Publications by authors named "Angie Rantell"

29 Publications

  • Page 1 of 1

Healthcare professional's choice for surgical management of stress urinary incontinence in a U.K. tertiary hospital.

Eur J Obstet Gynecol Reprod Biol 2021 May 24;263:7-14. Epub 2021 May 24.

Department of Urogynaecology, King's College Hospital, London, UK.

Objective: In July 2018, NHS England, introduced a pause on vaginal mesh, including the mid-urethral sling (MUS) for treatment of stress urinary incontinence (SUI). NICE guidelines recommend MUS as one of the surgical options for SUI. The aim of our study was to investigate healthcare professionals choices for surgical treatment of SUI, if conservative measures failed.

Study Design: The urogynaecology department at our tertiary level hospital devised a questionnaire using SurveyMonkey. This was distributed via email to 1058 healthcare professionals of different medical backgrounds. The surgical options were based on the NICE guideline and its patient decision making aid. We also used surgical information from the British society of Urogynaecology (BSUG) and British association of urological surgeons (BAUS).

Results: We received 214 responses of which 204 were complete. Twenty six percent of replies were from obstetricians and gynaecologists, 36 % had over 20 years experience and 79 % were female. Forty four percent had no previous knowledge of surgical options. Mid-urethral sling was the most popular choice based on description, success and specific complications. Urethral bulking agent was the only option that increased in popularity after describing complications. Twenty two percent would avoid surgery due to the risk of complications.

Conclusion: This is the first study evaluating healthcare professionals surgical choice for SUI. Despite negative media publicity and NHS pause on MUS, it was still the most popular choice before and after informing of specific complications. The urethral bulking agent was the only surgical treatment, which increased in popularity after considering complications.
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http://dx.doi.org/10.1016/j.ejogrb.2021.05.039DOI Listing
May 2021

Pharmacist's knowledge regarding the management of overactive bladder in elderly women.

Eur J Obstet Gynecol Reprod Biol 2021 Mar 16;258:269-272. Epub 2021 Jan 16.

Department of Urogynaecology, King's College Hospital, London, UK.

Objective: Anticholinergic drugs are the mainstay treatment of OAB. Anticholinergic load is the cumulative effect of taking anticholinergic medication. Recent evidence suggests that in the elderly this can have a detrimental affect, with the potential to develop dementia. A previous study found that knowledge of anticholinergic load was lacking in our healthcare professionals. The aim of this study was to assess knowledge of pharmacists, who in the UK have the potential where qualified to prescribe as well as dispense.

Study Design: A questionnaire was formulated based on the previous study. It was sent out to 418 pharmacists from; a south London hospital trust, a south London clinical commissioning group and United Kingdom Clinical Pharmacists Association.

Results: Seventy-five pharmacists completed the questionnaire. Solifenacin and tolterodine was the most popular drug prescribed in the elderly without dementia, whilst mirabegron was the most popular in the elderly with dementia. One pharmacist suggested using oxybutynin. Sixty-two percent discuss anticholinergic load with the patients, 40 % advice prescribers and 42 % consider anticholinergic load when dispensing the drug. Fifteen percent have had patients report confusion/memory loss. Thirty percent know how to assess anticholinergic load. Only 15 % felt dementia was a concern with anticholinergic drugs. Worryingly, 54 % though mirabegron exerted anticholinergic effects.

Conclusion: This is the first study looking at pharmacist knowledge on the use of anticholinergic medication for OAB in elderly women. Knowledge amongst all healthcare professionals including pharmacists is lacking and needs to be improved.
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http://dx.doi.org/10.1016/j.ejogrb.2021.01.021DOI Listing
March 2021

Social media awareness among non-urogynecologists regarding the current mesh discussions in urogynecology: a survey study.

Int Urogynecol J 2020 06 17;31(6):1231-1243. Epub 2020 Feb 17.

Department of Urogynecology, King's College Hospital, London, UK.

Introduction And Hypothesis: There has been a great deal of discussion about mesh complications in urogynecology in recent years. However, awareness of other doctors who are not urogynecologists is unknown. This study was aimed at determining the level of awareness of mesh discussions among medical doctors whose specialty is not urology or gynecology.

