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Y3 - Repro > Incontinence and Prolapse > Flashcards

Incontinence and Prolapse Flashcards

1
Q

What is urinary inconinence?

A

Involuntary leakage of urine

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2
Q

What are the types of urinary incontinence?

A

Stress incontinence
Overactive bladder syndrome
Mixed
Overflow incontinence

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3
Q

What are risk factors for urinary incontinence?

A 
Age
Women who have had children
Post-menopausal women
Obesity
Smoking
Lack of exercise
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4
Q

What is stress incontinence?

A

Involuntary leakage of urine when there is increased intra-abdominal pressure with the absence of detrusor muscle contraction
Occurs when intravesical pressure exceeds urethral closing pressure

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5
Q

Who are most commonly affected by stress incontinence?

A

After childbirth
After pelvic surgery
Oestrogen deficiency

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6
Q

What is the presentation of stress incontinence?

A

Triggered by coughing, sneezing, exercise
Leakage is often a small volume
Prolapse of urethral and anterior vaginal wall could be present

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7
Q

What is the investigation of stress incontinence?

A

Exclude UTI
Frequency/volume charts showing normal volume frequency and bladder capacity
Urodynamic studies

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8
Q

What is the lifestyle management for stress incontinence?

A 
Weight loss
Smoking cessation
Avoid constipation
Avoid heavy lifting
Caffeine reduction
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9
Q

What is the conservative management of stress incontinence?

A

Pelvic floor muscle exercises for 3 months

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10
Q

What is the medical management of stress incontinence?

A

Duloxetine

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11
Q

When is stress incontinence managed medically?

A

If patient declines or is unsuitable for conservative or surgical options

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12
Q

What are some side effects of duloxetine?

A 
Difficulty sleeping
headaches
Dizziness
Blurred vision
Change in bowel habits
Nausea and vomiting
Dry mouth
Sweating
Decreased appetite and weight loss
Decreased libido
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13
Q

What are the surgical options for stress incontinence management?

A 
Bulking agents
Autologous rectus fascial sling
Laparoscopic or open colposuspension
Artificial urinary sphincters
Tension free vaginal tapes
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14
Q

What is overactive bladder (urge incontinence)?

A

When an individual has increased urgency and frequency to void urine

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15
Q

What are the causes of OAB (urge incontinence)?

A 
Idiopathic
Pelvic sugery
Multiple sclerosis
Spina bifida
Secondary to pelvic floor/incontinence surgery
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16
Q

What is the presentation of OAB (urge incontinence)?

A 
Frequency
Urgency
With or without incontinence
Triggered by hearing running water, cold weather, key in lock
Larger volumes of leakage
May have nocturia
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17
Q

How might a patient with OAB (urge incontinence) describe their condition?

A

“If I have to go I have to go immediately”

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18
Q

What do investigations show in OAB (urge incontinence)?

A

Frequency/volume charts - increased frequency, smaller volumes, may have nocturia
Urodynamic testing - over-activity of the detrusor muscle

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19
Q

What is the lifestyle management of OAB (urge incontinence)?

A

Decrease fluid intake
Minimise caffeine and diuretics, reduce alcohol
Use of pads
Bladder retraining

20
Q

What is the medical management of OAB (urge incontinence)?

A 
Anticholinergic
- oxybutynin
- tolterodine or solifenacin preferred in the elderly ad it can cause cognitive impairment
Intravaginal oestrogens
Desmopressin if nocturia
21
Q

What is the surgical management of OAB (urge incontinence)?

A

Botox
Percutaneous sacral nerve stimulation
Augmentation cystoplasty

22
Q

What is overflow incontinence?

A

Leakage of urine from a full urinary bladder, often with the absence of an urge to urinate

23
Q

What are causes of overflow incontinence?

A

Inactive detrusor muscle (neurological conditions)
Involuntary bladder spasms
Cystocele or uterine prolapse
Men > women

24
Q

What is the presentation of overflow incontinence?

A

Leakage of urine

Often with absence of urge to urinate

25
Q

What investigations are done for overflow incontinence?

A

Frequency/volume charts

Urodynamic testing - inactivity of the detrusor muscle

26
Q

What is urogenital prolapse?

A

Descent of one of the pelvic organs resulting in protrusion of the vaginal

27
Q

What is prolapse of the bladder called?

A

Cystocele

28
Q

What is prolapse of the rectum called?

A

Rectocele

29
Q

What organs can prolapse?

A 
Bladder
Uterus
Vagina
Rectum
Small bowel
30
Q

What is urogenital prolapse caused by?

A

Weakening of pelvic floor normally secondary to childbirth

31
Q

What is first degree prolapse?

A

Mild protrusion on examination

-1cm of introitus

32
Q

What is second degree prolapse?

A

Prolapse present at introitus of vagina/anus/urethra

Between -1cm and +1cm of introitus

33
Q

What is third degree prolapse?

A

Prolapse protruding outside of introitus

Beyond +1cm of introitus

34
Q

What is fourth degree prolapse?

A

Procidentia - complete prolapse

35
Q

What are the degrees of uterine prolapse?

A

1st degree - cervix remains in vagina
2nd degree - cervix at vaginal orifice
3rd degree - cervix outside vagina
4th degree - entirely outside vagina

36
Q

What is vaginal vault prolapse?

A

Drop of the top of the vgina into lower vagina

37
Q

When is vaginal vault prolapse common?

A

Post-hysterectomy

38
Q

What are the risk factors for urogenital prolapse?

A 
Increasing age
Multiparity with vaginal deliveries
Obesity
Spina bifida
Smoking
Heavy lifting
39
Q

What is the presentation of urogenital prolapse?

A 
Sensation of pressure, heaviness
Incontinence
Frequency, urgency
Difficulty voiding or incomplete emptying
Dyspareunia
40
Q

What investigations are done for urogenital prolapse?

A

Speculum examination
Urodynamic studies
Bladder scan - check for outflow obstruction
Urinalysis to exclude UTI

41
Q

What is the lifestyle management of urogenital prolapse?

A 
Weight loss
Avoid constipation
Smoking cessation
Avoid heavy lifting
Caffeine reduction
42
Q

What is the conservative management of urogenital prolapse?

A

Physiotherapy - pelvic floor training

Ring pessary

43
Q

What is the surgical management of cystocele?

A

Anterior colporrhaphy

44
Q

What is the surgical management of uterine prolapse?

A

Hysterectomy

Sacro-hysteropexy

45
Q

What is the surgical management of vaginal vault prolapse?

A

Sacrospinous fixation

46
Q

What is the surgical management of rectocele?

A

Posterior colporrhaphy

Y3 - Repro (13 decks)

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