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Repro > Pelvic Floor Disorders > Flashcards

Pelvic Floor Disorders Flashcards

1
Q

What are the 3 categories of pelvic floor issues?

A

Urinary Incontinence
Pelvic floor prolapse
Anal incontinence

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2
Q

What urethral problems cause urinary incontinence?

A

Urethral sphincter incompetence
Detrusor instability
Retention with overflow
Functional

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3
Q

What Extraurethral problems can cause urinary incontinence?

A

Congenital

Fistula

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4
Q

What are the 4 types of urinary incontinence?

A

Stress
Urge
Mixed
Overflow

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5
Q

What is the incidence of Urinary Stress Incontinence?

A

1 in 33 women aged 55 and over

1 in 10 will need surgery

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6
Q

What are risk factors for urinary incontinence?

A 
Sex - women
Age - older
Obesity
Smoking
Kidney disease
Diabetes
Higher number of children
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7
Q

What is OAB?

A

Overactive Bladder Syndrome

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8
Q

What is OAB wet?

A

Urge incontinence is present

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9
Q

What is OAB dry?

A

Incontinence is absent

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10
Q

Describe urge incontinence

A

Preceded by an urge to void

Can involve triggers such as running water etc.

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11
Q

Describe Mixed urinary incontinence?

A

Involuntary leakage associated with urgency and also with exertion, sneezing or coughing (stress)

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12
Q

What physical examinations should be done on a patient with incontinence?

A

Abdomen - masses, palpable bladder etc.
Pelvis/Perineum - External genitalia, atrophic vaginitis
Vagina - prolapse, malignancy, fistula
Rectal - tone, massesm teach Kegels during exam
Neurological - reflexes, sensory, motor

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13
Q

What bladder specific examinations should be done with someone with incontinence?

A

Stress test
Post void residual
Urine analysis (dipstick)
Bladder diary

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14
Q

What lifestyle measures can help with incontinence?

A

Bladder retraining
Sensible fluid intake
Caffeine reduction
Weight reduction if BMI >30

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15
Q

If a women urinates during penetrative sex, is that stress or urge?

A

Stress

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16
Q

If a women urinates during orgasm, is that stress or urge?

A

Urge

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17
Q

What physical treatments can help with incontinence?

A

Pelvic floor muscle exercises (PFME) - helps mixed and stress

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18
Q

What help do antimuscarinic agents do for incontinence?

A

Reduce intra-vesical pressure
Increase compliance
Raise volume threshold for micturation
Reduce uninhibited contractions

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19
Q

Give 3 examples of antimuscarinics

A

Oxybutynin
Solifenacin
Tolterodine

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20
Q

What are side effects of anti-muscarinics?

A

Dry mouth
Constipation
Blurred vision
Somnolence

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21
Q

What are Beta3 agonists?

A

First class selective B3 adrenoceptor agonist

22
Q

What is the method of action of Beta3 agonists?

A

Relaxes bladder smooth muscle through activation of the B3 adrenoceptor
Selective agonist for the human B3 adrenoceptor with low intrinsic activity for B1 and B2

23
Q

How much liquid should be taken in each day?

A

24ml per kg per 24 hours

24
Q

What do B3 adrenoceptors do?

A

Increase the voiding interval and inhibit spontaneous bladder contractions

25
Q

Give an example of a B3-adrenoceptor agonist?

A

Mirabegron

26
Q

When would a B3-adrenoceptor agonist be recommended?

A

When there is contraindications of antimuscarinics or they are ineffective

27
Q

What are the 3 first choice drugs for women with OAB or mixed UI according to NICE?

A

Oxybutynin
Tolterodine
Propiverine
(All immediate release)

28
Q

What are the 3 second choice drugs for women with OAB or mixed UI according to NICE?

A

Trospium (immediate)
Oxybutynin (extended)
Darifenacin

29
Q

What are indications for using Uroflowmetry?

A 
Hesitancy
Voiding difficulty
Neuropathy
History of urine retention
Post-operative follow up
30
Q

What are indications for Multichannel Urodynamics?

A

Uncertain diagnosis
Fail to respond to treatment
Prior surgery

31
Q

What does flow rate enable you to measure?

A

Peak flow
Mean flow
Voided volume
(min of 200ml needed)

32
Q

What is cystometry?

