Epidemiology Flashcards
According to the National Health and Nutrition Examination Survey (NHANES) data, what % of women reported incontinence?
51%
According to WHI, what percent of women reported POP?
41% of women age 50-79
What percentage of women report FI?
25%, with more not reported
DDx for Bladder pain (8 items)
-UTI
-Painful Bladder Syndrome
-Urethritis (GC)
-Genitourinary Syndrome of Menopause
-levator myaglia
-foreign body (stones,mesh)
-psychogenic
-undiagnosed retention
DDx for urethral pain (11)
-UTI
-Pelvic Inflammatory Disease
-IC
-Urethritis (GC or non-GC)
-Genitourinary Syndrome of Menopause
-Lichen
-myofascial pain
-diverticulum
-malignancy
-foreign body (stones,mesh)
-psychogenic
list the components of the comprehensive pelvic exam
- Inspection of the vestibule/mons/labia/ vagina
- Neuro exam- sensation, anal wink and bulbocavernous reflex
- Levator exam
- POP-Q
- CST
- UA
- PVR
- Rectal
DDX for myofascial pain (10)
-Levator myalgia
-pudendal neuralgia
-mass effect
-trauma
-vulvodynia
-genitourinary syndrome of menospause
-lichen
-Infection
-endometriosis
-constipation
during VCUG, what time of catheter is used for urethral imaging
Trattner catheter - double balloon catheter
How long do you keep a foley in after fistula repair
10-14 days
what is “the knack”
conscious contraction to occlude urethra
How effective is PFPT for SUI? and how often do the exercises need to be done at home
60-85% reduction in SUI
3 sets a day
How effective is PFPT for OAB? and how does this compare to medications
60-80%
equally effective to short term OAB use
How effective is PFPT for POP?
> 60% of women report benefit
What percentage of myofascial pain patients will have pain in the following areas:
Levators:
iliopsoas:
obturator:
Levators: 90%
iliopsoas: 60%
obturator: 45%
What is the mechanism of myofascial trigger points?
abnl neural response causes excess Ach which results in mild tissue hypoxia/microdamage, inflammation, pain. feedback loop leads to chronic sensory changes
Pessary:
Vaginal erosion rate: ___%
bothersome discharge: ___%
Vaginal erosion rate: 14-24%
bothersome discharge: 30%
Pessary:
What percentage of women can be fit with a pessary?
Name 3 risk factors for poor fit.
70%
GH >5cm
short TVL 6cm or less
prior prolapse surgery
Pessary benefits:
-no prolapse sx:
-urinary sx improvement:
-bowel sx improvement:
-increase in sexual function:
-no prolapse sx: 90%
-urinary sx improvement: 30-50%
-bowel sx improvement: 30-50%
-increase in sexual function: 60%
Should POP patients do PFPT with pessary?
POP
both PFPT with pessary show more improvement in QOL than pessary alone
Should SUI patients do PFPT with pessary?
in the short term, doing both is better than just pessary.
at 12 months, PFPT with pessary did not significantly improve SUI compared to pessary alone
Which improve QOL of life more: gelhorn or ring
no difference, both are great
Risk factors to d/c pessary
large rectocele
desire for surgery
wide GH
occult SUI
