The urodynamics test,a painless examination lasts about 30-45 minutes and requires no anesthesia. You don't have to fast beforehand.

You will be asked to arrive with a normal urge to urinate .

Remember to bring a list of medications taken regularly and the results of urodynamic assessments already made.

You need to stop treatment prescribed to treat your bladder at least 15 days before the examination.

What is the purpose of a urodynamics test?

The urodynamic assessment is designed to accurately assess how your bladder and urethral sphincter work by studying the way you urinate, the bladder sensitivity, the ability to detain and value your urethral sphincter.

How is a urodynamics test carried out?

Everything begins with an assessment interview during which your background will be required and the troubles you have will be detailed. This meeting will be followed by a clinical examination at the best with a full bladder.

The urodynamic examination itself involves several steps:

-a flowmetry to measure the volume of urine emitted, the power of the urinary stream and the volume remaining at the end of voiding your bladder.

-The cystometry measures the sensitivity and capacity of your bladder and pressure variations during filling and during voiding.

-Closure pressure (urethral profile), which assesses the activity of the urethral sphincter.

To perform a urodynamic test, it is necessary to establish two catheters of very small size to fill and empty the bladder while measuring the pressure inside your bladder and your urethra.

Their introduction may be a little uncomfortable but not really painful.

A small rectal catheter will be introduced to record your abdominal pressure.

The equipment used is sterile and disposable.

Following this review the mechanisms of urinary disorders you suffer will be specified, the curves of your exploration will be given to you and a copy of this examination will be sent to your doctor..

And after the examination?

It is normal to experience transitory discomfort after the examination but you can resume your normal activities immediately.

. You are advised to drink 1.5 liters to 2 liters of water for 2 days after your assesment Antibiotic treatment or a urinary antiseptic can be prescribed to reduce the risk of urinary tract infection.

The value of a mammography is much higher when the patient is older and especially post menopausal. Indeed, the breast becomes less dense after menopause, which results in a better visualization of its frame in the radiology, and therefore a better visualization of potential defects in the frame.

In younger women premenopausal, a mammography should be performed early in the cycle.

A standard mammography includes 3 frames per breast: one frontal, a profile and an oblique.

A mammography performed in screening campaigns has only one frame per breast, usually an oblique one; it is just a screening test that will be confirmed by a normal mammogram (to 6 shots) in case of malfunction.

Technique

Vaginal ultrasound has made undeniable progress, it remains licit in certain situations to supplement the examination by a suprapubic.ultrasound

Indications

-Ovarian disease:

Ultrasound especially allows us to visualize the ovaries, and because they are located deeply inside the pelvis, are difficult to investigate clinically.

Any ovarian pathology will therefore be a potential indication for ultrasound.

We can use ultrasound for the assessment of pelvic tumor to recognize the nature of the mass:

-fluid,, it will evoke an ovarian cyst;

-solid, evoke an ovarian tumor (sometimes malignant) or uterine fibroids.

Ultrasound is indispensable during ovarian stimulation and in case of IVF, to monitor follicular growth and aspiration of mature follicles: one uses a vaginal probe.

-Uterine pathology:

The uterus is also seen well on ultrasound, endometrial clear separation between the myometrium.

Ultrasound is the first examination to propose in the evaluation of malformations of the female genital tract, pathology of the myometrium. This is the gold standard in diagnosing fibroids it enables a precise mapping

It is less effective for the diagnosis of adenomyosis and endometrial pathologies (polyps, submucous myomas, hyperplasia and atrophy).

The injection of liquid into the uterine cavity is the hysterosonography and improves the accuracy of ultrasonography in the evaluation of intra-cavitary disease.

It will allow the study of the lining of the cervix using a binocular magnifying 10 times.

This examination requires no anesthesia.

Its main interest is the identification of suspected areas thanks to dyes such as acetic acid and iodine, and the lugol to guide the biopsy. It is a safe examination, but requires great skill, colposcopy is of great importance in the detection and diagnosis of cervical cancer.

If cytology examinations like the pap smears are screening tests, biopsies are going to allow an accurate histological diagnosis. Thus, if the smears can be carried out by the medical practitioner, biopsies should be performed by a gynaecologist

CERVICAL BIOPSY:

It is carried out with a special instrument called biopsy forceps after the Lugol test on the neck and, at best, under colposcopic identification. It will help confirm malignancy. In fact the answer given by the pathologist is more specific than the cytologistconcerning the height of the epithelium involved in cellular abnormalities.

ENDOMETRIAL BIOPSY :

This is a biopsy of the endometrium.

It has several indications:

-Histological evidence of cancer corpus uteri

-As part of an infertility evaluation (to assess endometrial maturation during the menstrual cycle of the patient).

There are some contraindications: :

-Suspicion of pregnancy:we could indeed end a pregnancy.

