Anatomy 5: Urinary Incontinence and Prolapse Flashcards

1
Q

What are the 3 components which made up the pelvic floor?

A

Pelvic diaphragm
Muscles of perineal pouches
Perineal membrane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the two groups of muscles which make up the pelvic diaphragm?

A

Levator ani

Coccygeus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What passes through the pelvic diaphragm?

A

Urogenital hiatus

Passage for urethra and vagina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the 3 parts of the levator ani?

A

Puborectalis
Pubococcygeus
Iliococcygeus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Where does the Levator Ani attach?

A
  • Pubic bones, ischial spines and tendinous arch of levator ani
  • Perineal body, coccyx and walls or organs in midline
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What innervates the levator ani?

A
Pudendal nerve (S2,3,4)
Nerve to Levator Ani (S3,4,5)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the supporting ligaments/fascia of the pelvic organs?

A

Endo-pelvic fascia

Pelvic ligaments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the Pelvic Ligaments?

A
  • Fibrous Endo-pelvic fascia
  • Uterosacral
  • Transverse cervical
  • Lateral ligament of bladder
  • Lateral rectal ligament
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Where is the deep perineal pouch?

A

Lies below the fascia covering the inferior aspect of the pelvic diaphragm

Lies above the perineal membrane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What does the Deep Perineal Pouch contain?

A
  • Part of the urethra (and vagina in females)
  • Bulbourethral glands in males
  • Neuromuscular bundle for penis/clitoris
  • Extensions of the ischioanal fat pads and muscles
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the difference between the deep transverse perineal muscle in the males and females?

A

In males there is the bulbourethral gland

In females, just smooth muscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Where is the location of the perineal membrane?

A

Superficial to the deep perineal pouch
Thin sheet of tough, deep facia
Attaches laterally to the sides of the pubic arch, closing the urogenital triangle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the features of the Perineal Membrane?

A

Opening for the urethra (and vagina in females)

Together with the perineal body, it is the last passive support of the pelvic organs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Where is the location of the superficial Perineal Pouch?

A

-Lies below the perineal membrane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What makes up the superficial perineal pouch in males?

A

Contains the root of the penis:

  • Bulb (corpus spongiosum and corpus cavernousum)
  • Associated muscles (bulbospongiosus and ischiocavernosus)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What makes up the superficial perineal pouch in females?

A

Contains female erectile tissue and associated membrane:

  • Clitoris and Crura (corpus cavernosum)
  • Bulbs of vestibule (paired)
  • Associated muscles: bulbospongiosus and ischiocavernosus
17
Q

What 3 factors does urinary incontinence depend on?

A
  • Urinary bladder neck support
  • External urethral sphincter
  • Smooth muscle in urethral wall
18
Q

How can prolapse be repaired surgically?

A

Sacrospinous fixation

Incontinence surgery

19
Q

What is sacrospinous fixation?

A
  • Sutures placed in sacrospinous ligament
  • Just medial to the ischial spine
  • To repair cervical/vault descent
  • Performed vaginally
  • Risk of injury to pudendal NVB and sciatic nerve
20
Q

What is incontinence surgery?

A
  • Trans-obturator approach
  • Mesh through obturator canal
  • Create a sling around the urethra
  • Incisions through vagina and groin
21
Q

What is the nerve roots of the detrusor muscle?

A

Supplied primarily by parasympathetic nerves derived from pelvic splanchnic nerves S2,3,4

22
Q

What is the nerve roots the urethral smooth muscle?

A

Supplied primarily by sympathetic nerves derived from spinal cord at T10-L2

23
Q

What predominates during bladder filling- sympathetic or parasympathetic?

A

Sympathetic to allow bladder muscle to relax

24
Q

At what ml is there usually a desire to micturate?

A

About 400mls

25
Q

What happens in the voiding stage?

A
  • The parasympathetic supply (via the pelvic Splanchnic nerves S2,3,4) causes detrusor contraction and urine enters the urethra
  • The pudendal nerve (S2,3,4) ensures relaxation of the external urethral sphincter and pelvic floor
26
Q

How is the micturition reflex initiated?

A

The sense of urine in the urethra is via the pudendal nerve

27
Q

What does the term “vulva” relate to?

A

The collective name given to the female urogenital triangle structures: the mons pubis, labia majora, labia minora, vestibule, vaginal orfice, orfices of the vestibular glands and clitoris