Pelvic Relaxation

Question 1

The pelvic floor is made up of the ____ and _______

Answer 1

diaphragm and perineal membrane

Question 2

The pelvic diaphragm consists of the _____ and ______

Answer 2

levator ani and coccygeus muscles.

Question 3

This is a triangular sheet of dense fibromuscular tissue that spans
the anterior half of the pelvic outlet. The vagina and the urethra pass through this

Answer 3

Perineal membrane.

Question 4

The main structures that support the uterus are the
1
2
3

Answer 4

cardinal ligaments, the uterosacral ligaments, and the endopelvic fascia.

Question 5

The etiology of pelvic relaxation is most commonly related to _____

Answer 5

childbirth

Question 6

Types of pelvic relaxation

Answer 6

The components of pelvic relaxation include uterine prolapse, cystocele, rectocele,
and enterocele.

Lesser forms of pelvic relaxation include vaginal or vault prolapse.

Question 7

Grades of uterine prolapse

Answer 7

– Grade I: Cervix descends half way to the introitus.
– Grade II: Cervix descends to the introitus.
– Grade III: Cervix extends outside the introitus.
– Grade IV or procidentia: The entire uterus, as well as the anterior and posterior
vaginal walls, extends outside the introitus

Question 8

Herniation or bulging of the anterior vaginal wall and overlying bladder base into the vaginal lumen

Answer 8

Cystocele

Question 9

Herniation or bulging of the posterior vaginal wall and underlying rectum into the vaginal lumen

Answer 9

Rectocele

Question 10

Herniation of the pouch of Douglas containing small bowel into the vaginal lumen

Answer 10

Enterocele

Question 11

Mx of prolapse

______involve voluntary contractions of the pubococcygeus muscle

Answer 11

Kegel exercises

Question 12

Mx of prolapse

______may be useful in postmenopausal women.

Answer 12

Estrogen replacement

Question 13

Mx of prolapse

_____ are objects inserted into the vagina that elevate the pelvic structures into their more normal anatomic relationships

Answer 13

Pessaries

Question 14

Mx of Prolapse

The _____ repairs the uterine prolapse, the anterior vaginal repair repairs the cystocele,
and the posterior vaginal repair repairs the rectocele.

Answer 14

vaginal hysterectomy

Question 15

The _______ uses the endopelvic fascia that supports the bladder and the rectum, and a
plication of this fascia restores normal anatomy to the bladder and to the rectum

Answer 15

anterior and posterior colporrhaphy

Question 16

Urinary incontinence is the inability to hold urine, producing involuntary urinary
leakage.

Answer 16

URINARY INCONTINENCE

Question 17

These are found primarily in the urethra and when stimulated cause contraction of urethral smooth muscle, preventing micturition

Answer 17

a-adrenergic receptors

Question 18

a-adrenergic receptors agonists

Answer 18

Drugs: ephedrine, imipramine (Tofranil), and estrogens

Question 19

a-adrenergic receptors antagonists

Answer 19

relax the urethra, enhancing micturition. Drugs: phenoxybenzamine (Dibenzyline).

Question 20

These are found primarily in the detrusor muscle and when stimulated cause relaxation of the bladder wall, preventing micturition

Answer 20

b-adrenergic receptors.

Question 21

b-adrenergic receptors agonst.

Answer 21

Drugs: flavoxate (Urispas) and progestins.

Question 22

These are found primarily in the detrusor muscle and when stimulated cause contraction of the bladder wall, enhancing micturition

Answer 22

Cholinergic receptors

Question 23

Cholinergic receptor agonists

Answer 23

Drugs:bethanecol (Urecholine) and neostigmine (Prostigmine)

Question 24

Anticholinergic medications

block the receptors, inhibiting micturition. Drugs:_________

Answer 24

oxybutynin (Ditropan) and propantheline

Pro-Banthine

Question 25

A urinary catheter is first used to empty the bladder and then left in place to infuse saline by gravity, with a syringe into the bladder

Answer 25

Cystometric studies

Question 26

What is measured in Cystometric studies

Answer 26

Residual volume
Sensation-of-fullness volume
Urge-to-void volume

Question 27

How to assess involuntary bladder contractions

Answer 27

By watching the saline level in the syringe rise or fall, involuntary detrusor contractions can be detected.

