Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

3a > O&G:Urogynae > Flashcards

O&G:Urogynae Flashcards

1
Q

What are the two main causes of incontinence in females?

A

1) Uncontrolled increases in detrusor pressure
- Increased bladder pressure beyond that of normal urethra, most common cause OAB
2) Increased intrabdominal pressure
- Most common cause is urinary stress incontience

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is urinary stress incontinence?

A

Involuntary leakage of urine on effort or exertion eg. sneezing or coughing. aka urodynamic stress incontinence.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Causes of urinary stress incontinence?

A
  • Pregnancy
  • Vaginal delivery
  • Prolonged labour
  • Forcep delivery
  • Obesity
  • Age
  • Prev hysterectomy
  • Prolapse usually coexists
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Mechanism of urinary stress incontinence?

A

Increased abdominal pressure compresses the bladder, but weak sphincter causes incontinence.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Clinical features of urinary stress incontinence?

A

Frequency, urgency, urge incontinence, faecal incontience (due to childbirth injury)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

On examination of stress incontinence?

A

Sims speculum: Cystocele, urethrocele
Leakage with coughing
Palpate abdomen to exclude distended bladder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Investigations for stress incontinence/

A

Urine dipstick to exclude infection

Cystometry to exclude OAB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the conservatiive management of stress incontinence?

A
  • Pelvic floor muscle training for minimum 3 months. At least 8 contractions 3 times a day
  • Vaginal cones - held in position by voluntary muscle contraction
  • Lose weight, decrease excessive fluid intake, address underlying cough eg smoking
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the pharmaceutical management of stress incontinence?

A
  • Duloxetine: an SNRI, enhances urethral striated sphincter activity.
    S/e: Nausea, dyspepsia, dry mouth, dizzy, insomnia, drowsy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the surgical management of stress incontinence?

A
  • Tension free vaginal tape
  • Transobturator tape
  • Injectable peri-urethral bulking agents
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is overactive bladder?

A

Urgency, with or without urge incontinence, usually with frequency or nocturia, in the absence of proven infection.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Causes of OAB?

A
  • Mostly idiopathic
  • Bladder neck obstruction, post USI operation
  • Underlying neuropathy eg.ms
  • Detrusor overactivity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is detrusor overactivity?

A

A urodynamic diagnosis characterised by involuntary detrusor contractions during the filling phase. Either spontaneous or provoked eg. coughing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Clinical features of OAB?

A
  • Urgency
  • Urge incontinence
  • Frequency
  • Incontinence
  • Nocturia
  • Stress incontinence
  • Leak at night or at orgasm
  • Faecal urgency
  • Hx of childhood enuresis is common
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Investigations of OAB?

A

Examination: often normal (may be incidental cystocele)
Urinary diary:
- Frequent passage of small volume of urine, especially at night.
- High intake of caffeine
Cystometry:
- Contractions on filling or provocation
- Indicated after failure of lifestyle changes and drug management

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Conservative management of OAB?

A

Conservative:

  • Reduce fluid intake and caffeine
  • Bladder training
17
Q

Drug management of OAB?

A

Drugs:

  • Anticholinergics/antimuscarincs - block detrusor smooth muscle action eg Oxybutynin s/e dry mouth
  • Oestrogens - in post-meno it reduces sx of vaginal atrophy and decreases sx
  • Botulinum toxin a - blocks the neuromuscular transmission, so weakens detrusor. s/e retention, voiding dysfunction
18
Q

Other managemnt of OAB?

A

Other tx:

  • Neuromodulation and sacral nerve stimulation
  • Surgery - Clam-augmented iliocystoplasty
19
Q

What is a level one prolapse?

A

Cervix and upper 1/3rd of vagina

  • Cardinal ligament
  • Uterosacral ligament
20
Q

What is a level two proplapse?

A

Midportion of vagina

- Endopelvic fascia attach vagina laterally to side walls

21
Q

What is a level three prolapse?

A

Lower 1/3rd of vagina

- Supported by levator ani muscles and the perineal body

22
Q

What is a Urethrocele?

A

Prolapse of lower anterior vaginal wall involving urethral only

23
Q

What is a Cystocele?

A

Prolapse of upper anterior vaginal wall involving the bladder

24
Q

What is a Cystourethrocele?

A

Prolapse involves bladder and urethra

25
Q

What is an apical prolapse?

A

Prolapse of uterus, cervix and upper vagina

26
Q

What is an enterocoele?

A

Prolapse of upper posterior wall of vagina, resulting pouch may contain loops of bowel

27
Q

What is a rectocele?

A

Prolapse of lower posterior wall of vagina, involving anterior wall of rectum.

28
Q

What is the ICS pelvic organ prolapse scoring system?

A

0: No descent of pelvic organs during strainign
1: Leading surface of proplapse does not descend below 1cm above the hymenal ring
2: Leading edge of prolapse extends from 1cm above to 1cm below the hymenal ring
3: Prolapse extends 1cm or more below the hymenal ring but without complete vaginal eversion
4: Vagina completely everted (complete procidentia)

29
Q

Risk factors for prolapse?

A
  • Vaginal delivery and Pregnancy: Large infants, Prolonged 2nd stage, Instrumental delivery
  • Congenital factors: Abnormal collagen metabolsim eg. Ehlers-Danlos syndrome
  • Menopause: Deterioration of collagenous connective tissue following oestrogen withdrawal
  • Chronic predisposing factor: Obesity, chronic cough, constipation, heavy lifting, pelvic mass
  • iatrogenic: Hysterectomy, incontinence procedures
30
Q

Presentation of prolapse?

A
  • often asymptomatic
  • Dragging sensation or sensation of lump
  • Stress incontinence
  • Severe prolapse will interfere w/ intercourse, ulcerate and bleed
  • Cystourethrocele - freq incomplete bladder emptying
  • Rectocoele - difficulty defecating
  • Back pain
31
Q

Examination of prolapse?

A
  • Abdo exam
  • Bimanual pelvic exam
  • Sims: Inspect anterior and posterior walls separately
  • Large prolapse may be visible from outsie
  • Cough or bear down to demonstrate
32
Q

Management of prolapse?

A

Lifestyle: lose weight, reduce constipation, stop smoking, pelvic floor exercises, physio
Pessaries: For those unwilling/unfit for surgery, act as artificial pelvic floor. placed in vagina behind pubis and in front of sacrum. Ring and Shelf. Change every 6 months.
Surgical management

33
Q

What are complications of pessaries?

A
  • Vaginal ulceration
  • Pain
  • Urinary retention
  • Infection
  • Fall out

3a (25 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions