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Year 3 - Obs & Gynae Anatomy > Clinical Anatomy of Urinary Incontinence & Prolapse > Flashcards

Clinical Anatomy of Urinary Incontinence & Prolapse Flashcards

1
Q

What is the pelvic floor?

A

Separates pelvic cavity from perineum

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2
Q

What are the roles of the pelvic floor?

A

Provide support to pelvic organs
Plays a role in maintaining continence

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3
Q

What are the three layers of pelvic floor (debated)?

A

Pelvic diaphragm
Muscles of perineal pouches
Perineal membrane

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4
Q

What is the pelvic diaphragm and what does it consist of?

A

Deepest layer of pelvic floor (most internal layer)

Consists of two muscle groups:
- Levator ani + coccygeus

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5
Q

What exists between the medial borders of the pelvic diaphragm?

A

An anterior gap between medial borders
- Urogenital hiatus
- Passage for urethra and vagina

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6
Q

What does the pelvic diaphragm look like?

A

Appearance of a sling

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7
Q

Label this

A
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8
Q

What does the levator ani attach?

A

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

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9
Q

Describe tonic contraction of levator ani

A

Tonically contracted most of time

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10
Q

What are the 3 muscles of the levator ani?

A

Puborectalis
Pubococcygeus
Iliococcygeus

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11
Q

What innervates the levator ani?

A

Pudendal nerve and nerve to levator ani

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12
Q

The levator ani forms most of what?

A

Pelvic diaphragm

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13
Q

What does the endo-pelvic fascia consist of?

A

Some loose areolar tissue
Some fibrous (collagen and elastic fibres)

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14
Q

Label this

A
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15
Q

Describe the pelvic ligaments

A

Fibrous endo-pelvic fascia
Uterosacral
Transverse cervical (cardinal)
Lateral ligament of bladder
Lateral rectal ligaments

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16
Q

Label this diagram

A
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17
Q

Where does the deep perineal pouch lie?

A

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

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18
Q

What does the deep perineal pouch contain?

A

Part of urethra (and vagina in females), bulbourethral glands in male, neuromuscular bundle for penis / clitoris, extensions of sischioanal fat pads and muscles

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19
Q

Label this diagram

A
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20
Q

Label this diagram

A
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21
Q

Where does the perineal membrane lie?

A

Superficial to deep perineal pouch

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22
Q

What is the perineal membrane?

A

Thin sheet of tough, deep fascia

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

23
Q

What does the perineal membrane have openings for?

A

Urethra and (vagina in females)

24
Q

Together with the perineal body, what is the last passive support of the pelvic organs?

A

Perineal membrane

25
Q

Label this

A
26
Q

Label this diagram

A
27
Q

Where does the superficial perineal pouch lie in females?

A

Lies below perineal membrane

28
Q

What does the superficial perineal pouch contains in females?

A

Contains female erectile tissue and associated muscle:
- Clitoris and crura - corpus cavernosum
- Bulbs of vestibule - paired
- Associated muscles - bulbospongiosus and ischiocavernosus

Also contains greater vestibular glands, superficial transverse perineal muscle and branches of internal pudendal vessels and pudendal nerve

29
Q

Label this

A
30
Q

Label this

A
31
Q

Describe where the superficial perineal pouch in males lie

A

Below perineal membrane

32
Q

Is the superficial perineal pouch part of pelvic floor?

A

Technically no, but needs to be covered for completion

33
Q

What does the superficial perineal pouch in males contain?

A

Contains root of penis
- Bulb: corpus spongiosum, crura - corpus cavernosum
- Associated muscles - bulbospongiosus and ischiocavernosus

Also contains proximal spongy (penile) urethra, superficial transverse perineal muscle and branches of internal pudendal vessels and pudendal nerve

34
Q

Label this

A
35
Q

What is another name for greater vestibular glands?

A

Bartholin’s glands

36
Q

Label this

A
37
Q

What is the perineal body important for?

A

Support of pelvic floor

38
Q

Going from top to bottom in this image, what is deep and what is superficial?

A

Top 3 pelvic floor
Bottom 2 superficial perineal pouch

39
Q

What are functions of pelvic floor?

A

Provides support to pelvic organs
Helps maintain continence

40
Q

How does pelvic floor provide support to pelvic organs?

A

Normally tonically contracted
Actively contracts - coughing, sneezing, vomiting

41
Q

How does the pelvic floor maintain continence?

A

Urinary - external urethral sphincter, compressor urethrae, levator ani

Faecal - tonic contraction of puborectalis bends the anorectic anteriorly; active contraction maintains continence after rectal filling (anorectal angle decreases if contraction of muscle and this maintains faecal continence)

42
Q

When can injury to pelvic floor occur?

A

MAJOR/COMMON

Pregnancy
Childbirth - stretching or tearing; pudendal nerve damage

Minor / less common

Chronic constipation
Obesity
Heavy lifting
Chronic cough or sneeze
Previous injury to pelvis / pelvic floor
Menopause

43
Q

What is urinary incontinence?

A

Involuntary loss of urine

44
Q

What does urinary continence depend on?

A

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

45
Q

What organs can be involved in prolapse?

A

Can involve uterus, vagina or both (also bladder and rectum)

46
Q

What is prolapse?

A

Common gynaecological disorder
Failure of support for pelvic organs

47
Q

What is vaginal prolapse and how does it present?

A

Herniation of urethra, bladder, rectum or rectouterine pouch through supporting fascia
Presents as lump in vaginal wall
Urethrocele, cystocele, rectocele, enterocoele

48
Q

Label this diagram

A
49
Q

Describe uterine prolapse and degrees of uterine prolapse

A

Descent of uterus
1st, 2nd or 3rd degree
Dragging sensation
Feeling of lump
Urinary incontinence

50
Q

What prolapse can be treated?

A

Both uterine and vaginal prolapse

51
Q

What is sacrospinous fixation?

A

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

52
Q

In sacrospinous fixation, there is risk of injury to?

A

Pudendal neurovascular bundle and sciatic nerve

53
Q

Describe incontinence surgery

A

Trans-obturator approach
Mesh through obturator canal (space in obturator foramen for passage of obturator neurovascular bundle)
Create a sling around urethra
Incisions through vagina and groin

Year 3 - Obs & Gynae Anatomy (7 decks)

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