Methods: A survey study was administered, and all medical doctors, except gynecologists and urologists, were invited. Respondent doctors were classified into four groups: King's College Hospital (KCH), UK; Uludag University Hospital (UUH), Turkey; the United States (USA); and the world (WORLD). The primary outcome was the awareness of mesh discussion in urogynecology, and the secondary outcome was the social media awareness of the mesh discussion.

Results: 1231 doctors responded to the survey. The awareness of the current mesh problems among the respondent doctors was 15.8% in KCH, 15.4% in UUH, 26.9% in the USA, and 16.2% in WORLD. The social media awareness about mesh problems was 20.8% in KCH, 20.3% in UUH, 32.8% in the USA, and 20.6% in WORLD. Although there were no differences among three of the groups with regard to primary and secondary outcomes, the USA group score was statistically significantly higher than the others.

Conclusions: Social media can influence doctors' thinking on controversial academic issues. In this survey study, non-urogynecologist doctors in the USA cohort have higher awareness levels and a higher social media awareness level than other groups.
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http://dx.doi.org/10.1007/s00192-020-04242-3DOI Listing
June 2020

Recommendations and future research initiative to optimize bladder management in pregnancy and childbirth International Consultation on Incontinence - Research society 2018.

Neurourol Urodyn 2019 12;38 Suppl 5:S104-S110

Department of Urogynaecology, King's College Hospital, London, UK.

With increasing birth rates globally, obstetric bladder care and long term pelvic floor dysfunction continues to be a issue. This paper aims to provide an overview of the concerns in the antenatal, intrapartum an post partum periods and presents recommendation for the research requirements necessary and education to challenge current practice.
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http://dx.doi.org/10.1002/nau.24053DOI Listing
December 2019

Review of the 6th International Consultation on Incontinence: Primary prevention of urinary incontinence.

Neurourol Urodyn 2020 01 18;39(1):66-72. Epub 2019 Nov 18.

Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.

Aims: To report the state of the science on primary prevention of urinary incontinence (UI) in adults from the 6th International Consultation on Incontinence with an update through January 2019.

Methods: Online databases PubMed, CINAHL, PsycInfo, and Medline were searched in March 2016 and February 2019 with a focus on literature published after 2010. The International Consultation on Urological Diseases modified Oxford Centre for Evidence-Based Medicine Levels of Evidence and grades of recommendation were used to evaluate the literature.

Results: Grade B recommendations to prevent UI in pregnant and postpartum women are available and promising evidence exists for educational interventions to prevent UI up to 2 years in older women. There is little evidence for adding preoperative pelvic floor muscle exercises to postprostatectomy pelvic floor muscle exercises for men to regain continence. Insufficient evidence exists for the effectiveness of screening for UI in women. The absence of information on primary prevention remains for adolescents, nulliparous and perimenopausal women, and middle-aged and aged men and women.

Conclusions: Few primary prevention interventions for UI exist for specific populations, especially pregnant and postpartum women. Research interest in developing foundational knowledge to design these interventions is growing.
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http://dx.doi.org/10.1002/nau.24222DOI Listing
January 2020

Vaginal Pessaries for Pelvic Organ Prolapse and Their Impact on Sexual Function.

Authors:
Angie Rantell

Sex Med Rev 2019 10 2;7(4):597-603. Epub 2019 Aug 2.

Department of Urogynaecology, King's College Hospital NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland. Electronic address:

Introduction: Pelvic organ prolapse (POP) is a common condition among parous women and its prevalence increases with age. Vaginal pessaries are one of the management options for women with prolapse. In the current health climate, where there are controversy surrounding surgical procedures, an increasing number of women are considering a pessary over surgical management.

Aim: This article aims to provide an overview of POP, its associated symptoms, and the different types of pessaries available. It will go on to describe how sexual activity (SA) and sexual function (SF) needs to be considered as part of the pessary selection discussion, and common concerns expressed by women.

Methods: A literature review was undertaken to record the current evidence regarding SA and pessary use, and clinical practice and experience are discussed.

