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
