Prolapse

Question 1

definition of urinary incontinence?

Answer 1

involuntary loss of urine which can be demonstrated and is a social or hygienic problem

Question 2

leakage of urine during raised intra abdominal pressure?

Answer 2

stress urinary incontinence

Question 3

leakage associated with urgency, usually with detrusor activity?

Answer 3

OAB

Question 4

what would detrusor hypotonia cause?

Answer 4

voiding difficulties

Question 5

symptoms of urinary incontience?

Answer 5

precipitated by stress or urgency. Irritative symptoms:frequency, urgency, nocturne, dysuria
voiding difficulties: poor stream, incomplete emptying

Question 6

most common form of incontinence?

Answer 6

stress incontinence (48 percent of women)

Question 7

how would you investigate incontinence?

Answer 7

urinalysis, bladder chart, URODYNAMICS

Question 8

useful investigation to differentiate between stress incontinence and urge?

Answer 8

urodynamics

Question 9

urodynamics contains uroflowmetry and cystometry

Answer 9

y

Question 10

what is flow rate?

Answer 10

measures peak flow, mean flow and voided volume

Question 11

cystometry?

Answer 11

a method by which the pressure/volume relationship of the bladder is measured during filling, provocation and voiding

Question 12

what would stress in look like on graph?

Answer 12

spikes of urine flow after cough or sneeze

Question 13

overactive bladder?

Answer 13

involuntary detrusor contractions

Question 14

bladder outlet obstruction?

Answer 14

high detrusor/bladder pressure. low flow arte/no flow rate

Question 15

treatment of stress incontinence?

stress - dul

Answer 15

lifestyle - stop smoking, weight loss, avoid caffeine drinks etc. physio for pelvic floor retraining.

Question 16

which drug (combined noradrenaline and serotonin repute inhibitor) increases intraurethra closure pressure?

Answer 16

duloexetine

Question 17

surgical procedures for stress incontinence?

Answer 17

low tension vaginal tape, intraurethral injection, artificial sphincters, colposuspension

Question 18

treatment of overactive bladder

OAB - oxy

Answer 18

avoid caffeinated drinks, bladder training. Oxybutanin (anti muscarinic drugs)
OAB - oxybutanin

Question 19

surgical? (rarely used)

Answer 19

botox injections

Question 20

pelvic organ prolapse. classifications?

Answer 20

1st degree (in vagina)
2nd degree (at introits)
3rd degree (outside vagina)
procidentia - completely outside vagina

Question 21

term for prolapse completely outside vagina?

Answer 21

procidentia

Question 22

types of pelvic organ prolapse?

Answer 22

urethrocele (urethra), cytocele (bladder), rectocele(rectum) enterocele (pouch of douglas containing small bowel) vaginal vault, uterus and cervix

Question 23

symptoms of uterovaginal prolapse?

Answer 23

backache, ulceration of procidentia, coital difficulties, urinary retention, constipation,

Question 24

management of prolapse?

Answer 24

rassure, avoid heavy lifting, lose weight, stop smoking, reduce constipation, vaginal oestrogen, only if symptomatic atrophic vaginitis, physiotherapy

Question 25

women unfit for surgery or awaiting surgery?

Answer 25

pessarie

Question 26

when do you consider surgical management?

Answer 26

only after failed conservative management

Question 27

sacrospinous ligament fixation - what is this?

Answer 27

securing vaginal vault to sacrospinous ligament using sutures

Question 28

what group of people have problem with oxybutanin?

Answer 28

old people?

Question 29

biggest problem with oxybutanin?

Answer 29

dry cough

Question 30

what type of drug is oxybutanin?

Answer 30

an antimuscarinic

Question 31

how long does oxybutanin take to start working?

Answer 31

4 weeks

Question 32

whats a better option than oxybutanin for older patients?

Answer 32

tolteradine