Mr Mark Malak

Consultant Gynaecologist & Urogynaecologist

MB BCh, MSC, DFFP, MRCOG, PhD, FRCOG

Mr Malak is a consultant Obstetrician, Gynaecologist and Urogynaecologist. He is currently the Lead Clinician at East Sussex NHS Hospitals Trust and has worked at Eastbourne since 1995.

Mr Malak has a special interest in urogynaecology, colposcopy and minimally invasive laparoscopic & hysteroscopic gynaecological surgery (for abnormal bleeding, pelvic masses and pelvic pain).

Mr Malak is the East Sussex Hospitals Lead Urogynaecologist. He established the first integrated, multidisciplinary urogynaecology team in Eastbourne in 1996. His team was awarded the 2nd place in the prestigious “Hospital Doctor” award for the best urinary continence team in United Kingdom.

He has extensive clinical and surgical expertise to manage urinary incontinence, frequency, urgency & recurrent cystitis and to perform pelvic reconstructive surgery for incontinence & uterovaginal prolapse. A subjective retrospective audit of his continence surgery showed a success rate of 97% (complete cure rate of 94%).He also is interested in the management of sexual dysfunction, including vaginal corrective surgery.

He is the Eastbourne Lead Colposcopist and is responsible for management of cervical abnormal cytology (smears).

Mr Malak was awarded the Department of Health Clinical Excellence Awards in 2005, 06, 07, 08 and 2009.

He was awarded the Doctor of Philosophy degree (Ph D) and the “Ernest Frizelle Prize” from University of Leicester for his important clinical research (45 publications). In 2008, Mr Malak was elected to the membership of the publication Committee of the International Urogynaecology Association.

Mr Malak publishes regular educational “Gynaecology Update” for GPs since 1997. He has also established educational internet sites for medical professions (markmalak.com) and for patients (mrmalak.com).

Mr Malak's achievements were featured in many national and local media (newspapers and TV news) regarding the introduction of minimally invasive surgery for heavy periods, impact of his clinical research and when his team won the 2nd place in the prestigious “Hospital Doctor” award.

He is keen to ensure that patients are fully informed and involved in all aspects of their care. Patients' feedback

For more information please visit the Author section

Women Wellbeing is provided for information only. The information found is not a substitute for professional medical care by a health care professional. ALWAYS check with your doctor if you have any concerns about your condition or treatment...... Disclaimer

To search Women Wellbeing for information choose a topic from the left column or use this search engine

Unique Search engine for Medical Information

The author has customized this search engine to include a link to specific internet sites of reputable institutions and specialized medial informaion faculties. The information could be very useful, however....Disclaimer

                 Medical Dictionary

Daily Press Monitoring

Swine Flu

Advice for pregnant women

Pregnant women are one of the higher risk groups for swine flu, as they are for all influenza viruses. It is therefore important for them to take precautions.

Swine flu advice for pregnant women.

Swine flu pregnancy and parenting Q&A.

Swine flu symptoms, including high-risk groups.

Chief medical officer's advice on pregnancy, holidays, and parents.

Swine Flu and pregnancy: RCOG

HITTING THE HEADLINES

The National Library for Health

'Caesareans 'riskier for mother and baby''

Caesarean sections increase the risk of poor outcomes for mothers and babies, reported three national newspapers (31 Oct 2007). These articles were based on a large cohort study the conclusions of which appear appropriate.

The newspaper articles (1-3) reported an increase in the risk of death or serious complications for both mothers and babies after caesarean section. All also reported that caesarean delivery reduced the risk for babies presenting breech (feet or bottom first).

The reports were based on a study published in the BMJ(4). The WHO funded study collected data on 93,000 births from 120 hospitals in 8 Latin American countries. The data showed an approximate doubling in the risk of maternal death or serious complication with planned caesarean section after other explanatory factors had been accounted for. The risk of death for babies presenting breech, delivered by a planned caesarean was one quarter of that following vaginal delivery. The risk of being admitted to intensive care for babies presenting head-first after planned caesarean was doubled.

The newspaper reports each reflected different aspects of the results, but all were essentially correct. The research appears to have been well conducted and the author's conclusions appropriate.

Evaluation of the evidence base for mother and baby outcomes following caesarean delivery

What were the authors' conclusions?
caesarean delivery increased maternal death and serious complications when the baby presented head first delivery by caesarean section is recommended for all breech babies
vaginal complications and fetal death during delivery might be reduced by caesarean section
How reliable are the conclusions?

The authors' conclusions appear to follow from the results of the study. There is a risk with this type of study design that women who planned to have a caesarean had a higher risk of poor outcomes anyway. However, the conclusions are based on a large number of births in a very wide range of practice settings in Latin America, and take account of many other factors that might be alternative explanations for the differences shown. This increases confidence in the findings.

