G3 consultant teaching Flashcards
What is stress incontinence?
Involuntary urine leakage on effort or exertion or on sneezing/coughing
What is urge incontinance?
Involuntary urine leakage accompanied or immediately preceded by urgency
Caused by:
- Too much alcohol or caffeine
- Poor fluid intake – this can cause strong, concentrated urine to collect in your bladder, which can irritate the bladder and cause symptoms of overactivity
- Urinary tract infection (UTI)
- Constipation
- Bladder tumour
- Medications
What is urodynamic testing?
Looks into how well the bladder, sphincters, and urethra work to store and release urine
Which medication can be prescribed for an overactive bladder?
Antimuscarinic drugs like:
- Oxybutynin (avoid in frail old women)
- Tolterodine
- Darifenacin
Can be given transdermally
Name an invasive treatment for an overactive bladder
Botulinum toxin A injection
- If not responded to medication
Percutaneous sacral nerve stimulation
- If botox and drugs have failed
Augmentation cystoplasty
- An operation to enlarge the bladder
Urinary diversion surgery
- Surgery to bypass an obstruction
What is prolapse?
The abnormal descent or herniation of the pelvic organs from their normal attachment sites or their normal position in the pelvis
What are some treatment options for prolapse?
Ring or shelf pessary
Surgery - mesh for recurrent prolapse
What is infertility defined as?
Failure to achieve a pregnancy after one year of regular unprotected sexual intercourse in couples in the reproductive age group
What are the female reasons for infertility?
- Aged over 35 years
- Amenorrhoea/oligomenorrhoea
- Previous abdominal/pelvic surgery
- Previous PID/STD
- Abnormal pelvic examination
What are some male reasons for infertility?
- Previous genital pathology (history of testicular maldescent, surgery, infection or trauma, there is a greater incidence of abnormal semen parameters)
- Previous STD
- Significant systemic illness
- Abnormal genital examination
What is the difference between primary and secondary infertility?
Primary: never had a pregnancy
Secondary: pregnant or fathered a pregnancy in the past but can’t anymore
What are the requirements for conception?
- Timely release of a healthy oocyte
- Progressively motile normal sperm capable of reaching and fertilizing the oocyte
- Free passage for the sperm to reach the oocyte and for the embryo to reach the uterus
- A healthy endometrium that allows implantation
What is included in the female assessment for infertility?
- Screen for chlamydia & Rubella
- Ovarian reserve (Early follicular phase hormone level (FSH, LH & E2) AMH (Anti-Mullerian Hormone) and AFC (Antral Follicle Count)
- Ovulation test
- Tubal test
What is AMH (Anti-Mullerian Hormone)?
- Produced by the Granulosa cells of pre-antral and small antral stages
- Levels of AMH constant through monthly periods but declines with age
- Higher AMH levels predict a good response
What are some methods of testing and predicting ovulation?
- Most women who have a regular menstrual cycle (21–35 days) are likely to be ovulating
- Ovulation detection kits (bought over the countermeasure LH levels)
- Ultrasound follicular tracking (expensive)
- Mid-luteal phase Progesterone (7 days before menstruation) should be above 30mmol/L
What is included in the semen analysis?
Count
Motility
Morphology
Volume
What is azoospermia?
No sperm in the ejaculate
Caused by:
- Congenital absence of the vasa deferens associated with cystic fibrosis mutations
- Previous surgery of testes and vas deferens
- Male sterilization (vasectomy)
- Inflammatory strictures like Chlamydia and Gonorrhoea
What are some tubal causes of infertility?
- Chlamydia infection (most common). Risk of tubal damage increases with each infection
Other causes: septic abortion, ruptured appendix, pelvic surgery and ectopic pregnancy
What is Hysterosalpingogram (HCG)?
An X-ray procedure that is used to view the inside of the uterus and fallopian tubes
What are some uterine abnormalities that can cause infertility?
Adhesions, polyps, submucous fibroids and septae
What are some treatments for infertility?
- Ovulation induction
- Intra-uterine insemination (IUI)
- IVF
- ISCI (intra-cytoplasmic insemination)
How can ovulation be induced?
Clomid (Clomifene Citrate) for women who have PCOS
- Anti-oestrogen effect on hypothalamic pituitary axis
- FSH injections for resistant PCO or Hypogonadotrophic Hypogonadism
- Risk of multiple pregnancy
- Monitor 1st cycle using USS
How can semes parameters be improved?
Use of Vitamins A,C,E Zinc and Selenium may improve semen parameters
- Little evidence of increased pregnancy rates
Who is intrauterine insemination offered to?
Single women, same sex couples, or heterosexual couples who have problems with intercourse
Not for couples with unexplained infertility
Who is IVF offered to?
- Couples with unexplained infertility
- Tubal damage
- Low sperm quality
- Low ovarian reserve
Which disease causes ‘powder burn spots’?
Endometriosis
Appear as dark spots in the endometrium
