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Repro and Sexual Health > Anatomy of urinary incontinence and prolapse > Flashcards

Anatomy of urinary incontinence and prolapse Flashcards

1
Q

What does the pelvic floor separate?

A

Pelvic cavity from perineum

Important role in support to pelvic organs

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2
Q

What makes up the pelvic floor?

A

Pelvic diaphragm
Muscles of perineal pouches
Perineal membrane

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3
Q

What are the main functions of the pelvic floor?

A

Maintenance of urinary and faecal continence

Support of pelvic organs

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4
Q

What 2 muscle groups form the pelvic diaphragm?

A

Levator ani

Coccygeus

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5
Q

What passes through the anterior gap between the medial borders of the pelvic diaphragm?

A

Urogenital hiatus containing urethra and vagina (in females)

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6
Q

What are the 3 parts to the levator ani?

A

Puborectalis
Pubococcygeus
Iliococcygeus

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7
Q

Where does the levator attach to?

A

Pubic bones, ischial spines, tendinous arch of levator ani

Perineal body, coccyx and walls of organs in midline

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8
Q

Is the levator ani tonically contracted?

A

Yes; most of time

Will relax to allow for urination and defecation

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9
Q

What innervates the levator ani?

A

Pudendal nerve

Nerve to levator ani

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10
Q

Describe the puborectalis?

A

Attaches form pubic bone to form a sling around rectum = FAECAL continence

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11
Q

Describe the pubococcygeus

A

Attaches from posterior aspect of pubic bone to insert onto the midline coccyx
Inserts onto the vagina and prostate

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12
Q

Describe the iliococcygeus?

A

Attaches from ileum/ ischial spine

Most lateral

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13
Q

What are the pelvic ligaments which provide support to pelvic organs?

A 
Endopelvic fascia
Uterosacral 
Transverse cervical (cardinal) 
Lateral ligament of bladder
Lateral rectal ligaments
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14
Q

What makes up the endopelvic fascia?

A

Connective tissue “packing”
Loose areolar tissue
Fibrous; collagen and elastic fibres

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15
Q

Where does the deep perineal pouch lie?

A

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

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16
Q

What is contained within the deep perineal pouch?

A 
Urethra 
Vagina (in females) 
Bulbourethral gland (male) 
Neurovascular bundle for penis/ clitoris
Extensions of ischioanal fat pads
Deep transverse perineal muscle
Compressor urethrae
External urethral sphincter
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17
Q

What muscles are contained within the deep perineal pouch?

A

Deep transverse perineal muscle
Compressor urethrae
External urethral sphincter

18
Q

Where can the perineal membrane be found?

A

Superficial to deep perineal pouch

19
Q

Where will the perineal membrane attach?

A

Laterally to sides of pubic arch, closing the urogenital triangle

20
Q

Are there openings in the perineal membrane?

A

Yes; for urethra and vagina

21
Q

Where does the superficial perineal pouch lie?

A

Below perineal membrane

22
Q

In the male, what does the superficial perineal pouch contain?

A

Root of penis: bulb (spongiosum), crura (cavernosum), bulbospongiosus and ischiocavernosus
Proximal spongy urethra
Superficial transverse perineal muscle
Branches of internal pudendal and pudendal nerve

23
Q

Do the muscles in the superficial perineal pouch contribute to the perineal body?

A

No

24
Q

In the female, what does the superficial perineal pouch contain?

A

Female erectile tissue and assoc muscles:
Clitoris and crura (cavernosum)
Bulb of vestibule; bartholin’s glands
Bulbospongiosus and ischiocavernosus muscle
Superficial transverse perineal muscle
Branches of internal pudendal vessels and pudendal nerve

25
Q

Describe the difference in location of bulbourethral gland in males and females?

A

Male; deep perineal pouch

Female; superficial perineal pouch

26
Q

What is one of the most important structures in support of pelvic floor?

A

Perineal body in superficial perineal pouch

27
Q

Describe the layers of the pelvic floor as you move from internal to superficial?

A 
Pelvic diaphragm
Deep perineal pouch
Perineal membrane
Erectile tissue
Superficial perineal pouch
28
Q

Which muscles maintain urinary continence?

A

External urethral sphincter
Compressor urethrae
Levator ani

29
Q

Which muscle maintains faecal continence?

A

Puborectalis bends the anorectum anteriorly maintaining continence after rectal filling

30
Q

What can cause injury to the pelvic floor?

A 
Pregnancy
Childbirth 
Chronic constipation 
Obesity
Heavy lifting
Chronic cough or sneeze
Previous injury to pelvis/ pelvic floor
Menopause
31
Q

What will urinary continence depend on?

A

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

32
Q

What will a prolapse commonly involve?

A

Uterus
Vagina
Bladder
Rectum

33
Q

What is a prolapse due to?

A

Failure of support of pelvic organs

34
Q

What is a vaginal prolapse?

A

Herniation of urethra, bladder, rectum or rectouterine pouch through supporting fascia
Presents as a lump in vaginal wall

35
Q

What are the different names given to prolapses?

A

Bladder; cystocele
Small bowel; enterocele
Rectum; rectocele
Urethra; urethrocele

36
Q

What will patients decribe when they have a uterine prolapse?

A

Dragging sensation
Feeling of a lump
Urinary incontinence

37
Q

What are the different types of uterine prolapse?

A

1st degree; cervix drops into superior vaginna
2nd degree; cervix drops further by still above opening of vagina
3rd degree; cervix drops below opening of vagina
4th degree; cervix and uterus below opening of vagina

38
Q

What are the 2 methods to treat vagina and uterine prolapse?

A

Sacrospinous fixation

Mesh

39
Q

Describe sacrospinous fixation

A

Sutures placed in sacrospinous ligament just medical to ischial spine to repair cervical/ vault descent
Performed vaginally

40
Q

What risks are assoc with a sacrospinous fixation?

A

Injury to pudendal NVB and sciatic nerve

41
Q

Describe “incontinence” surgery?

A

Trans-obturator support
Mesh through obturator canal to create a sling around the urethra
Incisions through vagina and groin

Repro and Sexual Health (77 decks)

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