Professor Jonathan Duckett    MB ChB MD FRCOG
Consultant Gynaecologist & Urogynaecologist

Research And Conditions

Surgical Treatment of Stress Incontinence
Urinary incontinence is a common disabling condition. In 2-3% of women their incontinence is so bad that they have difficulty getting out of the house. It is an embarrassing, distressing condition. Patients often delay going to their GP and fear nothing can be done. In the past treatment options were limited but there have been huge developments in treatments over the last 20 years. There are very few women who will not derive some benefit from seeing a specialist urogynaecologist. Sometimes patients need simple advice or medication and sometimes an operation to help with their condition.

If pelvic floor exercises fail, stress incontinence is frequently treated with a suburethral sling operation (often called TVT/tension free vaginal tape). I was originally trained in modern sling surgery in 1997. I have published widely on the original technique and more recently on newer variations such as transobturator tapes and minislings. This research has been aided by my surgical database, which currently holds details on 2500 surgical procedures. I originally published my experience with slings in different surgical situations eg. mixed incontinence. Subsequently I have studied ultrasound and tape position to assess different outcomes. My research produced the first randomised controlled trial(RCT) on minislings. My current research is looking at the long term outcomes of sling surgery.
I also offer periurethral injections for stress incontinence. Some patients have these under a local anaesthetic which allows patients a quicker recovery to normal activities.

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Medication for Stress Incontinence
Duloxetine became the first licensed medication for stress incontinence in 1997. I was involved in the initial phase 3 trials prior to registration and produced several post marketing surveillance studies after the introduction of the drug. These investigated the efficacy of the drug in non-trial situations, the use of the drug as an alternative to surgery and factors associated with successful drug therapy. I also produced several commentaries and reviews regarding the effectiveness and limitations of this drug. I now act as a specialist advisor to industry on the development of other drugs for stress incontinence.

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The Aetiology of Detrusor Overactivity/Overactive Bladder
This is a condition that affects 20% of the adult female population and results in significant impairment in quality of life. The current thrust of my research has looked at what causes this common condition. Possibly kinking the bladder tube (urethra) is important (commonly called an obstructive aetiology). I have looked at prolapse repair (which unkinks the tube) to see if this improves the bladder. I have also studied the effect of urethral dilatation (stretching the urethra) in a randomised trial. My research team is now looking at low grade infection as a cause for bladder problems. I am performing a study assessing the effect of cystodistension (stretching the bladder) on the overactive bladder. I offer posterior tibial nerve stimulation as a treatment for overactive bladder. This involves the placement of an acupuncture needle in the ankle. It gives a beneficial effect in around 70% of women and means that some women can avoid drug therapy.

I treat resistant cases with Botox treatment into the bladder. This can be highly effective when other treatments have not worked.

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Conservative Treatments for Bladder Conditions
Pelvic floor muscle exercises are a NICE (National Institute for Health and Clinical Excellence) recommended treatment for stress incontinence. Despite extensive use, the data regarding these treatments is limited and of poor quality. I am currently working to identify the patients who will respond to this treatment so that we can optimise treatment options for the patients most likely to improve. I have a joint study with Kings College Hospital in London (Prof Cardozo) called "Pelvic floor Muscle Training for female urinary incontinence - which women benefit? Development of a screening tool".

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Qualitative Research
Most medical research relies on quantitative research methodologies. This is where we measure and analyse numbers and differences between different treatment groups eg 90% get better with one treatment but 95% with another. I have a number of papers using qualitative research. These studies involve interviewing patients in depth about their condition. These papers given a very valuable insight into the desires and expectations of our patients and may be even more valuable than the quantitative studies.

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Drug Research
This is highly regulated area of research in the UK. I have taken protocols through ethical approval and MHRA (Medicines and Healthcare products Regulatory Authority) regulation. I have studied the effect of drug therapy on ultrasound changes in the bladder valve (urethra). I have taken part in a number of commercial drug company sponsored research projects eg trials involving duloxetine (for stress incontinence), solifenacin and tolterodine (for overactive bladder) and Mirabegron.

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Prolapse Treatments
Prolapse is a common condition and often presents with a "lump or something coming down". Although not life threatening, this can cause significant distress and affects quality of life. At least 11% of women will have had a prolapse repair by the time that they are 80. Again this was a "taboo illness" in the past and many women suffered in silence. I have studied how prolapse repair improves bladder function.

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Cost Effectiveness
Health economics are an important part of health care provision in the 21st century. I have worked with specialists in this field to study cost effectiveness of sling surgery, drug therapy and more recently mesh surgery.

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Review Articles
I have published a number of expert reviews on the subjects above. These have been commissioned externally or generated from within the research team.

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I have written an MD thesis at the University of London/ Imperial College on the subject "Why does detrusor overactivity and the overactive bladder get better after a Tension Free vaginal Tape procedure?".

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