"Folic acid may help prevent fetal heart defects"

NEW YORK (Reuters Health) - Here's another reason for pregnant women to take folic acid supplements: they help prevent fetal heart malformations, new research from the Netherlands suggests.

"Given the relatively high prevalence of congenital heart defects worldwide, our findings are important for public health," Dr. Ingrid M. van Beynum of Radboud University in Nijmegen and her colleagues write.

Folic acid supplements are now recommended for all pregnant women, and women planning on becoming pregnant, in order to prevent birth defects involving the neural tube such as spina bifida. Many countries, including the US, now require bread and other wheat products to be fortified with folic acid for this reason, but this practice hasn't been adopted in The Netherlands.

While there's been some evidence that folic acid may help prevent heart-related birth defects too, van Beynum and her team write, "this has not yet been definitively established." Such defects are quite common, they note, occurring in up to 2 out of every 100 newborns worldwide.

To investigate further, the researchers used a national register of birth defects to identify 611 mothers who had given birth to a child with a heart defect, matching them to 2,401 women who delivered babies with genetic defects or other birth defects unrelated to folate.

Women who took a supplement containing at least 400 micrograms of folic acid were nearly 20 percent less likely to have a child with a heart defect, compared to other non-folate-related malformations, while their risk compared to the general population was 26 percent lower.

Their risk of having a child with a heart defect involving the septum -- which separates one side of the heart from the other -- was nearly 40 percent lower than that of the general population.

National Recognition for a

Urogynaecology Team 

 Team Leader: Mr Mark Malak

Click to enlarge

  Urogynaecology

Treatment of urinary incontinence

&

Reconstructive pelvic and

vaginal surgery

Urinary Incontinence

Prolapse: Vaginal and uterine

Sexual Dysfunction

Pelvic Pain

Urinary Incontinence:

Embarrasing but Treatable

If you have urinary incontinence it means that you pass urine when you do not mean to (an involuntary leakage of urine). It can range from a small 'dribble' now and then, to large floods of urine. Incontinence may cause you distress as well as being a hygiene problem.

Urinary incontinence is common, especially in women. It can occur at any age, but it is more likely to develop the older you become. It is estimated that about three million people in the UK are regularly incontinent. Overall this is about 4 in 100 adults. However, as many as 1 in 5 women over the age of 40 have some degree of urinary incontinence.

The number of people affected may be even higher as many people don't tell anyone about their problem. One reason why some people do not tell their doctor about incontinence is due to embarrassment. Some people also wrongly think that incontinence is a normal part of ageing or that nothing can be done about it. This is wrong as it can be treated in many cases.

There are different types of urinary incontinence.

• Stress incontinence is the most common type. It occurs when the pressure in the bladder becomes too great for the bladder outlet to withstand. It usually occurs because the pelvic floor muscles which support the bladder outlet are weakened. Urine tends to leak most when you cough, laugh, or when you exercise (such as when you jump or run). In these situations there is a sudden extra pressure ('stress') inside the abdomen and on the bladder. Small amounts of urine may leak, but sometimes it may be quite a lot and cause embarrassment. The common reason for the pelvic floor muscles to become weakened is childbirth. Stress incontinence is common in women who have had several children. It is also more common with increasing age and with obesity.

• Urge incontinence (unstable or overactive bladder) is the second commonest cause. This is when you get an urgent desire to pass urine. Sometimes urine leaks before you have time to get to the toilet. The bladder muscle contracts too early and the normal control is reduced. The cause is not known but it seems that the bladder muscle gives wrong messages to the brain, and the bladder may feel fuller than it actually is.

• Mixed incontinence. Some people have a combination of stress and urge incontinence.More than 9 in 10 cases of urinary incontinence are due to the above causes. Other causes are less common 

Assessment
It is important to know which type of incontinence you have. Specialist will be able to assess your symptoms, examine you, and may do some simple tests to try to clarify the cause. You may also be asked to keep a diary for a few days to assess how often you go to the toilet, how much urine you pass each time, and how often you leak urine.

• Urinalysis. This is a simple 'dipstick' test to check for infection, blood or protein in urine.
• Flowmetry and assessment of Residual urine. This can assess the voiding pattern and finds out if any urine is left in your bladder, and how much urine is left, after you have gone to the toilet. This can be performed by using an ultrasound scan of the bladder
• Abdominal examination: To exclude the presence of pelvic or abdominal masses that may be pressing on the bladder
• Vaginal examination. This can assess the strength and tone of the pelvic floor muscles.
• Urodynamics (Bladder Pressure Studies): These are tests of bladder function that can determine the cause of the incontinence
  

  Treatment
  Treatment depends on the type of incontinence. pelvic floor muscle exercises may improve stress incontinence; bladder training may improve urge incontinence; medicines are sometimes used to help stop urge incontinence

  
  

  Surgery for stress incontinence is minimally invasive and very successful. It can be done as a day case and is associated with short recovery