Main Outcome Measures: The main outcome of this study was to consider the preservation or restoration of SF in women using a pessary for prolapse.

Results: There are several pessaries available on the market that enable women to maintain SA, and for many of these it will not be noticeable to their partners. If, however, the woman or their partner finds the pessary uncomfortable or obstructing during intercourse, women can be trained to remove and reinsert their pessary as necessary. The evidence suggests that, for those women who are sexually active with their pessaries in situ, they are happy and continue with this form of management in the long term.

Conclusion: Health care professionals need to ensure that SF or the desire to be sexually active (in whatever form that may be) is assessed and discussed as part of routine care and is considered in all decision making. Rantell A. Vaginal Pessaries for Pelvic Organ Prolapse and Their Impact on Sexual Function. Sex Med Rev 2019;7:597-603.
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http://dx.doi.org/10.1016/j.sxmr.2019.06.002DOI Listing
October 2019

Ambulatory urodynamics monitoring - a video demonstration.

Neurourol Urodyn 2018 11 17;37(8):2305. Epub 2018 Sep 17.

King's College Hospital, London.

Aims: To present a narrated video designed to demonstrate the steps involved in performing and interpreting ambulatory urodynamics monitoring (AUM).

Methods: This video provides an overview of the role of AUM in clinical practice and describes the process of performing AUM using solid state microtip transducers and the MMS / Laborie Luna ambulatory recorder. Line placement, calibration and the urodynamic protocol are discussed along with descriptions of provocation tests that can be used during AUM. Examples of AUM traces are reviewed demonstrating common findings eg detrusor overactivity, urodynamic stress incontinence and voiding difficulties. Good urodynamic practice in relation to the interpretation of AUM is presented. Its application in clinical practice is often limited due to the cost of equipment (particularly the microtip transducers which range from £1200-£2500) and appropriate decontamination of the transducers (in this unit an anti-sporacidal 3 stage wipe system is employed (Tristel) however, many hospital infection control teams do not consider this sufficient so disposable water or air filled lines are used). Other limitations include the requirement for additional training and the time necessary to perform the test.

Results: This video will educate and inform health care professionals regarding AUM so that they may consider its use in their armamentarium of investigations of lower urinary tract function and be able to counsel patients appropriately should they choose to refer them to an alternative provider for further investigation if they do not have direct access in their service.

Conclusion: AUM is a second line investigation of lower urinary tract dysfunction used in patients where conventional urodynamics have failed to make a diagnosis or replicate their symptoms. They allow for a more physiological assessment of bladder function. Protocols may vary from 1 h to 24 h but are dependent on re-creation of patient's symptoms.
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http://dx.doi.org/10.1002/nau.23573DOI Listing
November 2018

AbobotulinumtoxinA for the treatment of overactive bladder.

Expert Opin Biol Ther 2018 10 10;18(10):1005-1013. Epub 2018 Sep 10.

a Department of Urogynaecology , King's College Hospital , London , United Kingdom.

Introduction: Overactive bladder is a common condition that can have a negative impact on quality of life. Botulinum Toxin A is a third line treatment for overactive bladder following conservative measures and anticholinergic medication. At present, OnabotulinumtoxinA is the only preparation licensed for this indication. More recently, trials have been undertaken to compare the efficacy of this to AbobotulinumtoxinA. Areas covered: This article aims to provide an overview of AbobotulinumtoxinA, which is currently not yet licensed for overactive bladder or neurogenic detrusor overactivity. It will detail the pharmacokinetics and dynamics, assess the available clinical trial data and make comparisons with current clinical practice. A systematic literature search was completed, using ovid Medline and Embase, with the aim to review all data concerning the administration of AbobotulinumtoxinA for the treatment of overactive bladder. Expert opinion: Currently, there are a lack of data on the use of AbobotulinumtoxinA for overactive bladder or neurogenic detrusor overactivity. Current evidence concentrates on its use in neurogenic detrusor overactivity, and there are data to show it may be as efficacious as OnabotulinumtoxinA. However, there is a lack of homogenous data to compare the two products and therefore we are unable to recommend this currently.
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http://dx.doi.org/10.1080/14712598.2018.1510486DOI Listing
October 2018

Selecting an intermittent self-catheter: key considerations.