-Suspicion of pelvic inflammatory disease: biopsy of endometrial on the endometritis risk of flamber pelvic infection

VULVAR AND VAGINAL BIOPSIES: :

They are usually done under local anesthesia, with the biopsy forceps. Vulvar biopsy should be performed in the presence of any vulvar lesion, of which the diagnosis is uncertain, especially in elderly women in whom cancer of the vulva is more common. The vaginal biopsy should also be performed where there is a visible untagged lesion , it can also be done under a colposcopy test after acetic acid and iodine.

It was the fundamental examination in gynecology before the onset of hysteroscopy, providing important information on endocorps, the body, tubes and even for a trained eye on the peritoneum peri-tubo-ovarian. Since the onset of uterine endoscopy and ultrasonography, hysterosalpingography has lost many of its indications, but it remains an important examination, particularly in the investigation of infertility.

Definition

It is the radiography of uterine and tubal cavities made opaque by the injection inside the cavity of a contrast agent.

Technique

We use as contrast product water-soluble substances with 25% of iodine that will be injected into the uterus.

Indications

-Sterility: hysterosalpingography is part of the infertility test, it can judge the appearance and tubal patency. It also shows abnormalities of the uterine cavity - The history of repeated abortions (search for an anomaly on the uterine body or an incompetent cervix).

The contraindications

   Pregnancy (and the examination will be performed at the 5th or 6th day of the cycle, at the end of menstruation)

     Evolutive pelvic and genital infection where the hysterography may cause an outbreak

     Intolerance to iodine products, besides exceptional

     The excessive bleeding of uterine origin: clots accumulated in the cavity would make it impossible to film interpretation. Before practicing a hysterography we must dry the hemorrhage (the prescription of progestogens for example),

     The recent completion of a digestive opacification (barium enema) would prevent proper analysis of the images.

Hysteroscopy is the endoscopic examination of the uterine cavity done through a hysteroscope which is connected to a source of light. There are several types of hysteroscopy. This examination can be performed for diagnostic purposes, we simply look inside the uterine cavity, no anesthesia is necessary. Hysteroscopy may also allow surgical procedures, this is the operative hysteroscopy which is usually performed under general anesthesia and we will not consider in this course.

MRI offers a high quality imaging particularly interesting in many gynecological diseases.

MRI has become irreplaceable in gynecological oncology, especially for pre-treatment assesments of cancers of the cervix and endometrium. Less effective in ovarian cancers, it is nevertheless the least disappointing examination with ultrasound. It is very useful in diagnosing adenomyosis and endometriosis.

Cytological examination, the CVF has one major goal: the detection of cervical cancers. Incidentally it will bring more information on a hormonal level and it can also help find certain infectious agents.

The technique:

It must be done before a vaginal examination during a speculum examination. It is preferable that it be practiced early in the cycle and outside of menstruation of any infectious episodes when the cervical mucus is abundant and clear. The pap smear is a simple screening test that can be done by any doctor. It is made using the rounded end of the Ayre spatula or a Cervex Brush. The collected cellular material is either spread on a glass slide to obtain a steady spreading of cells (fixation is done immediately using a spray, projected perpendicularly to the blade, about twenty centimeters away to avoid the detachment of cells) or is placed in a liquid medium (monolayer smear the blade of which is prepared by the laboratory).

Indications, contraindications :

The systematic implementation of a pap smear has set back the frequency of cervical cancer of the uterus which is the fourth cancer in women in France while it remains first in the underdeveloped countries that have not implemented a policy of screening

. We must begin to carry out the pap smear at the onset of sexual life. At that time, the smears should be performed annually for 3 years and then, if normal, can be spaced with a smear every 2-3 years (depending on risk factors).

We must avoid doing smears in some circumstances: vaginal infection and genital bleeding. The smear is more difficult to interpret: pregnancy, the second half of the cycle and menopause.

Smear results are interpreted according to the Bethesda classification (the most commonly used abbreviations)

Atypical glandular cells AGC (Atypical Glandular Cells);

CSA atypical squamous cells (Atypical Squamous Cells)

, ASC-US atypical squamous cells of undetermined significance (Atypical Squamous Cells of Undetermined Significance),

ASC-H atypical squamous cells can not exclude a squamous intraepithelial lesion High-grade (Atypical Squamous Cells Can not exclude HSIL) neoplasia CIN 1 cervical intraepithelial grade 1 (Cervical Intraepithelial Neoplasia), CIN 2 or 3 neoplasm of cervical intraepithelial grade 2 or 3 (Cervical Intraepithelial Neoplasia);

CIS carcinoma in situ; HSIL lesion squamous intraepithelial high-grade (Grade Squamous Intraepithelial Lesion High)

LSIL squamous intraepithelial lesion (low-grade Squamous Intraepithelial Lesion Low Grade) NIL / M no intraepithelial lesion or malignancy (Negative for Intraepithelial Lesion or Malignancy);