Module 18 - Urogynaecology & pelvic floor problems

Question 1

What is the prevalence of overactive bladder (OAB) in adult women aged >18 years?

Answer 1

13-16%

Question 2

65 year old patient presents with stress incontinence. How long do you recommend she performs pelvic floor exercises for?

Answer 2

3 months

Question 3

Stage I or II POP need to try PFE for a minimum of how long?

Answer 3

4 months

Question 4

46 year old patient presents with overactive bladder syndrome. How long do you recommend she performs bladder training for?

Answer 4

6 weeks

Question 5

What medical treatment can be given to patients with stress incontinence who decline surgery?

Answer 5

Duloxetine 40mg BD for 3 months

increase the sympathetic stimulation of the urethral sphincter
side effects - loss of libido, insomnia

Question 6

Woman presents with recurrent UTI and lower abdominal pain. Cystoscopy reveals multiple small haemorrhagic areas. What is the likely pathology?

Answer 6

Interstitial cystitis
Petechial haemorrhages seen on cystoscopy

Question 7

What proportion of women with overactive bladder syndrome will have urge incontinence?

Answer 7

1/3

Question 8

What is the incidence of PHVP (Post Hysterectomy Vaginal Vault Prolapse) in women who have had hysterectomies for prolapse?

Answer 8

11%

Question 9

What is the incidence of PHVP (Post Hysterectomy Vaginal Vault Prolapse) in women who have had hysterectomies for benign disease?

Answer 9

1.8%

Question 10

What are the normal voiding parameters in urodynamics?

Answer 10

Volume - >150ml
Max flow rate - >15ml/s
Max voiding detrusor pressure - <50cmH20

> 50 = obstruction
<50 + low flow rate = neurogenic cause

Question 11

What are the indications for performing urodynamics before surgery for stress incontinence?

Answer 11

1) Urge-predominant mixed urinary incontinence
2) Urinary incontinence where the origin isn’t clear
3) Previous hx of surgery for stress incontinence
4) Sx of stress incontinence with anterior or apical prolapse
5) Sx suggestive of voiding dysfunction

Question 12

What are the indications for cystoscopy? (4 points)

Answer 12

Cystoscopy is never 1st line, unless:

1) Haematuria - ?ca
2) ?fistula (perform after speculum)
3) ?mesh erosion
4) Overactive bladder that medical management has failed

Question 13

What is the recommended fluid intake in urinary incontinence?

Answer 13

1.5L/day
Don’t drink after 1800
Drink to thirst

Question 14

What are the surgical treatments for stress urinary incontinence?

Answer 14

1) Burch Colposuspension - gold standard. suture the paravaginal fascia of bladder neck to Cooper’s (pectineal ligaments)

2) Autologous rectus fascial sling

3) Urethral bulking agents (Bulkamid)

Question 15

Botox 100 units can be injected into the bladder musculature for the treatment of urge incontinence. When are patients reviewed?

Answer 15

Review in 3 months (12 weeks)
Can increase to 200 units if unsuccessful

Question 16

What is the definition of recurrent UTIs?

Answer 16

3 or more in 12 months
2 or more in 6 months

Question 17

Approximately what proportion of women are affected by stress urinary incontinence (SUI)?

Answer 17

1 in 3

Question 18

What is the best lifestyle intervention to reduce OAB (Overactive Bladder) symtpoms?

Answer 18

Reducing caffeine intake