Br J Nurs 2018 Aug;27(Sup15):S11-S16

Lead Nurse Urogynaecology/Nurse Cystoscopist, King's College Hospital NHS Foundation Trust.

This article explores the factors that must be considered when assessing patients for intermittent self-catherisation (ISC). It discusses the various types of intermittent catheters and their properties. Key considerations for the health professional when making product recommendations are covered and emphasis is placed on teaching patients the ISC technique. The article also highlights what patients value in terms of product choice and the importance of ongoing support. It concludes by introducing the GentleCath Glide, a new product that incorporates FeelClean™ technology, which leaves less residue on the hands and clothes.
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http://dx.doi.org/10.12968/bjon.2018.27.Sup15.S11DOI Listing
August 2018

What is the utility of urodynamics, including ambulatory, and 24 h monitoring, in predicting upper urinary tract damage in neuro-urological patients and other lower urinary tract dysfunction? ICI-RS 2017.

Neurourol Urodyn 2018 06 19;37(S4):S25-S31. Epub 2018 Jul 19.

Hospital Universitario de Canarias, Universidad de La Laguna, Canary Islands, Spain.

Aims: This article focuses on how, and if, urodynamics can help to identify which kidneys are in danger of deteriorating in function and also gives recommendations for future research.

Methods: At the International Consultation on Incontinence-Research Society (ICI-RS) in 2017, a multi-disciplinary group presented a literature search of what is known about the utility of Urodynamics, including ambulatory, and 24 h monitoring, in predicting upper urinary tract damage in neuro-urological patients and other lower urinary tract dysfunctions. Wider discussions regarding knowledge gaps, and ideas for future research ensued and are presented in this paper along with a review of the evidence.

Results: The current treatment strategy both in congenital and acquired neurogenic bladder is rather aggressive and successful when addressing hazards to kidney function. This article has highlighted uncertainties concerning the use of 40 cmH2O DLPP and even the lower value of 20. The current literature suggests that patients with spina bifida and those with spinal cord injury have a higher risk of developing upper urinary tract damage and kidney function impairment than those with multiple sclerosis.

Conclusions: Future research should focus on less invasive methods to assess the risk to the upper and lower urinary tract such as urine and serum measurements of cytokines that are involved in the pathophysiology of urinary tract impairment.
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http://dx.doi.org/10.1002/nau.23599DOI Listing
June 2018

Urethral pressure profilometry-A video demonstration.

Neurourol Urodyn 2018 06 23;37(5):1521. Epub 2018 Apr 23.

King's College Hospital, London, UK.

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http://dx.doi.org/10.1002/nau.23499DOI Listing
June 2018

Narrated video demonstrating the procedure of videourodynamics.

Neurourol Urodyn 2018 03 11;37(3):1176-1177. Epub 2017 Nov 11.

King's College Hospital, London, England.

Aims: To present a narrated video designed to demonstrate the steps involved in the procedure of videourodynamics.

Methods: The technique shown and described in this teaching video is that performed in the urogynaecology Department at King's College Hospital, London. The equipment utilizes fluid filled lines and external pressure transducers which provide accurate and consistent results.

Results: The advantage of videocystourolodraphy is that as well as incorporating screening fluoroscopy with a cystometric trace, simultaneous assessment of lower urinary tract anatomy and morphology and function is possible.

Conclusion: Videourodynamics or videocystourogrpahy is a diagnostic tool that incorporates urodynamics with imaging of the lower urinary tract which occurs simultaneously. Thus both functional anatomy and physiology can be assessed.
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http://dx.doi.org/10.1002/nau.23437DOI Listing
March 2018

Lower urinary tract infections in women.

Br J Nurs 2017 May;26(9):S12-S19

Lead Nurse for Urogynaecology/Nurse Cystoscopist, King's College Hospital, London.

