Gyn - Urogynaecology

Question 1

60-year-old para 6 lady presented with stage II cystocele and uterine prolapse. How would you counsel the patient?

Answer 1

Counselling:
Explain the diagnosis: explain the physical findings, symptoms & how they affect her QoL
Determine her goals and expectation for treatment: realistic counselling about the efficacy

Conservative: avoid risk factors and pelvic floor muscle exercise - may not improve symptoms, chance of worsen

Vaginal ring pessary: no complications, improve symptoms but failure to retain, infection/bleeding/ulcer

Surgery: reconstructive vs obliterative: surgical/GA complications, risk of vault prolapse, incomplete correction of symptom

Question 2

The patient opted for vaginal hysterectomy with pelvic floor repair, she had a urodynamics study. Given urodynamic chart, how would you describe the results to the patient?

Answer 2

This is a urodynamic chart of X done on Y. In filling phase, detrusor pressure < 15cm H2O. On provocation (coughing/ straining), there is leakage of urine (?ml). In voiding phase, total volume of urine is ??. The curve is in bell shape in general, the peak flow rate is ??. Voiding time ??. Residual urine ?? ml.

The diagnosis is urodynamic stress incontinence

Question 3

The patient had VHPFR and TVT. Now post-op day 1, presented with difficulty in voiding, what is your diagnosis and management?

Answer 3

UTI Oral antibiotics after MSU C/ST
• Inadequate analgesia provide stronger analgesics, e.g. tramadol (avoid strong opioids which can 
also cause urinary retention)
• Tight TVT adjust the tightness
• Post-operation hematoma drainage