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Repro > Pelvic floor disorders > Flashcards

Pelvic floor disorders Flashcards

1
Q

causes of urethral incontinence

A

urethral sphincter incompetence
detrusor instability
retention with overflow
function

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2
Q

types of extraurethral urinary incontinence

A

congenital

fistula

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3
Q

types of urinary incontinence

A

stress
urge - over reactive bladder
mixed
overflow

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4
Q

incidence of USI

A

1/3 women over 55

1/10 will need surgery for it

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5
Q

risk factors for USI

A 
women>men
age 
obesity 
smoking - chronic cough
kidney disease/DM
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6
Q

what is over reactive bladder syndrome

A

urgency with or without urge urinary incontinence usually with frequency and nocturne in the absence of pathological or metabolic conditions that might explain these symptoms

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7
Q

difference between OAB wet and OAB dry

A

wet is where urge incontinence is present

dry is where incontinence is absent

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8
Q

what is urge incontinence

A

proceeded by an urge to void - triggers such as running water, opening a door

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9
Q

what is mixed urinary incontinence

A

involuntary leak associated with urgency and also with exertion such as sneezing, coughing

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10
Q

what is happening to the bladder in OAB and UUI

and the what happens in SUI

A

bladder experiencing frequent involuntary contractions

bladder muscle experiences stress related contraction and support muscles unable to remain completely shut

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11
Q

examination

A

abdomen - masses, bladder
external genitalia
vaginal - prolapse, malignancy, fistula
rectal - tone, masses

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12
Q

what exam can be done for incontinence

A

standing or supine stress test - cough standing up
post void residual
urine analysis
bladder diary

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13
Q

treatment in OAB

A 
lifestyle advice
bladder drill
pelvic floor physio
drugs
botulinum toxin
neuromodulation
reconstructive surgery
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14
Q

lifestyle advice in OAB

A 
bladder retraining to increase bladder capacity and decrease frequency 
anti muscarinic if frequency a problem 
sensible fluid intake 
caffeine reduction 
weight reduction if BMI >30
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15
Q

physical treatments in OAB

A

pelvic floor muscle exercises - not as useful in urge incontinence

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16
Q

anti muscarinic agents when should they be given

what do they do

A

after lifestyle changes for OAB syndrome

reduce intra vesical pressure
increase compliance
raise volume threshold for micturition
reduce uninhibited

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17
Q

types of anti muscarinics

A

oxybutynin
tolterodine
solifenacin
propiverine

18
Q

anti muscarinic SE

A

dry mouth
constipation
blurred vision
somnolence

19
Q

B3 agonists example

what does this drug do

A

mirabegron
relaxes smooth muscle through activation of the b3 adenoreceptor
increases the voiding interval and inhibit spontaneous bladder contractions during filling

20
Q

when is mirabegron given to px

A

given in overreactive bladder syndrome when antimuscarinic agents are contraindicated, clinically ineffective or have unacceptable side effects

21
Q

what nerve thing can be done for OBS and what does it lead to

A

percutaneous posterior tibial nerve stimulation - can reduce symptoms in the short and medium term

22
Q

what should be offered to women with OAB or mixed UI

A

oxybutanin
tolterdodine
peopiverine

23
Q

what is the second line treatment for OAB

A

tropsium
oxybutynin - extended release
darifenacin

24
Q

what is uroflowmetry

what are the indications for it

A

measurement of volume of urine in mls expelled from the bladder each second. can measure peak flow, mean flow and voided volume

hesitancy 
voiding difficulties
neuropathy
history of urinary retention 
post op follow up
25
Q

indications for multi channel urodynamics

A

uncertain dx
fail to respond to treatment
prior surgery

26
Q

what is cystometry

A

pressure/volume relationship of the bladder is measures during filling, porvocation and during voiding

27
Q

post ovoidal residue and urine dipstick findings

A

normal - age dependent 10-80cc

abnormal >100-150cc

28
Q

causes of overflow incontinence

what should be stopped

A

obstruction of urethra
poor contractile bladder muscle

anticholinergics

29
Q

treatment of stress urinary incontinence

A

lifestyle - lose weight, stop smoking, stop caffeine
physio - pelvic floor muscle exercise
drugs - duloexetine
surgery

30
Q

treatment for overactive bladder

A

lifestyle - avoid caffeine
physio - bladde training
drugs - oxyb
surgery

31
Q

types of prolapse

A

anterior
middle or apical
posterior

32
Q

who does pelvic prolapse occur in
risk of surgery
why is it increasing

A

almost 50% of parous women
11% lifetime risk
women LE increasing

33
Q

classification of uterovaginal prolapse

A

1st degree- in vagina
2ng - at interiottus
3rd degree - outside vagina
prociedentia - entirely outside vagina

34
Q

anterior cystocele symptoms

A

bulging, pressure, mass, difficulty voiding, incomplete emptying, splinter vaginal wall, difficulty inserting tampon, pain with intercourse

35
Q

middle/apical
vaginal vault prolapse symptoms
and retrocede (posterior

A

bulging, pressure, mass, difficulty voiding, incomplete emptying, splinter vaginal wall, difficulty inserting tampon, pain with intercourse

36
Q

pelvic organ prolapse quantification system

A

with the px straining 6 sites are evaluated and at rest 3 sites are measured
measure each site in relation to the hymenal ring which is fixed
if its above the hymen -ve
if its below +ve

37
Q

risk factors for vaginal apical prolapse

A 
raging
pelvic surgery
menopause
loss of muscle tone
multiple vaginal births
obesity
chronic constipation, coughing, heavy lifting 
uterine fibroids
FH
38
Q

management of uterovaginal prolapse conservative

A 
reassure 
avoid heavy lifting 
lose weight 
stop smoking 
vaginal oestrogen IF SYMP ATROPHIC VAGINITIS
39
Q

prolapse treatment options

A

physio
pessary
surgery - abd, vaginal, lapro, mesh kits

40
Q

indications for pessaries

A

women unfit for surgery
relief of symptoms while waiting for surgery
further pregnancies planned or preg
as a dx test for prolapse/ensure correction of large cystourethrocele
px request

Repro (56 decks)

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