In her lifetime, a woman is highly likely to develop at least one lower urinary tract infection. Early detection and treatment are key. Being aware of predisposing factors for infection and understanding appropriate diagnosis and treatment regimens will help nurses in both primary and acute care manage these patients correctly. This will not only benefit patients but will also help prevent incorrect antimicrobial management and avoid unplanned admissions. This aim of this article is to provide nurses with the information they need to best advise both colleagues and patients on how to manage lower urinary tract infections in women.
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http://dx.doi.org/10.12968/bjon.2017.26.9.S12DOI Listing
May 2017

Are we justified in suggesting change to caffeine, alcohol, and carbonated drink intake in lower urinary tract disease? Report from the ICI-RS 2015.

Neurourol Urodyn 2017 04;36(4):876-881

Department of Urogynaecology, Kings College Hospital, London, United Kingdom.

Aims: There is increasing evidence that diet may have a significant role in the development of lower urinary tract symptoms. While fluid intake is known to affect lower urinary tract function the effects of alcohol, caffeine, carbonated drinks, and artificial sweeteners are less well understood and evidence from epidemiological studies is mixed and sometimes contradictory. The aim of this paper is to appraise the available evidence on the effect of caffeine, alcohol, and carbonated drinks on lower urinary tract function and dysfunction in addition to suggesting proposals for further research.

Methods: Literature review based on a systematic search strategy using the terms "fluid intake," "caffeine," "alcohol," "carbonated" and "urinary incontinence," "detrusor overactivity," "Overactive Bladder," "OAB."

Results: In addition to fluid intake, there is some evidence to support a role of caffeine, alcohol, and carbonated beverages in the pathogenesis of OAB and lower urinary tract dysfunction. Although some findings are contradictory, others clearly show an association between the ingestion of caffeine, carbonated drinks, and alcohol with symptom severity. CONCLUSIONS Given the available evidence lifestyle interventions and fluid modification may have an important role in the primary prevention of lower urinary tract symptoms. However, more research is needed to determine the precise role of caffeine, carbonated drinks, and alcohol in the pathogenesis and management of these symptoms. The purpose of this paper is to stimulate that research. Neurourol. Urodynam. 36:876-881, 2017. © 2017 Wiley Periodicals, Inc.
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http://dx.doi.org/10.1002/nau.23149DOI Listing
April 2017

Adolescents with nocturnal enuresis and daytime urinary incontinence-How can pediatric and adult care be improved-ICI-RS 2015?

Neurourol Urodyn 2017 04;36(4):843-849

Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark.

Aims: Nocturnal enuresis (NE) and daytime urinary incontinence (DUI) are common in adolescents. The aim of this paper was to review studies on prevalence, clinical symptoms and associated risk factors and to formulate recommendations for assessment and treatment.

Materials And Methods: A systematic Scopus search was performed and relevant publications were selected. The topic was discussed during the ICI-RS meeting in 2015.

Results: One to two percent of older adolescents are affected by NE and 1% by DUI. NE and DUI are associated with multiple risk factors such as fecal incontinence and constipation, obesity, chronic illness, and psychological impairment. Chronic treatment-resistant, relapsing and new-onset cases can occur. Adolescent NE and DUI can be treated by a multidisciplinary team according to pediatric principles. Additional treatment components have been developed for adolescents. Transition from pediatric to adult services is frequently disorganized.

Conclusions: Incontinence in adolescents is a neglected research topic and clinical care is often suboptimal. As adolescents are seen by both pediatric and adult services, alignment and harmonization of diagnostic and therapeutic principles is needed. Also, an organized transition process is recommended to improve care for adolescent patients. Neurourol. Urodynam. 36:843-849, 2017. © 2017 Wiley Periodicals, Inc.
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http://dx.doi.org/10.1002/nau.22997DOI Listing
April 2017

How does lower urinary tract dysfunction (LUTD) affect sexual function in men and women? ICI-RS 2015-Part 2.

Neurourol Urodyn 2017 04;36(4):869-875

Department of Urogynaecology, King's College Hospital, London, UK.

