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

Clinical Anatomy of Urinary Incontinence & Prolapse Flashcards

(53 cards)

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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?

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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?

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A

Urethra and (vagina in females)

24
Q

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

Study These Flashcards
A

Perineal membrane

25
Label this
26
Label this diagram
27
Where does the superficial perineal pouch lie in females?
Lies below perineal membrane
28
What does the superficial perineal pouch contains in females?
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
Label this
30
Label this
31
Describe where the superficial perineal pouch in males lie
Below perineal membrane
32
Is the superficial perineal pouch part of pelvic floor?
Technically no, but needs to be covered for completion
33
What does the superficial perineal pouch in males contain?
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
Label this
35
What is another name for greater vestibular glands?
Bartholin's glands
36
Label this
37
What is the perineal body important for?
Support of pelvic floor
38
Going from top to bottom in this image, what is deep and what is superficial?
Top 3 pelvic floor Bottom 2 superficial perineal pouch
39
What are functions of pelvic floor?
Provides support to pelvic organs Helps maintain continence
40
How does pelvic floor provide support to pelvic organs?
Normally tonically contracted Actively contracts - coughing, sneezing, vomiting
41
How does the pelvic floor maintain continence?
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
When can injury to pelvic floor occur?
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
What is urinary incontinence?
Involuntary loss of urine
44
What does urinary continence depend on?
Urinary bladder neck support External urethral sphincter Smooth muscle in urethral wall
45
What organs can be involved in prolapse?
Can involve uterus, vagina or both (also bladder and rectum)
46
What is prolapse?
Common gynaecological disorder Failure of support for pelvic organs
47
What is vaginal prolapse and how does it present?
Herniation of urethra, bladder, rectum or rectouterine pouch through supporting fascia Presents as lump in vaginal wall Urethrocele, cystocele, rectocele, enterocoele
48
Label this diagram
49
Describe uterine prolapse and degrees of uterine prolapse
Descent of uterus 1st, 2nd or 3rd degree Dragging sensation Feeling of lump Urinary incontinence
50
What prolapse can be treated?
Both uterine and vaginal prolapse
51
What is sacrospinous fixation?
Sutures placed in sacrospinous ligament just medial to ischial spine To repair cervical / vault descent Performed vaginally
52
In sacrospinous fixation, there is risk of injury to?
Pudendal neurovascular bundle and sciatic nerve
53
Describe incontinence surgery
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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