POP & UI (NICE) Flashcards
MDT in managing SUI, OAB and primary prolapse should include…?
Urogynaecology, CNS nurse, PFM physiotherapy, OT, colorectal surgeon, geriatrics
What is the place of pad tests in routine assessment of women with UI?
Do not use
What is the place of Q-tip, Bonney, Marshall and Fluid-Bridge tests in the assessment of women with urinary incontinence?
Do not use
What types of fluid can exacerbate overactive bladder?
caffeine, alcohol, carbonated drinks, sugary drinks
At what BMI should women with OAB be counselled to lose weight?
> 30
What should PFMT consist of?
- supervision
- physiotherapist
- 3 months
- 8 contractions, 3x per day
What are the indications for electrical stimulation and/or biofeedback in overactive bladder?
women who cannot actively contract pelvic floor muscles
aid motivation and adherence to therapy
What is an example of a behavioural therapy for OAB?
bladder training for minimum 6 weeks
In what circumstance should percutaneous posterior tibial nerve stimulation be used in the setting of OAB?
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
What is the place of intermittent catheterisation?
Urinary retention with:
- incontinence
- symptomatic infections
- renal dysfunction
- cannot otherwise be corrected.
Contraindications to oxybutynin?
- older women at higher risk of physical/cognitive decline
- glaucoma
- urinary retention
Contraindications to B3 adrenoceptor agonists?
Pregnancy or breastfeeding
Renal or liver impairment
Prolonged QT
How often should you review women on long term medicine for OAB or UI?
6-12 monthly. 6 monthly if >75yo.
When should botox of detrusor be offered?
- after MDT
- no response to pharmacological and other managements
- women willing to perform intermittent catheterisation if needed or temporary indwelling catheter.
What is augmentation cystoplasty indicated for
idiopathic detrusor overactivity in cases no responsive to non-surgical management, and in women willing to self-catheterise.
Three options for SUI if non-surgical management has failed?
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
When should trans-obturator approach for MUS indicated?
previous pelvic procedures in which the retropubic approach should be avoided?
List 5 procedures NICE does not recommend for treatment of SUI.
Anterior colporrhaphy Needle suspension paravaginal defect repear porcine dermis sling Marshall-Marchetti Krantz procedure
List 4 essential points of examination in gynaecological clinical assessment of POP?
assess degree POPQ
assess PFM activity
assess for vaginal atrophy
rule out pelvic mass or other pathology
3 lifestyle modifications for management of POP?
lose weight if BMI >30
minimise heavy lifting
prevent or treat constipation
In what stage of POP is PFMT likely to be beneficial?
Stage one or two.
How often should women with pessaries be reviewed?
6 monthly- prevents serious complications.
What is the risk of correcting anterior or apical prolapse in an otherwise asymptomatic woman?
de novo postoperative urinary incontinence
What surgery can be offered for uterine prolapse?
- vaginal hysterectomy +/- SSF
- vaginal sacrospinous hysteropexy with sutures
- Manchester repair
- Colpoclesis
What surgery can be offered for vault prolapse?
Vaginal sacrospinous fixation with sutures
Colpoclesis
List some symptoms of mesh-related complications
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
How would a vesicle-vaginal fistula be investigated with imaging?
fluoroscopic studies +/- CT
What would the role of MRI be in diagnosis of mesh complications?
- suspected mesh infection
- anatomical mapping of suspected fistula
- anatomical mapping/mesh localisation for pre surgical planning
- back pain following abdominal mesh placement with attachment to sacral promontory
- identification of discitis or osteomyelitis
How can you manage mesh erosion?
- topical oestrogen cream and follow up in 3 months
2. partial or complete surgical removal of mesh
What are the risks of mesh removal?
incomplete removal.
Risk of urinary or bowel injury
risk recurrent prolapse
may require abdominal surgery