Aim: To discuss available data on the links between LUTD and sexual dysfunction, what is still unknown about the causative effect of disease processes on sexual function (SF), and to suggest proposals for further research.

Methods: At the 2015 International Consultation on Incontinence-Research Society (ICI-RS), a multi-disciplinary group presented a literature search of what is known about the effect of LUTD on SF in men and women. Wider discussions regarding knowledge gaps, and ideal research methodology ensued and are presented.

Results: The underlying mechanisms of the impact of LUTD on SF remain largely unknown. Risk factors for the metabolic syndrome may cause both LUTS and ED in men, and their improvement may improve both conditions. In women, neurovascular changes may be common in LUTD and FSD. Successful LUTS management results in FSD improvement, but the mechanisms are ill understood. Gaps in standardization of sexual dysfunction terminology, variations of assessment, and treatment in clinical practice and research make most studies not comparable. The sensitive knowledge and subjective nature of the problem present challenges and often result in neglecting it.

Conclusion: Neurovascular and hormonal factors, but also indirect effects may link LUTD to SD in both sexes, but the evidence is not robust and the mechanisms unclear. There is a need for defining the terminology and standardizing outcomes assessed in clinical trials. The multifactorial nature of SF in both sexes makes trial design challenging and "real world" studies may prove more beneficial for patients' outcomes and clinicians' understanding.
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http://dx.doi.org/10.1002/nau.23088DOI Listing
April 2017

How does lower urinary tract dysfunction affect sexual function in men and women? ICI-RS 2015-Part 1.

Neurourol Urodyn 2017 04;36(4):949-952

Department of Urogynaecology, King's College Hospital, London, United Kingdom.

Aim: The aim of this paper is to review the literature on the effect of lower urinary tract symptoms (LUTS) on sexual function and dysfunction.

Methods: At the International Consultation on Incontinence-Research Society (ICI-RS) in 2015, a multidisciplinary group presented a literature search of what is known about the effect of lower urinary tract dysfunction (LUTD) on sexual function (SF) in men and women. Wider discussions regarding knowledge gaps and ideal research methodology ensued.

Results: A body of evidence supports associations between LUTS/urinary incontinence on SF in both men and women, but the true prevalence of the impact of LUTD on SF remains largely unknown. There is still reluctance among health care professionals (HCP's) to discuss SF with patients and often patients who are not asked will not volunteer their problems.

Conclusion: A significant knowledge gap in this area remains. Education among HCP's on assessment and treatment of sexual dysfunction and communication skills are essential to encourage, and engage patients with HCP's. Neurourol. Urodynam. 36:949-952, 2017. © 2017 Wiley Periodicals, Inc.
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http://dx.doi.org/10.1002/nau.23040DOI Listing
April 2017

Anticholinergic prescription: are healthcare professionals the real burden?

Int Urogynecol J 2017 Aug 13;28(8):1249-1256. Epub 2017 Jan 13.

Department of Urogynaecology, King's College Hospital, London, UK.

Introduction And Hypothesis: Anticholinergic medication is the medical treatment for overactive bladder (OAB). These drugs can act on the central nervous system and can lead to cognitive decline, dementia, and potentially death. Patients taking drugs with anticholinergic effects increase their anticholinergic burden-defined as the cumulative effect of taking one or more drugs that can have adverse effects. When prescribing anticholinergic medication for the elderly, we must choose the right drug. We aimed to discover the level of understanding on this subject and its application to real clinical practice amongst our healthcare professionals (HCPs).

Methods: An 18-point questionnaire was distributed to urogynaecologists, general gynaecologists, urologists, geriatricians, general practitioners (GPs), and nurse specialists to assess knowledge on the subject.

Results: A total of 96 HCPs completed the questionnaire. The nurse specialists had the highest score in identifying that oxybutynin was the drug most likely to cross the blood-brain barrier (BBB). The urogynaecologists had the highest score in identifying that trospium chloride was least likely to cross the BBB, whereas the GPs had the lowest score. Solifenacin was the most popular anticholinergic drug prescribed in the elderly without dementia. Trospium chloride was the most popular drug prescribed in the elderly with dementia.

