Pelvic Organ Prolapse & Urinary Disorders

Question 1

Uterine prolapse is MC after ______.

Answer 1

Childbirth

Question 2

What are the 4 grades of pelvic organ prolapse?

Answer 2

I: Descent into the upper 2/3 of the vagina

II: Cervix approaches introitus

III: Outside introitus

IV: Entire uterus outside of the vagina–> Complete Prolapse

Question 3

Management of Pelvic Organ Prolapse…

Answer 3

1. Prophylactic: Kegels and Weight control
2. Non-Surgical: Pessaries and Estrogen Therapy
3. Surgical: Hysterectomy (for uterine prolapse) and Uterosacral or Sacrospinous ligament fixation

Question 4

When the Pouch of Douglas (small bowel) herniates into the upper vagina this is known as an ______.

Answer 4

Enterocele

Question 5

Urine leakage due to increased intra-abdominal pressure is known as ____ incontinence.

Answer 5

Stress

*Due to laxity of pelvic floor muscles (childbirth, surgery, postmenopausal estrogen loss, post-prostatectomy)

Question 6

______ is a good class of medications for Stress Incontinence. Some examples are Midodrine and Pseudoephedrine.

Answer 6

Alpha agonists

Question 7

A first line treatment for stress incontinence includes ______.

Answer 7

Kegel exercises, biofeedback

Question 8

Other management options for stress incontinence include…

Answer 8

1. Surgery: increases urethral outlet resistance, artificial sphincter
2. Anti-incontinence devices: vaginal cone helps to strengthen pelvic floor muscles
3. Estrogen: cream or ring

Question 9

Urine leakage accompanied by or preceded by urge is known as _____ incontinence. Common cause of nocturia.

Answer 9

Urge

• Due to detrusor muscle overactivity
• OVERACTIVE BLADDER

Question 10

______ (class of medication) are the first line treatment medication for urge incontinence.

Answer 10

Anticholinergics: Ditropan XL, Detrol

Question 11

_____ is a beta 2 agonist and bladder relaxant that is very effective at treating urge incontinence.

Answer 11

Mirabegron (Myrbetriq)

Question 12

Urinary retention (incomplete bladder emptying) is associated with ____ incontinence.

Answer 12

Overflow

• Due to DECREASED detrusor muscle activity
• *UNDERACTIVE BLADDER: DM, MS, autonomic dysfunction, spinal cord injury
• **BPH: bladder outlet obstruction

Question 13

____ is the first line treatment for bladder atony (overflow incontinence).

Answer 13

Intermittent or indwelling caths

• Also- Cholinergics: Bethanechol
• *BPH- a-blockers: Tamsulosin