contraception, termination of pregnancy, sexually transmitted infections and HIV, sexual problems)

Learning outcomes

• To understand and demonstrate appropriate knowledge, skills and attitudes in relation to fertility control (contraception and termination of pregnancy), the diagnosis and management of sexually transmitted infections (including HIV) and sexual dysfunction.

It is recognised that there may be conscientious objection to the acquisition of knowledge and skills within the contraception and abortion components; however, it is essential that undergraduates are familiar with the issues and with the management options. Even though they may choose not to practice electively in this area, they must be aware of and able to recognise complications that may arise from this area of practice to be competent to provide appropriate emergency care in their careers.

KNOWLEDGE CRITERIA	CLINICAL COMPETENCY	PROFESSIONAL SKILLS AND ATTITUDES
Reversible, irreversible and emergency contraception and termination of pregnancy: mode of action and efficacy.methods, indications, contraindications and complications. Ethical and legal issues relating to fertility control. Be aware of the sexual healthcare needs of vulnerable groups, e.g. the young, commercial sex workers and drug abusers. Sexually transmitted infections including HIV/AIDS:·transmission, diagnosis, management and prevention. Awareness of psychosexual problems.	Attend a family planning clinic. Attend an genitourinary clinic. Take a history in relation to:· contraceptive and sexual health needs.unplanned pregnancy.	Have an understanding of the psychosocial impact of sexually transmitted infections and living with HIV/AIDS. Understand the need to respect cultural and religious beliefs as well as sexual diversity.

44   Details of knowledge criteria

• Fertility control methods:
  • natural methods of family planning.
  • barrier (condom: male and female, diaphragm, caps).
  • chemical.
  • hormonal: oral, transdermal, subdermal, intramuscular, intrauterine.
  • male and female sterilisation.
  • intrauterine contraception, (copper or progestogen).
  • postcoital methods (progestogen, intrauterine contraceptive device).
• Unplanned/unwanted pregnancy:
  • failure to use adequate contraception.
  • contraceptive failure.
  • management options.
• Sexually transmitted infections, including HIV/AIDS:
  • contact tracing.
• national screening programmes.

45   Module 16: Early pregnancy care

Learning outcomes

• To understand and to demonstrate appropriate knowledge, skills and attitudes in relation to early pregnancy loss.

KNOWLEDGE CRITERIA	CLINICAL COMPETENCY	PROFESSIONAL SKILLS AND ATTITUDES
Causes of bleeding and/or pain in early pregnancy. Classification of miscarriage. Presentation and management of miscarriage and ectopic pregnancy. Use of ultrasound and endocrine assessment in early pregnancy problems. Use of anti-D. Hyperemesis in pregnancy.	Explain the normal symptoms of pregnancy. Take a relevant gynaecological history in a woman complaining of vaginal bleeding and/or abdominal pain in early pregnancy. Perform a urinary pregnancy test and interpret the result. Perform a circulatory assessment and abdominal examination of a woman with an early pregnancy problem and identify those requiring immediate intervention. Describe appropriate resuscitation techniques. Awareness of treatment of cervical shock.	Demonstrate the ability to communicate effectively and sensitively with patients and relatives. Recognises need for a supportive environment that addresses religious and cultural issues around early pregnancy loss.

Details of knowledge criteria

(Please note topics in italics may be taught in other O&G modules)

• Epidemiology, aetiology and characteristics of:
  • normal symptoms of early pregnancy.
  • miscarriage.
  • ectopic pregnancy.
  • molar pregnancy.

• Investigations:
  • clinical signs, including cardiovascular collapse.
  • urine pregnancy test.
  • blood tests:
  • haematology
  • rhesus status
  • serum beta-hCG.
  • pelvic ultrasound.
  • laparoscopy.

• Management:
  • conservative, medical and surgical management of:
  • miscarriage including cervical shock
  • ectopic pregnancy
  • molar pregnancy.
  • national register of trophoblastic disease.
• Other issues:
  • sensitive disposal of fetal remains.
  • recurrent miscarriage.
  • miscarriage support groups.

46   Module 17: Gynaecological oncology

Learning outcomes

• To understand and to demonstrate appropriate knowledge, skills and attitudes in relation to gynaecological oncology.

KNOWLEDGE CRITERIA	CLINICAL COMPETENCY	PROFESSIONAL SKILLS AND ATTITUDES
Understand the epidemiology, aetiology, diagnosis, management and prognosis of gynaecological cancers. Understand the short- and long-term complications of therapies for gynaecological cancers. Screening and management of premalignant conditions of the cervix. Understand the principles of palliative care. Understand the principles of managed clinical networks.	Perform a cervical smear (model/patient). Explain the significance of cervical smear result and appropriate management. Observe a colposcopy.	Demonstrate awareness of cultural diversity, especially with respect to death and burial practices.

Details of knowledge criteria

• Anatomy:
  • Relevant anatomy of the pelvic organs and the relationship with the urinary and gastro-intestinal tracts.
• Cervix:
  • human papillomavirus screening.
  • preclinical phase of invasive squamous cell carcinoma.
  • squamous cell carcinoma.
• Uterus:
  • endometrial hyperplasia.
  • adenocarcinoma.

• Ovary:
  • epithelial tumours.
  • germ cell tumours.
• Palliative and terminal care:
  • symptom relief.
  • hospice care.
• Role of minor procedures and diagnostic imaging procedures:
  • cervical and endometrial sampling
  • ultrasound
  • pelvic endoscopy
  • magnetic resonance imaging and computed tomography.

47   Module 18: Urogynaecology and pelvic floor problems

Learning outcomes

• To understand and demonstrate appropriate knowledge skills and attitudes in relation to incontinence and prolapse.
• It is recognised that the learning outcome may be achieved following teaching in different components of the medical course.

KNOWLEDGE CRITERIA	CLINICAL COMPETENCY	PROFESSIONAL SKILLS AND ATTITUDES
Genitourinary anatomy and physiology and the maintenance of urinary continence. An understanding of the clinical features associated with disorders of urinary tract and pelvic floor. The management of urinary tract infection. Be aware of the investigations employed in the assessment of incontinence and prolapse. Be aware of the approaches to the management of urinary incontinence and genital prolapse.	Be able to take a history from a patient with incontinence and/or prolapse. Be able to recognise prolapse on examination. Be able to explain investigations and treatment of urinary incontinence and genitourinary prolapse.	Be aware of society’s and the patient’s reluctance to discuss incontinence and consequently to deal sensitively with issues surrounding incontinence. Be aware of the roles of other healthcare professionals in the management of the woman with incontinence, e.g. incontinence advisors and physiotherapists.

Details of knowledge criteria

(Details in Italics are likely to be taught in disciplines other than obstetrics and gynaecology or within gynaecology but primarily associated with another module)

• Epidemiology, aetiology and characteristics of:
  • stress incontinence.
  • urge incontinence.
  • urinary frequency.
  • urinary tract infections.
• Investigations:
  • microbiology
  • urodynamics.
  • cystoscopy.
  • imaging:
  • ultrasound
  • intravenous urography.
• Treatments (non-surgical):
  • coping with incontinence and retention:
  • pads and garments.
  • catheterisation.
  • bladder retraining.
  • pelvic floor exercises.
• Medical therapies.
• Surgical therapies:
  • vaginal repair with or without hysterectomy.
  • sling procedures and tapes.
  • colposuspension.