Bernard T. Haylen

Professor UNSW
MBBS (SYD) MD (L'POOL)
FRCOG FRANZCOG CU

 


Clinical Examination

There are 4 main parts to the clinical examination 

  1. TESTING FOR URINARY INCONTINENCE WITH COUGHING (Clinical Stress Leakage)
  2. EXAMINATION FOR UTERINE AND/OR VAGINAL PROLAPSE
  3. PELVIC EXAMINATION
  4. VAGINAL ULTRASOUND EXAMINATION

All of these examinations are well tolerated. They are performed with a maximum of care, discretion and consideration.

1. Clinical Stress Leakage

A comfortably full bladder will assist this examination.

2. Examination for Uterine and/or Vaginal Prolapse 

This follows the above examination. It requires the bladder to be emptied. The four types of prolapse are:

There are four stages of prolapse (IUGA/ ICS definitions - Haylen et al. 2010). Different grades might apply to each of the above types of prolapse. It is common to have more than one type of prolapse present.

Stage I: Descent at least half way to the vagina
Stage II: Descent to within 1 cm of the vaginal entrance
Stage III: Descent more than 1 cm outside the vaginal entrance
Stage IV: Type of prolapse totally outside the vagina

Stages of prolapse

 

3. Pelvic Examination

This is the usual gynaecological examination for any enlargement of the uterus or ovaries. A careful inspection is made of the outside (vulva) as well as the vagina. A pap smear will be taken if due.

4. Vaginal Ultrasound

This was introduced into Australia in 1989 by the then Dr Haylen as a non-invasive source of excellent clinical information. This includes:

Residual urine volume (postvoid residual) assessment

An image of postvoid residual of 65ml by transvaginal ultrasound, reducing to 4ml with a subsequent attempt at voiding.

Uterine version 

Examples of anteversion and retroversion. From Llewellyn-Jones D. Fundamentals of Obstetrics & Gynaecology. Vol 2 Gynaecology. 1970. Fig 21/1. P202. Faber & Faber. London. Reproduced by permission of Prof Suzanne Abraham.


© Copyright Bernard T. Haylen 2017 - www.bladder.com.au

Printed on: Sun 17 December 2017 at 1:16:19 PM AEDT