Epidemiology of PFD

Question 1

According to the National Health and Nutrition Examination Survey (NHANES) data, what % of women reported incontinence?

Answer 1

51%

Question 2

According to WHI, what percent of women reported POP?

Answer 2

41% of women age 50-79

Question 3

What percentage of women report FI?

Answer 3

25%, with more not reported

Question 4

DDx for Bladder pain (8 items)

Answer 4

-UTI
-Painful Bladder Syndrome
-Urethritis (GC)
-Genitourinary Syndrome of Menopause
-levator myaglia
-foreign body (stones,mesh)
-psychogenic
-undiagnosed retention

Question 5

DDx for urethral pain (11)

Answer 5

-UTI
-Pelvic Inflammatory Disease
-IC
-Urethritis (GC or non-GC)
-Genitourinary Syndrome of Menopause
-Lichen
-myofascial pain
-diverticulum
-malignancy
-foreign body (stones,mesh)
-psychogenic

Question 6

list the components of the comprehensive pelvic exam

Answer 6

1. Inspection of the vestibule/mons/labia/ vagina
2. Neuro exam- sensation, anal wink and bulbocavernous reflex
3. Levator exam
4. POP-Q
5. CST
6. UA
7. PVR

Question 7

DDX for myofascial pain (10)

Answer 7

-Levator myalgia
-pudendal neuralgia
-mass effect
-trauma
-vulvodynia
-genitourinary syndrome of menospause
-lichen
-Infection
-endometriosis
-constipation

Question 8

during VCUG, what time of catheter is used for urethral imaging

Answer 8

Trattner catheter - double balloon catheter

Question 9

How long do you keep a foley in after fistula repair

Answer 9

10-14 days

Question 10

what is “the knack”

Answer 10

conscious contraction to occlude urethra

Question 11

How effective is PFPT for SUI? and how often do the exercises need to be done at home

Answer 11

60-85% reduction in SUI
3 sets a day

Question 12

How effective is PFPT for OAB? and how does this compare to medications

Answer 12

60-80%
equally effective to short term OAB use

Question 13

How effective is PFPT for POP?

Answer 13

> 60% of women report benefit

Question 14

What percentage of myofascial pain patients will have pain in the following areas:
Levators:
iliopsoas:
obturator:

Answer 14

Levators: 90%
iliopsoas: 60%
obturator: 45%

Question 15

What is the mechanism of myofascial trigger points?

Answer 15

abnl neural response causes excess Ach which results in mild tissue hypoxia/microdamage, inflammation, pain. feedback loop leads to chronic sensory changes

Question 16

Pessary:

Vaginal erosion rate: ___%
bothersome discharge: ___%

Answer 16

Vaginal erosion rate: 14-24%
bothersome discharge: 30%

Question 17

Pessary:

What percentage of women can be fit with a pessary?

Name 3 risk factors for poor fit.

Answer 17

70%

GH >5cm
short TVL 6cm or less
prior prolapse surgery

Question 18

Pessary benefits:
-no prolapse sx:
-urinary sx improvement:
-bowel sx improvement:
-increase in sexual function:

Answer 18

-no prolapse sx: 90%
-urinary sx improvement: 30-50%
-bowel sx improvement: 30-50%
-increase in sexual function: 60%

Question 19

Should POP patients do PFPT with pessary?

Answer 19

POP
both PFPT with pessary show more improvement in QOL than pessary alone

Question 20

Should SUI patients do PFPT with pessary?

Answer 20

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

Question 21

Which improve QOL of life more: gelhorn or ring

Answer 21

no difference, both are great

Question 22

Risk factors to d/c pessary

Answer 22

large rectocele
desire for surgery
wide GH
occult SUI