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3rd Year - Reproduction > Anatomy 9 - Anatomy of urinary incontinence and prolapse > Flashcards

Anatomy 9 - Anatomy of urinary incontinence and prolapse Flashcards

1
Q

What is the purpose of the pelvic floor? (3)

A

Separates the pelvic cavity from the perineum
Plays important role in providing support to pelvic organs
Plays an important role in maintaining continence (urinary and faecal)

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2
Q

3 layers of the pelvic floor?

A

Pelvic diaphragm
Muscles of the perineal pouches
Perineal membrane

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3
Q

Which is the deepest layer of the pelvic floor?

A

Pelvic dipahragm

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4
Q

What 2 muscles make up the pelvic diaphragm?

A

Levator ani

Coccygeus

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5
Q

What shape is the pelvic diaphragm?

A

Sling-shaped

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6
Q

What is the name for the anterior gap between the medial borders of the pelvic diaphragm muscles?

A

Urogenital hiatus

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7
Q

Purpose of the urogenital hiatus?

A

Passageway for urethra (males and females) and vagina

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8
Q

Is levator ani or coccygeus more posterior?

A

Coccygeus

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9
Q

What ligament does coccygeus lie on?

A

Sacrospinous ligament

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10
Q

Attachments of levator ani?

A

Pubic bone, ischial spines and tendinous arch of levator ani

Perineal body, coccyx and walls of organs in midline

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11
Q

3 parts of levator ani? (from medial to lateral)

A

Puborectalis
Pubococcygeus
Iliococcygeus

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12
Q

What happens to the levator ani when you urinate/ defecate?

A

It must relax

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13
Q

Nerve supply to levator ani?

A

Pudendal nerve

Nerve to levator ani

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14
Q

Apart from the pelvic floor, what are 2 other groups of supportive tissues for the pelvic organs?

A

Endo-pelvic fascia

Pelvic ligaments

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15
Q

What is endo-pelvic fascia?

A

Connective tissue “packing” -> what the bladder and rectum expand into

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16
Q

What is the endo-pelvic fascia made of?

A 
Loose areolar tissue (loose connective tissue)
Fibrous tissue (collagen and elastic fibres)
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17
Q

Name 5 supporting pelvic ligaments?

A 
Utero-sacral ligamnet
Transverse cervical ligament (cardinal ligament)
Tendinous arch of pelvic fascia
Tendinous arch of levator ani
Lateral ligament of bladder
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18
Q

Where does the deep perineal pouch lie?

A

Below the fascia covering the inferior aspect of the pelvic diaphragm
Above the perineal membrane

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19
Q

What does the deep perineal pouch contain? (6)

A 
Part of the urethra
Part of the vagina in females
Bulbourethral glands in male
Neurovascular bundle of penis/ clitoris
Extensions of the ischioanal fat pads
Muscles
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20
Q

Deep perineal pouch muscles in males and females?(3)

A

External urethral sphincter
Compressor urethrae
Deep transverse perineal muscles

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21
Q

Is the deep transverse perineal muscle voluntary or involuntary in males?

A

Skeletal = voluntary

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22
Q

Is the deep transverse perineal muscle voluntary or involuntary in females?

A

Smooth (involuntary)

23
Q

What does the perineal membrane separate?

A

Superficial and deep perineal pouch

24
Q

What is the perineal membrane?

A

Thin sheet of tough, deep fascia

25
Q

What does the perineal membrane attach to laterally?

A

Pubic arch

26
Q

What does the perineal membrane close?

A

Urogenital traingle

27
Q

Are there any holes in the perineal membrane?

A

Yes, for the urethra and the vagina in geamles

28
Q

Where does the superficial perineal pouch lie?

A

Below the perineal membrane

29
Q

What does the root of the penis consist of?

A

Bulb
Crura
Associated muscles (bulbospongiosus and ischiocarvernosus)

30
Q

What does the superficial perineal pouch consist of in the male? (4)

A

Root of the penis
Proximal spongy urethra
Superficial transverse perineal muscle
Branches of internal pudendal vessels and pudendal nerve

31
Q

Is the superficial perineal pouch part of the pelvic floor?

A

No

32
Q

What does the female superficial perineal pouch contain?

A

Female erectile tissue
Greater vestibular glands
Superficial transverse perineal muscle
Branches of internal pudendal vessels and nerve

33
Q

Name the erectile tissue in females? (3)

A

Crura and clitorris
Bulbs of vestibule (paired)
Associated muscles - bulbospongiosus and ischiocavernosus

34
Q

What is located at the bottom of the bulbs of vestibule in females?

A

Greater vestibular glands (bartholin’s glands)

35
Q

What structure between the vagina and anus is important for pelvic floor support?

A

Perineal body

36
Q

How does the pelvic floor provide support to pelvic organs?

A

Normally tonically contracted and actively contracts during coughing, sneezing and vomiting

37
Q

What parts of the pelvic floor help maintain urinary continence? (3)

A

External urethral sphincter
Compressor urethrae
Levator ani

38
Q

How does the pelvic floor help to maintain faecal continence?

A

Tonic contraction of puborectalis bends the anorectum anteriorly
Active contraction maintains continence after rectal filling

39
Q

How can childbirth lead to pelvic floor injury?

A

Stretching or tearing

Pudendal nerve damage

40
Q

Is the external urethral sphincter voluntary or involuntary in females?

A

Voluntary (same as in males)

41
Q

What does urinary continence depend on? (3)

A

Urinary bladder neck support
External urethral sphincter
Smooth muscle in urethral wall

42
Q

What structures can prolapse? (6)

A 
Uterus
Vagina 
Bladder
Urethra
Rectum
Intestine
43
Q

Name for part of prolapsed bladder?

A

Cystocele

44
Q

Name for part of prolapsed intestine?

A

Enterocele

45
Q

Name for part of prolapsed rectum?

A

Rectocele

46
Q

Name for part of prolapsed urethra?

A

Urethrocele

47
Q

What is the name for the herniation of urethra, bladder, rectum or rectouterine pouch through the supporting fascia of the vagina?

A

Vaginal prolapse

48
Q

How does a vaginal prolapse present?

A

Lump in vaginal wall

49
Q

1st degree uterine prolapsed?

A

Slippage of the cervix slightly further down

50
Q

2nd degree uterine prolapsed?

A

Both the cervix and uterus sliding down

51
Q

3rd degree uterine prolapsed?

A

Whole uterus slides down, passing out of the body

52
Q

Treatment of a uterine prolapsed?

A

Sacrospinous fixation - sutures placed in sacrospinous ligament to repair cervical descent

53
Q

Describe incontinence surgery?

A

Mesh put through obturator canal to create a sling around the urethra
(incisions made through vagina and groin)

54
Q

What can be injured during prolapse repair? (2)

A

Sciatic nerve

Pudendal NVB

3rd Year - Reproduction (10 decks)

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