Anatomy of the Pelvis Flashcards
What is a prolapse?
Protrusion of an organ or structure beyond its
normal confines.
In gynaecology, what are the 3 compartments of which prolapse occurs?
- Anterior Vaginal Wall - Urethra (urethrocele), Bladder (cystocele)
- Posterior vaginal wall prolapse - Rectum (rectocele), Small bowel (enterocele)
- Apical vaginal prolapse - Uterovaginal, Vault (post hysterectomy)
What is Procidentia?
Protrusion of uterine prolapse outside the vagina. Cervix and vaginal wall seen outside the vagina, sometimes with bladder or bowel
What are the 3 grades of prolapse?
1st degree - decent within the vagina
2nd degree - decent into the entrance of the vagina
3rd degree - decent outside the entrance to the vagina (Procidentia)
What non surgical treatment options are available?
Correct underlying risk factors (obesity, chronic cough, constipation)
Physiotherapy
Vaginal Pessaries - ring pessary (restores anatomy, risk of infection and ulceration
What is urinary incontinence?
Involuntary loss of urine that is objectively demonstrable and is a social or hygienic problem
What are the risk factors for incontinence?
Damage during childbirth - pelvic floor, nerve supply to urethral sphincter
Menopause - loss of tissue vascularity - reduced urethral closure pressure
Increased abdo pressure - cough, obesity, constipation
Smoking - 2-3x risk
Radiotherapy
What is the pathophysiology of Stress Incontinence?
Abnormal bladder neck or proximal urethral decent
Intraurethral pressure is less than intravesical pressure as rest
Lax suburethral support - pelvic floor injury
Transmission of intra-abdominal pressure to bladder and urethra becomes unequal which reverses the pressure gradient between bladder and urethra
What are the symptoms for Stress Incontinence?
Involuntary leakage associated with raised intra abdominal pressure - laughing, sneezing
Leakage on intercource
Can have urgency and frequency too (mixed picture)
What are the symptoms for Overactive Bladder?
Frequency and urgency Urge incontinence Nocturia Frequent infections Incomplete emptying
What investigations can be done to differentiate between Stress Incontinence and Overactive Bladder?
Urinalysis and microscopy and culture - infection more likely OB
Bladder Diary - frequent voiding = OB, Leakage = SI
Pad tests
Urodynamics - Uroflowmetry (suspected voiding dysfunction), Cystometry (Detrusor muscle overactivity)
What does Cystometry involve?
Measure abdominal pressure & intravesical pressure while filling bladder, then voiding
Abdominal – intravesical = detrusor pressure
Check whether detrusor activity is spontaneous or provoked
What treatment is available for Stress Incontinence?
Conservative - Pelvic floor exercises, continence pessary
Surgical - Suburethral Sling procedures, Colposuspension, Bladder Neck Injections
What do they inject in a Bladder Neck injection?
Bulking agent - to aid sphincter
What treatment is available for Overactive Bladder
Conservative - Control co-morbidities (weight loss, smoking cessation)
Medical - Anticholinergic medication - Mirabegron
Surgical - Botox, Nerve Stimulation