The absence of contractions is normal

Question 28

Involuntary rises in bladder pressure occur owing to detrusor contractions
stimulated by irritation from any of the following bladder conditions: infection, stone,
tumor, or a foreign body

Answer 28

Sensory Irritative Incontinence

Question 29

Sensory Irritative Incontinence

Cystometric studies (which are usually unnecessary) would reveal

Answer 29

normal residual volume with involuntary

detrusor contractions present.

Question 30

This is the most common incontinence in young women.

Answer 30

Genuine Stress Incontinence

Question 31

History of pts with Genuine Stress Incontinence

Answer 31

Loss of urine occurs in small spurts simultaneously with coughing or sneezing.
It does not take place when the patient is sleeping

Question 32

Genuine Stress Incontinence Q tip test results

Answer 32

The Q-tip test is positive when a lubricated cotton-tip applicator is placed in
the urethra and the patient increases intraabdominal pressure, the Q-tip will rotate
>30 degrees.

Question 33

Genuine Stress Incontinence Stress test results

Answer 33

Cystometric studies are normal with no involuntary detrusor contractions seen.

Question 34

Mx of Genuine Stress Incontinence

Answer 34

Surgical therapy aims to elevate the urethral sphincter so that it is again an intraabdominal location (urethropexy

Question 35

Procedures of (urethropexy)

Answer 35

This is done by attachment of the
sphincter to the symphysis pubis, using the Burch procedure as well as the Marshall-
Marchetti-Kranz (MMK) procedure.

Question 36

Minimally invasive procedure for genuine stress incontinence

Answer 36

A minimally invasive surgical procedure is the tension-free vaginal tape procedure
in which a mesh tape is placed transcutaneously around and under the mid
urethra

Question 37

_____This is the most common incontinence in older women.

Answer 37

Motor Urge (Hypertonic) Incontinence.

Question 38

Motor Urge (Hypertonic) Incontinence Etiology

Answer 38

Involuntary rises in bladder pressure occur from idiopathic detrusor contractions
that cannot be voluntarily suppressed

Question 39

Cystometric studies of Motor Urge (Hypertonic) Incontinence

Answer 39

Cystometric studies show normal residual volume, but involuntary detrusor contractions are present even with small volumes of urine in the bladder.

Question 40

Mx of Motor Urge (Hypertonic) Incontinence

Answer 40

Anticholinergic medications (e.g., oxybutynin [Ditropan]); nonsteroidal antiinflammatory drugs (NSAIDs) to inhibit detrusor contractions; tricyclic antidepressants;
calcium-channel blockers

Question 41

Rises in bladder pressure occur gradually from an overdistended, hypotonic
bladder.

When the bladder pressure exceeds the urethral pressure, involuntary urine
loss occurs but only until the bladder pressure equals urethral pressure

Answer 41

Overflow (Hypotonic) Incontinence

Question 42

Overflow (Hypotonic) Incontinence causes

Answer 42

This may be caused by denervated
bladder (e.g., diabetic neuropathy, multiple sclerosis) or systemic medications (e.g.,
ganglionic blockers, anticholinergic

Question 43

History Overflow (Hypotonic) Incontinence

Answer 43

Loss of urine occurs intermittently in small amounts. This can take place
both day and night. The patient may complain of pelvic fullness.

Question 44

Neuro exam of pts with Overflow (Hypotonic) Incontinence

Answer 44

however, the neurologic examination will show decreased pudendal nerve sensation.

Question 45

Overflow (Hypotonic) Incontinence

Cystometric studies show

Answer 45

markedly increased residual volume, but involuntary detrusor contractions do not occur

Question 46

Mx of overflow incontinence

Answer 46

Intermittent self-catheterization may be necessary. Discontinue the offending systemic medications.

Cholinergic medications to stimulate bladder contractions and a-adrenergic blocker to relax the bladder neck

Question 47

The patient usually has a history of radical pelvic surgery or pelvic radiation
therapy.

Loss of urine occurs continually in small amounts. This can take place both
day and night

Answer 47

Fistula

Question 48

Dx of Fistula

Answer 48

An intravenous pyelogram (IVP) will demonstrate dye leakage from a urinary tract fistula