Urogynaecology and Menopause
Urogynaecology
Lower urinary tract dysfunction and genital prolapse affects over 20% of the adult population. Prolapse and lower urinary tract problems cause significant psychological and quality of life impairment. The costs of managing urinary incontinence and genital prolapse to the DoH are significant. Current treatments and access to treatment have significant scope for improvement and real world evaluation outside the context of controlled clinical trials.
Urogynaecology is currently carried out on two sites within King’s Heath Partners, at Kings College Hospital by Professor Linda Cardozo, Dr Dudley Robinson and Mr John Bidmead, and at St Thomas’ Hospital by Mr Con Kelleher.
The Urogynaecology Unit at Kings College Hospital NHS Foundation Trust is the largest tertiary referral centre in London and has an established national and international reputation for active clinical research, clinical practice, teaching and training. It currently employs three full time Consultant Urogynaecologists (Cardozo, Robinson, Bidmead), one subspecialty trainee, two clinical research fellows, two senior urogynaecology nurse specialist, one specialist nurse and two women’s health physiotherapists
Urogynaecology at Guys and St Thomas’ NHS Foundation Trust is run by one Consultant Gynaecologist (Kelleher), a nurse specialist and an MD Fellow. There is also a shared subspecialty trainee between two sites. Both units work in collaboration with the specialties of urology, colorectal surgery, healthcare for the elderly, and stroke unit. Clinical practice, teaching, training, and clinical research are at present not integrated between sites.
Current research funding is from industry grants, competitive grants and private sponsorship. Grants and funding pay for the salaries and overheads of research fellows and specialist additional equipment.
Research Staff
Menopause Research
As the average female life expectancy in the UK is now 82 years, women are spending more than 40% of their lives in the postmenopausal state. This means that a significant proportion of health care is being provided to this group of women, HRT has received a lot of bad press over the past few years and has instilled uncertainty and fear into doctors and their female patients. This has had a detrimental effect on women’s quality of life, as not only does HRT eliminate hypo-oestrogenic symptoms but it protects against bone loss and prevents cardiovascular disease if taken at the right time (commenced close to the menopause) thereby alleviating some of the financial burden on the healthcare system. There are still unanswered questions i.e. how long it should be taken for? what dosage? and which preparation?
The Menopause Research Unit, led by Professor Janice Rymer, is based on the Guy’s Campus and intertwines with the NHS Menopause Clinic, a busy clinic (> 1000 appointments per year) receiving referrals from local GPs and those around the UK, and from other hospital specialties.
As well as delivering a high quality service which facilitates for outpatient hysteroscopy, it also provides training opportunities for O&G junior doctors as well as GP, genitourinary medicine, and community gynaecology trainees. The clinic is able to provide facilities for completion of the Faculty of Reproductive and Sexual Health’s Menopause Module, the RCOG Advance Training Module in Menopause, and the Subspecialty requirement for the menopause section for Reproductive Medicine accrediatation. This clinic provides a substantial and underutilised resource for research into the menopause.
The Menopause Research Unit was established in 1991 by Professor Rymer and commenced with a collaborative study with the Guy’s Osteoporosis Unit to investigate the first “nonbleeding” hormone replacement therapy (HRT), the primary outcome being bone density. This 15-year follow up study was the longest running HRT trial in the UK. The Unit collaborates with many other disciplines in GSTFT: radiology, nuclear medicine, neuropharmacology, cardiology, cytology, histopathology, breast medicine, oncology, biochemistry and psychiatry. Research fellows in the unit have focussed on the following areas: HRT and osteoporosis, HRT as add back therapy with GnRH analogues, and cardiovascular effects of different nonbleeding HRTs. A major collaboration with the Institute of Psychiatry is ongoing, investigating the effect of sex hormones on brain function. The Unit has been involved in many pharmaceutical multicentre trials.
Current research includes a trial on women who have had premature ovarian failure (POF). If the women choose to have treatment they are randomised to HRT or the oral contraceptive pill. The primary outcome measure is bone density. We are also collaborating with the Daisy Network (a support group for POF sufferers). The research fellow responsible for the trial (her MD project) has also started up an innovative NHS Premature Ovarian Failure Clinic with support from the Guy’s & St Thomas’ Charity and has established a database. This is an example of a research idea evolving into the delivery of a specialty clinic that is both service and research-orientated.
In the laboratory setting, Professor Kevin O'Byrne is studying the neural mechanisms underlying hot flushes, using a radio-telemetry system to monitor rat tail skin temperature (TST); a relevant animal model, which has been extensively validated. His is the only unit in Europe with this capability and are currently studying the effects of selective ER-alpha and ER-beta agonists and antagonists on the vasomotor disturbances that underlie hot flushes. We are also interested in the potential use of phytoestrogens as "alternative" therapies for hot flushes.
Research Staff