Conclusions: We have found that knowledge is lacking amongst all our HCPs, but especially amongst our first-line doctors, our GPs. Education is key in developing knowledge and safe prescribing, to improve the care we give to our patients.
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http://dx.doi.org/10.1007/s00192-016-3258-3DOI Listing
August 2017

Antepartum voiding symptoms following prior tension-free vaginal tape (TVT) operation: A case report.

J Obstet Gynaecol 2016 Nov 14;36(8):1002-1003. Epub 2016 Sep 14.

b Department of Urogynaecology , King's College Hospital , London , UK.

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http://dx.doi.org/10.1080/01443615.2016.1217512DOI Listing
November 2016

Assessment of the impact of urogenital prolapse on sexual dysfunction.

Maturitas 2016 Oct 21;92:56-60. Epub 2016 Jul 21.

Department of Urogynaecology, King's College Hospital, London.

Sexual dysfunction is one of the symptoms that motivates women to seek medical help in the management of urogenital prolapse. Conservative or surgical interventions may be offered to treat the prolapse but the question remains as to whether treatment restores sexual function (SF). This article briefly discusses the assessment of SF in women with a urogenital prolapse and reviews the effect of therapeutic interventions on SF.
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http://dx.doi.org/10.1016/j.maturitas.2016.07.001DOI Listing
October 2016

Personal goals and expectations of OAB patients in the UK.

Neurourol Urodyn 2017 Apr 26;36(4):1194-1200. Epub 2016 Aug 26.

St. Mary's Hospital, Imperial College, London, UK.

Introduction: In clinical practice and in research patient-centred outcomes are often utilised to help improve communication between patients and clinicians and to help manage expectations from treatment. However, many of these goals are generic and do not adequately capture the details of day to day life that bother patients the most and that they hope will improve with therapy. This study aimed to understand what are the goals of patients with overactive bladder symptoms in the UK who were taking part in a clinical trial and to assess goal achievement.

Methods: This was a qualitative analysis of the patients goals recorded using the Self-Assessment Goal Achievement (SAGA) Questionnaire during the UK study assessing flexible dose fesoterodine in adults (SAFINA) trial. Free text patient goals were completed at baseline and an assessment of achievement was performed at the end of treatment. Grounded theory was used to develop themes and sub themes.

Results: Three hundred and thirty-one patients completed the trial and 1137 open ended goals were set. Six themes emerged from the data including, OAB, other LUTS and finishing the task in hand with multiple subthemes noted.

Conclusions: By assessing and understanding what is important to the patient, it may help to tailor patient care and treatment and improve patient satisfaction.
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http://dx.doi.org/10.1002/nau.23094DOI Listing
April 2017

UKCS Minimum Standards for Continence Care.

Authors:
Angie Rantell

Br J Nurs 2016 Aug;25(15):826

Lead Nurse, Urogynaecology/Nurse Cystoscopist, King's College Hospital.

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http://dx.doi.org/10.12968/bjon.2016.25.15.826DOI Listing
August 2016

Do we manage incontinence in children and adults with special needs adequately? ICI-RS 2014.

Neurourol Urodyn 2016 Feb;35(2):304-6

Department of Urogynaecology, King's College Hospital, London, United Kingdom.

Aims: To review studies on the associations of incontinence and special needs in children and adults and to outline future directions in research and clinical care.

Materials And Methods: A review of literature was conducted. Open questions and future directions were discussed during the ICI-RS meeting in 2014.

Results: Special needs comprise a wide variety of conditions and disabilities. Individuals with special needs carry a greater risk for all types of incontinence. There is a high tendency for incontinence to persist from childhood into adulthood. Many people do not receive adequate medical care for their incontinence.

Conclusions: More detailed research is needed, especially in the adult population with special needs. Assessment and treatment of incontinence should be offered routinely to all those with special needs.
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http://dx.doi.org/10.1002/nau.22823DOI Listing
February 2016

Minimum standards for continence care in the UK.

Neurourol Urodyn 2016 Mar 16;35(3):400-6. Epub 2015 Jan 16.

