Miscellanous gynae

Question 1

What are the most two common types of incontinence

Answer 1

Stress and overactive bladder/urge incontinence

Question 2

What are the rarer causes of incontinence

Answer 2

Fistulae between vagina and urethra and bladder- after chemo, radio, malignancy, surgery 
Overflow obstruction 
Functional obstruction 
Neurological 
Mixed incontinence (urge and stress)

Question 3

What are the causes of stress incontinence?

Answer 3

Pregnancy- vaginal, instrumental, prolonged labour
Obesity
Increasing age
Previous hysterectomy
Prolapse- urethra may prolapse or become kinked

Question 4

What are the features of stress incontinence?

Answer 4

Leakage of urine secondary to cough, sneezing, laughing, lifting, exercise, exertion/movement

Question 5

What are the causes of overactive bladder?

Answer 5

idiopathic
Neurological damage- spastic bladder- MS, PD, stroke, dementia, diabetes, spinal cord injury
risk increases as age increases

Question 6

Features of overactive bladder?

Answer 6

Urge
Urge incontinence
Frequency >4-7 times a day
Nocturia
Nocturnal eneuresis
Stress incontinence common- eg with intercourse or orgasm
Triggered by handwashing, key in the door

Question 7

What are the two most important things to exclude when someone presents with incontinence?

Answer 7

• Diabetes

- UTI

Question 8

What are the investigations conducted for incontinence (excluding secondary investigations)

Answer 8

1. Urinanalysis MSU
2. Examination- digital examination of muscular contraction of pelvic floor muscles and bimanual vaginal for prolapse, also check for vaginal atrophy
3. Bladder diary/ frequency volume chart
4. Postvoid residual volume- postvoid bladder ultrasound or in-out catheter
5. Patient questionarre eg EP4Q

Question 9

When do you conduct urodynamic studies/cytometry?

Answer 9

if preop for stress incontinence

Or overactive bladder not responded to conseravative management

Question 10

What would the cytometry findings show for urinary stress incontinence and overactive bladder?

Answer 10

USI- no increase in pressure- urine flow with cough

OAB- increase in pressure- urine flow if pressure can overcome sphicter pressure

Question 11

What are general lifestyle measures indicated for incontinence?

Answer 11

Weight loss, reduced caffeine, reduced fluid intake, smoking cessation, recuced straining and manage constipation

Question 12

Conservative and medical management of USI?

Side effects of medical management

Answer 12

• Pelvic floor muscle exercise- min 3 months
  1st lin med: Duloexteine SNRI
  SE: nausea, insomnia, dry mouth, dizziness

Question 13

Surgical management of USI?

Surgical in elderly?

Answer 13

Urethral sling using tension free vaginal tape or transobturator tape
Colposuspension sling

Injectable periurethral bulking agent

Question 14

Conservative management of OAB, what is min you try for?

Answer 14

Bladder diary and for 6 weeks

Question 15

Medical/surgical management of OAB? What are side effects

Answer 15

1. Anticholinergics- Oxybutinin- dry mouth, dry eyes, double vision, drowsiness, constipation, tachycardia, delerium
2. Beta- alpha adrenergic agonsit- Mirabegron- hypertension
3. Botulinum toxin type A

Question 16

In OAB, at what level is sacral nerve stimulation administered?

Answer 16

S3 nerve root

Question 17

What are the causes of chronic urinary retention?

Answer 17

Due to flaccid or overflow incontinence due to blockage

• enlarged prostate in men
• Obstruction by a pelvic mass
• Surgery
• Autonomic neuropathies eg diabetes
• MS, PD, stroke, dementia

Treat with CISC

Question 18

What are fibroids?

Answer 18

Also called leimoyomas, benign tumours of the myometrium