This page sets out the OSATS requirements for subspecialty training in urogynaecology.
You have to be competent in:
- Cystoscopy
- Posterior repair
- Sacrocolpopexy
- Sacrospinous fixation
- Urodynamics
- Vaginal hysterectomy and anterior repair
- Laparoscopic sacrocolpopexy (optional module only)
Cystoscopy
Items under observation:
- Obtain appropriate consent
- Clean and drape correctly
- Choose correct scope
- Assemble scope correctly
- Visualise whole bladder
- Identify ureteric orifices
- Observe the urethra
- Appropriate use of antibiotics
- Empty bladder at end of procedure
Posterior repair
Items under observation:
- Obtain appropriate consent
- Correct use of antibiotics
- Patient positioned correctly on the operating table
- Clean and drape correctly
- Assess prolapse under anaesthesia
- Appropriate infiltration
- Appropriate vaginal incision
- Mobilise the rectum
- Insert appropriate supporting sutures
- Excise appropriately excess vaginal tissue
- Drainage of bladder, as appropriate
- Pack inserted, as appropriate
- Intraoperative rectal examination, as appropriate
Sacrocolpopexy
Items under observation:
- Obtain appropriate consent
- Correct use of antibiotics
- Patient positioned correctly on the operating table
- Clean and drape correctly
- Patient catheterised throughout
- Correct incisions
- Deal with adhesions, as necessary
- Identify ureters
- Identify vaginal vault, bladder and rectum
- Reflect peritoneum off the vault/bladder/rectum, as appropriate
- Open peritoneum over promontory
- Choose appropriate mesh and suture for operation
- Attach mesh to vagina and promontory appropriately with correct tension
- Bury mesh, as appropriate
- Drain, if appropriate
- Close incisions correctly
- Drain bladder appropriately
Sacrospinous fixation
Items under observation:
- Obtain appropriate consent
- Correct use of antibiotics
- Patient positioned correctly on the operating table
- Clean and drape correctly
- Assess prolapse under anaesthesia
- Appropriate infiltration
- Appropriate vaginal incision
- Mobilise the rectum
- Open the pararectal space to identify sacrospinous ligament
- Place suture through ligament
- Check correct hold of suture
- Attach sutures to vault
- Excise appropriate excess tissue
- Posterior repair, as required
- Close vagina
- Pack and catheter, as appropriate
Urodynamics
Items under observation:
- Checks for UTI test results
- Gives antibiotics as appropriate
- Obtains appropriate consent
- Is able to set up machine and check calibration
- Obtains free flow at start of test
- Cleans external urethral meatus
- Inserts bladder line and catheter appropriately
- Checks urinary residual
- Vaginal examination as appropriate
- Inserts rectal line
- Balances pressure lines
- Performs filling cytometry
- Undertakes appropriate provocation tests
- Appropriate stress testing
- Obtains pressure/voiding trace
- Removes lines
- Obtains post-test residual
Vaginal hysterectomy and anterior repair
Items under observation:
- Obtain appropriate consent
- Correct use of antibiotics
- Patient positioned correctly on the operating table
- Clean and drape correctly
- Assess prolapse under anaesthesia
- Appropriate infiltration
- Appropriate vaginal incision
- Mobilise the bladder
- Enter pouch of Douglas correctly
- Clamp, divide and ligate pedicles, as appropriate
- Check for haemostasis
- Close vault and peritoneum, as appropriate
- Incorporate adequate vaginal vault support
- Insert appropriate bladder supporting sutures
- Excise excess tissue correctly
- Close anterior vaginal wall
- Drainage of bladder, as appropriate
- Insert pack, as appropriate
Laparoscopic sacrocolpopexy
This OSATS is only applicable to those undertaking the optional module in laparoscopic urogynaecology.
Items under observation:
- Ensures correct positioning of the patient, catheterisation throughout and insertion of the uterine manipulator
- Assess patient habitus
- Correct use of antibiotics
- Safe use of Veress needle (if used)
- Safe insertion of primary port
- Appropriate position of and safe insertion of secondary ports
- Maintains good view of the operative field
- Uses appropriate instruments for the task
- Knowledge and safe use of energy modalities in laparoscopic surgery
- Identifies important anatomical structures on pelvic side wall (ureter, internal iliac artery/vein) and within broad ligament
- Identifies pelvic structures as appropriate
- Open peritoneum over promontory and over rectum and bladder as appropriate
- Open peritoneum over pelvic side wall
- Choose appropriate mesh and suture for operation
- Attach mesh to vagina and promontory appropriately with correct tension
- Bury mesh, as appropriate
- Drain if appropriate
- Drain bladder appropriately
- Remove ports and close incisions appropriately
- Shows efficiency of movement and demonstrates good three-dimensional spatial awareness
- Appropriate use of assistants