Consultant Urogynaecologist, Birmingham Women's Hospital, West Midlands, UK.

Aim: This paper reports on the publication of a joint statement on minimum standards for continence care in the UK.

Methods: A multidisciplinary working party were tasked with creating standards for both training and education in continence care, as well as explicit standards for a framework of service delivery. This was done through a process of extensive consultation with relevant professional bodies.

Results: The standards suggest a modular structure to continence training, including basic, male, female, catheter care etc. Discussions on service provision cover primary care through to expert tertiary centres.

Conclusions: This is the first attempt to standardise continence care and training for all health care professionals nationally. The document is available on the United Kingdom Continence Society website www.ukcs.uk.net.
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http://dx.doi.org/10.1002/nau.22717DOI Listing
March 2016

Fesoterodine fumarate and the oxybutynin ring for the treatment of urinary incontinence in women.

Expert Opin Pharmacother 2014 Feb 27;15(3):385-93. Epub 2013 Dec 27.

King's College Hospital , Denmark Hill, London, SE5 9RS , UK +0203 299 3568 ; +0203 299 3449 ;

Introduction: Urinary incontinence (UI) is a prevalent condition among women of all ages. It can have a significant negative impact on women's quality of life causing not only physical but also psychological distress.

Areas Covered: This article aims to provide a review of the pharmacology, efficacy, safety and tolerability of fesoterodine fumarate (the newest anticholinergic launched in the UK) and the oxybutynin vaginal ring (the newest route of drug delivery in development) in the treatment of urgency UI.

Expert Opinion: Fesoterodine is now a well-established treatment option; however, as with all oral anticholinergic agents its use is hindered by side effects. The efficacy of the oxybutynin ring has only been demonstrated in small studies. Larger clinical trials assessing the efficacy, tolerability and acceptability are required before appropriate recommendations can be made.
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http://dx.doi.org/10.1517/14656566.2014.875158DOI Listing
February 2014

Female intermittent self catheterisation.

Authors:
Angie Rantell

Nurs Times 2010 Oct 12-18;106(40):suppl 12-3

King's College Hospital, London.

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March 2011

Lower urinary tract symptoms in women with multiple sclerosis: 2.

Authors:
Angie Rantell

Br J Nurs 2009 Aug 13-Sep 9;18(15):920, 922-5

King's College Hospital, London, UK.

Bladder dysfunction in women with multiple sclerosis (MS) is a common and distressing problem affecting up to 75% of patients (Das Gupta and Fowler, 2003). It can seriously affect their quality of life and in some cases cause deterioration of MS symptoms. The first part of this article (Rantell, 2009) set out how to perform a full assessment of these patients and how to diagnose their lower urinary tract symptoms (LUTS). This second article aims to provide an overview of the conservative, pharmacological and surgical management of lower urinary tract symptoms. Often women will need a combination of therapies to achieve optimum benefit from treatment. Management and interventions should be regularly re-assessed as women's symptoms and their severity may change over time as the disease progresses.
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http://dx.doi.org/10.12968/bjon.2009.18.15.43561DOI Listing
October 2009

Lower urinary tract symptoms in women with multiple sclerosis: Part 1.

Authors:
Angie Rantell

Br J Nurs 2009 Apr 9-22;18(7):S14, S16-8

King's College Hospital, London.

Multiple sclerosis (MS) affects about 85,000 people in the UK, and is the commonest progressive neurological disease affecting young people (Compston and Coles, 2002). Bladder dysfunction can be found in up to 75% of patients with MS (DasGupta and Fowler, 2003). In a study by Hemmett et al (2004), 87% of people with MS reported bladder symptoms and 70% felt that they had a moderate to high adverse effect on their quality of life. This article, the first in a two-part series, examines how MS can affect normal bladder function, looking at what symptoms patients may present with. It also provides an overview of how nurses can assess and diagnose these bladder problems. The conservative, pharmacological and surgical interventions for the management of lower urinary tract symptoms will be discussed in the second part of this series.
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http://dx.doi.org/10.12968/bjon.2009.18.Sup3.41664DOI Listing
July 2009
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