Genital Prolapse and Incontinence

Question 1

Risk Factors for Urinary Incontinence:

Answer 1

: age, menopause, parity, BMI, chronic cough, neurologic disease, UTI, stool impaction, impaired mobility, confusional state, medications (diuretics, antipsychotics, antidepressants), pelvic surgery/treatment

Question 2

types of urinary incontinence

Answer 2

• Stress
• Urge
• Mixed
• Overflow
• Functional
• Vesicovaginal fistula

Question 3

outline the General Pelvic Organ Support Structures that prevent pelvic organ prolapse

Answer 3

Level 1: Cardinal-uterosacral ligament complex

Level 2: arcus tendineus fascia pelvis and the fascia overlying the levator ani muscles (middle part of the vagina)

Level 3: the urogenital diaphragm and the perineal body (lower part of the vagina)

Question 4

Risk factors for POP

Answer 4

Age, parity, obesity, prior hysterectomy, ethnicity, chronic constipation, connective tissue disorders, heavy lifting

Question 5

management of pelvic organ prolapse

Answer 5

Conservative Management: lifestyle changes, pessary

Surgical Management:

Vaginal: uterine suspension and vault suspension, anterior vaginal repair, posterior vaginal repair, with/out mesh, le fort or colpocleisis

Abdominal approach: sacrocolpopexy

Question 6

small volume leak with valsalva-> type of urinary incontinence?

Answer 6

stress

PE: BMI, cough stress test, Q tip test, pelvic muscle strength (oxford scale)

Question 7

moderate volume leak with sensation of urgency –> type of urinary incontinence

Answer 7

moderate volume leak with sensation of urgency

Question 8

continuous small volume leaking +/- full bladder sensation, bladder palpable abdominally. type of urinary incontincence?

Answer 8

overflow

Question 9

investigations for prolapse

Answer 9

Investigations

Voiding diary

PAD test

Mid stream urine for microscopy, culture and sensitivities

Voiding assessment; post void residual and uroflow

Urodynamic assessment

Diagnostic imaging

Question 10

antimuscarinic anticholinergics for voiding conditions

Answer 10

Antimuscarinic anticholinergics

• Oxybutynin
• Solifenacin, darifenacin, tolterodine, trospium

Adrenergic (mirabegron

Conservative Management

Lifestyle changes

Bladder retraining, pelvic floor therapy

Antimuscarinic anticholinergics

Oxybutynin

Solifenacin, darifenacin, tolterodine, trospium

Adrenergic (mirabegron)

Neuromodulation: sacral nerve, percutaneous tibial nerve stimulation

Surgical Management

Botox to prevent Ach release from presynaptic membranes

cystodistension