Incontinence and prolapse Flashcards
define urinary incontinence
involuntary leakage of urine
define stress urinary incontinence
involuntary leakage of urine after physical exertion e.g. coughing, sneezing, sports
define urge urinary incontinence
overactive bladder
feeling of urgency
trying to make it to the toilet on time causing leakage
define mixed urinary incontinence
features of both stress and urge urinary incontinence
RF for incontinence
age BMI parity menopause oestrogen deficiency hysterectomy UTI smoking FH caffeine alcohol (diuretic) DM
urinary symptoms can be categorised into what?
storage symptoms
voiding symptoms
list storage symptoms of UI
frequency nocturia urgency incontinence constant leakage
list voiding symptoms of UI
difficulty getting started dribbling hesitancy poor flow dysuria haematuria
examination for UI
BMI
abdominal exam
PV exam
neuro (S2-4)
investigations for UI
urinalysis post void bladder scanning bladder diary cystoscopy urodynamics
management of stress UI
Conservative: weight loss smoking cessation pelvic floor exercises incontinence ring Medical: vaginal oestrogen, (duloxetine) Surgical: bulking agents, fascial slings, colposuspension
mechanism of action of duloxetine
5HT and NA reuptake inhibitor
Management of overactive bladder
Conservative:
weight loss, reduce caffeine, smoking cessation, bladder retraining
Medical: vaginal oestrogen, anti-cholinergics, B3-agonist, desmopressin
Surgical: botox, PPTNS, augmentation cytoplasty
examples of anti-cholinergics used in OAB
tolterodine
solifenacin
oxybutynin
side effects of anti-cholinergics
dry mouth and eyes
tachycardia
urinary retention
constipation
example of B3 agonist used in OAB
mirabegron
what is Pelvic Organ Prolapse POP?
herniation of pelvic or abdominal organs through the vaginal canal
examples of POP
cystocele - anterior wall
rectocele - posterior wall
uterine prolapse
vaginal vault proplapse = top of the vagina post hysterectomy
RF of POP
age
high parity
post menopausal - oestrogen deficiency
BMI
smoker - chronic cough
neurological conditions - spina bifida, muscular dystrophy
collagen disorders - Marfans, Ehler-Danlos
symptoms of POP
heaviness sensation of dragging urinary frequency, urgency, incomplete voiding manual reduction of prolapse faecal incontinence straining sexual dysfunction
examination for POP
abdo and PV exam
system to classify POP
POP-Q classification system
management of POP
conservative: lifestyle advice, pelvic floor exercises, vaginal oestrogen
Pessaries
surgery
describe the POP-Q classification
uses the hymen as a landmark reference and defines 6 points (2 in each vaginal compartment - ant/superior/post)
describe stage 0 prolapse
no prolapse demonstrated
describe stage 1 prolapse
leading edge is -1cm or above
mild protrusion
describe stage 2 prolapse
leading edge is between -1cm and +1cm
present at introitus
describe stage 3 prolapse
leading edge is +1cm or below but without complete eversion
protruding outside introitus
describe stage 4 prolapse
complete vaginal eversion
aka procidentia
complete prolapse
complications of longterm use of vaginal pessaries
vaginal discharge
ulceration –> fistulae
fibrous band formation
how often should pessaries be changed and why
every 6 months with the additional use of topical oestrogen
to prevent fistula formation
side effects of duloxetine
difficulty sleeping headaches dizziness blurred vision CIBH N+V dry mouth sweating decreased appetite decreased libido
bladder diary features
number of pads volume of urine passed w = wet x = bowel motion p = changed a pad nocturia
indication for urodynamics
prior to surgical options
to ensure correct diagnosis
in stress incontinence, forget medical management, true or false
true
duloxetine is reserved as a very last line option
___ is harvested for fascial slings in surgical management of stress UI
rectus sheath
OAB vs urge UI
urge UI - they actually leak
OAB - don’t know if they are actually incontinent
why is oxybutynin not used as commonly
can worsen cognitive function
oxybutynin is the worst anticholinergic for this
side effects of mirabegron that need monitoring
BP
for overactive bladder, you can forget about surgical management, true or false
true
botox is the only thing
what is bladder pain syndrome
diagnosis of exclusion
chronic pain syndrome
long term definitive management of POP
surgery: anterior/posterior repair sacrospinous fixation colpoplexy colpocleisis - vaginal closing procedure (not fully in case of PMB)
management of POP
conservative - lifestyle advice, pelvic floor exercises, vaginal oestrogen
pessaries
surgery -
can you have sexual intercourse with pessaries
no, except for 1 type - self managed cube pessary
