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HB 3rd Year - Reproduction > ANATOMY OF URINARY INCONTINENCE & PROLAPSE > Flashcards

ANATOMY OF URINARY INCONTINENCE & PROLAPSE Flashcards

1
Q

What makes up the pelvic floor?

A

3 layers:

  • Pelvic diaphragm (top)
  • Muscles of perineal pushes (middle)
  • Perineal membrane (bottom)
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2
Q

What does the pelvic floor do?

A

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

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3
Q

What makes up the pelvic diaphragm?

A

Pelvic diaphragm is the deepest layer and has the appearance of a sling. Consists of 2 muscle groups:

  1. Levator ani (anterior & medial)
  2. Coccygeus (posterior & lateral )
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4
Q

What is the urogenital hiatus?

A

Anteriorly a gap between the medial borders of the pelvic diaphragm. The passage for the urethra (M+F) and vagina (F)

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5
Q

Where does the levator ani attach?

A

The pubic bones, ischial spines and tendinous arch of levator ani
Perineal body, coccyx and walls of organs in midline

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6
Q

What are the 3 parts of the levator ani?

A

Puborectalis - most medially
Pubococcygeus
Iliococcygeus

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7
Q

What innervates the levator ani?

A

Pudendal nerve and nerve to levator ani

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8
Q

The levator ani is ______ contracted most of the time - it must ______ to allow urination & defaecation

A

Tonically

Relax

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9
Q

Where is the deep perineal pouch?

A

Lies below the fascia covering the inferior aspect of the pelvic diaphragm and lies above the perineal membrane. A shallow compartment containing a number of structures

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10
Q

What structures does the deep perineal such contain?

A

Part of the urethra (and vagina in females)
Bulbourethral glands in male (Cowper’s glands)
Neurovascular bundle for penis/clitoris
Extensions of the sischioanal fat pads and muscles

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11
Q

What muscles are contained within the deep perineal pouch?

A

M+F both have an external urethral sphincter
Both also have a compressor urethrae
Males have a deep transverse perineal muscle - skeletal muscle
Females have a band of smooth muscle

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12
Q

What is the perineal membrane?

A

Used to be referred to as the urogenital diaphragm - superficial to the deep perineal pouch
A thin sheet of tough, deep fascia
Opening for urethra (and vagina in females)

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13
Q

Where does the perineal membrane attach?

A

Attached laterally to the sides of the pubic arch, closing the urogenital triangle

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14
Q

What is contained in the superficial perineal pouch in females?

A

Female erectile tissue and associated muscle:

  • Clitoris and crura (crura is formed from tissue called corpus cavernous)
  • Bulbs of vestibule - paired
  • Associated muscles - lie on top of the spongy/cavernous tissue - bulbospongiousus and ischiocavernosus
  • Bartholin’s glands, transverse perineal muscle and branches of internal pudendal vessels and pudendal nerve
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15
Q

What is contained in the superficial pouch in males?

A

Contains root of penis:

  • Bulb - corpus spongiosum; crura - corpus cavernous
  • Associated muscle - bulbospongiosus and ischiocavernosus
  • Proximal spongy (penile) urethra, superficial transverse perineal muscle and branches of internal pudendal vessels and pudendal nerve
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16
Q

What role does the perineal body play?

A

Links all the layers of the pelvic floor. A ball of tissue that contains fibrous tissue (collagen, elastic) and both skeletal and smooth muscle. Is where a number of the muscle converge and interweave

17
Q

What functions does the pelvic floor have?

A

Provides support to the pelvic organs - is usually tonically contracted
Will actively contract during things like sneezing, coughing, vomiting to maintain continence

18
Q

How can the pelvic floor be injured?

A 
Pregnancy - pressure & stress
Childbirth - stretching or tearing pelvic floor muscles themselves OR pudendal nerve damage which supplies the muscles 
Chronic constipation
Obesity
Heavy lifting 
Chronic cough or sneeze 
Previous injury to pelvis/pelvic floor 
Menopause
19
Q

What is urinary incontinence?

A

The involuntary loss of urine

20
Q

What does continence depend on?

A

Urinary bladder neck support - some from the external urethral sphincter & smooth muscle in the urethral walls
External urethral sphincter
Smooth muscle in urethral wall

21
Q

In general, what is a prolapse?

A

Can involve the uterus, vagina or both (and can even involve the bladder and rectum). Essentially is a failure of support for the pelvic organs

22
Q

What is a vaginal prolapse?

A 
Herniation of urethra, bladder, rectum or rectouterine such through supporting fascia
Presents as a lump in vaginal wall 
Urethra = urethrocele
Bladder = cystocele 
Rectum = rectocele 
Rectouterine pouch = entre ocele
23
Q

What is uterine prolapse?

A

Descent of the cervix/uterus into the vagina

24
Q

What is a 1st degree uterine prolapse?

A

When just the cervix is dropping into the vagina

25
Q

What is a 2nd degree uterine prolapse?

A

The cervix is dropping to a level just inside the opening of the vagina

26
Q

What is a 3rd degree uterine prolapse?

A

The cervix is outside the vagina

27
Q

What is a 4th degree uterine prolapse?

A

The entire uterus is outside the vagina

28
Q

How does a uterine prolapse often present?

A

As a dragging sensation or feeling a lump and urinary incontinence

29
Q

What are the treatment options for a prolapse?

A

Supraspinous fixation

  • sutures are placed in the sacrospinous ligament just medial to the ischial spine to repair cervical/vault descent
  • Performed vaginally
  • risk of injury to pudendal NVB and sciatic nerve
  • used for prolapse rather than incontinence

Incontinence surgery

  • Trans-obturator approach
  • Mesh is fed through the obturator foramen to create a sling posterior to the urethra and back out the other side. It is then stitched in place
  • The foramen is sued for the NVB
  • Incisions are made in the groin at each side and the vagina
  • The sling effectively support s the urethra

HB 3rd Year - Reproduction (3 decks)

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