POP & UI (NICE)

Question 1

MDT in managing SUI, OAB and primary prolapse should include…?

Answer 1

Urogynaecology, CNS nurse, PFM physiotherapy, OT, colorectal surgeon, geriatrics

Question 2

What is the place of pad tests in routine assessment of women with UI?

Answer 2

Do not use

Question 3

What is the place of Q-tip, Bonney, Marshall and Fluid-Bridge tests in the assessment of women with urinary incontinence?

Answer 3

Do not use

Question 4

What types of fluid can exacerbate overactive bladder?

Answer 4

caffeine, alcohol, carbonated drinks, sugary drinks

Question 5

At what BMI should women with OAB be counselled to lose weight?

Answer 5

> 30

Question 6

What should PFMT consist of?

Answer 6

• supervision
• physiotherapist
• 3 months
• 8 contractions, 3x per day

Question 7

What are the indications for electrical stimulation and/or biofeedback in overactive bladder?

Answer 7

women who cannot actively contract pelvic floor muscles

aid motivation and adherence to therapy

Question 8

What is an example of a behavioural therapy for OAB?

Answer 8

bladder training for minimum 6 weeks

Question 9

In what circumstance should percutaneous posterior tibial nerve stimulation be used in the setting of OAB?

Answer 9

When:

there has been a local MDT review AND

non-surgical management including OAB medicine treatment has not worked adequately AND

the woman does not want botox or percutaneous sacral nerve stimulation

Question 10

What is the place of intermittent catheterisation?

Answer 10

Urinary retention with:

• incontinence
• symptomatic infections
• renal dysfunction
• cannot otherwise be corrected.

Question 11

Contraindications to oxybutynin?

Answer 11

• older women at higher risk of physical/cognitive decline
• glaucoma
• urinary retention

Question 12

Contraindications to B3 adrenoceptor agonists?

Answer 12

Pregnancy or breastfeeding
Renal or liver impairment
Prolonged QT

Question 13

How often should you review women on long term medicine for OAB or UI?

Answer 13

6-12 monthly. 6 monthly if >75yo.

Question 14

When should botox of detrusor be offered?

Answer 14

• after MDT
• no response to pharmacological and other managements
• women willing to perform intermittent catheterisation if needed or temporary indwelling catheter.

Question 15

What is augmentation cystoplasty indicated for

Answer 15

idiopathic detrusor overactivity in cases no responsive to non-surgical management, and in women willing to self-catheterise.

Question 16

Three options for SUI if non-surgical management has failed?

Answer 16

Colposuspension (open, laparoscopic)- The neck of the bladder is lifted up and stitched in this position.
autologous rectus fascial sling
retropubic mid-urethral mesh sling

OR if not willing for above

Intramural bulking agents

Question 17

When should trans-obturator approach for MUS indicated?

Answer 17

previous pelvic procedures in which the retropubic approach should be avoided?

Question 18

List 5 procedures NICE does not recommend for treatment of SUI.

Answer 18

Anterior colporrhaphy
Needle suspension
paravaginal defect repear
porcine dermis sling
Marshall-Marchetti Krantz procedure

Question 19

List 4 essential points of examination in gynaecological clinical assessment of POP?

Answer 19

assess degree POPQ
assess PFM activity
assess for vaginal atrophy
rule out pelvic mass or other pathology

Question 20

3 lifestyle modifications for management of POP?

Answer 20

lose weight if BMI >30
minimise heavy lifting
prevent or treat constipation

Question 21

In what stage of POP is PFMT likely to be beneficial?

Answer 21

Stage one or two.

Question 22

How often should women with pessaries be reviewed?

Answer 22

6 monthly- prevents serious complications.

Question 23

What is the risk of correcting anterior or apical prolapse in an otherwise asymptomatic woman?

Answer 23

de novo postoperative urinary incontinence

Question 24

What surgery can be offered for uterine prolapse?

Answer 24

1. vaginal hysterectomy +/- SSF
2. vaginal sacrospinous hysteropexy with sutures
3. Manchester repair
4. Colpoclesis

Question 25

What surgery can be offered for vault prolapse?

Answer 25

Vaginal sacrospinous fixation with sutures

Colpoclesis

Question 26

List some symptoms of mesh-related complications

Answer 26

pain or sensory change in back, abdomen,

vagina, pelvis, leg, groin or perineum
vaginal discharge, bleeding, dyspareunia, penile trauma to partners

urine- recurrent urine infection, incontinence, retention or difficulty/pain with voiding

bowel- recurrent pain on defecation, intontninence, rectal bleeding, passage of mucous

symptoms of infection

Question 27

How would a vesicle-vaginal fistula be investigated with imaging?

Answer 27

fluoroscopic studies +/- CT

Question 28

What would the role of MRI be in diagnosis of mesh complications?

Answer 28

1. suspected mesh infection
2. anatomical mapping of suspected fistula
3. anatomical mapping/mesh localisation for pre surgical planning
4. back pain following abdominal mesh placement with attachment to sacral promontory
5. identification of discitis or osteomyelitis

Question 29

How can you manage mesh erosion?

Answer 29

1. topical oestrogen cream and follow up in 3 months

2. partial or complete surgical removal of mesh

Question 30

What are the risks of mesh removal?

Answer 30

incomplete removal.
Risk of urinary or bowel injury
risk recurrent prolapse
may require abdominal surgery