A

Method by which the pressure/volume relationship of the bladder is measured during filling, provocation and during voiding

33
Q

What is the normal range for Post Void Residual (PVR) and what is abnormal?

A 
Normal = 10-80cc (age dependant
Abnormal = >100-150cc
34
Q

What are causes of Overflow incontinence?

A

Obstruction of urethra
Poor contractile bladder muscle
Find out PVR
Stop antimuscarinics

35
Q

What is conservative treatment of stress UI?

A

Lifestyle changes
Physiotherapy
Drugs - Duloexetine (combined noradrenaline and serotonin reuptake inhibitor) - Increase intraurethral closure pressure
Incontinence pads, vaginal pessaries

36
Q

What are surgical treatments of stress UI?

A

Low tension vaginal tape
Intraurethral injection
Artificial sphincters
Colposuspension

37
Q

What is PTNS?

A

Percutaneous Posterior Tibial Nerve Stimulation - 12 week treatment

38
Q

What does the FemSoft do?

A

Inserted into the urethra
Tip inserts into bladder
Fluid fills a balloon
Creates a seal at the bladder neck and urethra

39
Q

What is the conservative treatment of an Overactive Bladder?

A

Lifestyle
Physiotherapy
Drugs - Antimuscarinics - block muscarinic receptors and decrease the ability of detrusor muscles to contract

40
Q

What are the surgical treatments of an Overactive Bladder?

A 
Augmentation cytoplasty
Sacral nerve modulation
Tibial nerve stimulation
Bladder overdistension
Botox injections
41
Q

What are the 3 compartments involved in a prolapse?

A

Anterior
Middle/Apical
Posterior

42
Q

What are the degrees of uterine descent in a Uterovaginal Prolapse?

A

1st degree - In vagina
2nd degree - At interiotus
3rd degree - Outside vagina
Procidentia - Entirely outside vagina

43
Q

What are symptoms of Cystocele (Anterior)?

A 
Bulging
Pressure
Mass
Difficulty voiding
Incomplete emptying
Splinting vaginal wall
Difficulty inserting tampon
Pain with intercourse
44
Q

What are symptoms of Vaginal vault prolapse / Enterocele (Middle/Apical)?

A 
Bulging
Pressure
Mass
Difficulty voiding
Incomplete emptying
Splinting vaginal wall
Difficulty inserting tampon
Pain with intercourse
45
Q

What are symptoms of a Rectocele? (Posterior)

A 
Bulging
Pressure
Mass
Difficulty defecating 
Incomplete defecation
Splinting vaginal wall or perineum
Difficulty inserting tampon
46
Q

What is a Complete Eversion (All compartments)

A

Uterine procidentia

Complete uterine prolapse

47
Q

What is the Pelvic Organ Prolapse Quantification System (POP-Q)?

A

Patient straining, 6 specific sites are evaluated, and 3 rest sites measured
Measure each site in relation to the hymen ring (cm) (zero point of reference)
If site is above hymen = negative number
If site is below hymen = positive number

48
Q

What are risk factors for a vaginal apical prolapse?

A 
Aging
Pelvic surgery
Menopause/Hypoestrogenism
Loss of muscle tone
Multiple vaginal births
Obesity
Uterine fibroids
Chronic constipation, coughing or heavy lifting
FHx
Connective tissue disorders e.g. Marfan's syndrome
49
Q

What is the conservative management of Uterovaginal Prolapse?

A 
Reassure
Avoid heavy lifting
Lose weight
Stop smoking
Reduce constipation
Vaginal oestrogens - if symptomatic atrophic vaginitis
50
Q

What are prolapse treatment options?

A

Expectant management
Physiotherapy
Pessary
Surgery - Abdominal, Vaginal, Laparoscopic, Robotic assisted laparoscopy, mesh kits

51
Q

Who is suitable for prolapse treatment with Pessaries?

A

If unfit for surgery
Relief symptoms while awaiting surgery
Further pregnancies planned or current pregnancy
As diagnostic test/Ensure correction of large cystourethrocele not cause SUI
Patient request

52
Q

What are repairs of Uterine prolapse/Vault prolapse?

A

Vaginal hysterectomy
Manchester repair (Cervix amputated, uterosacral ligaments shortened)
Sacrospinous fixation
Abdominal/Laparoscopic sacrocolpopexy, mesh techniques, colpocleisis

Repro (46 decks)

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