Prolapse and incontinence Flashcards
What are the pelvic ligaments that act to support the uterus in the upper part of the vagina?
Transverse cervical/cardinal ligaments
Uterosacral ligaments (round ligaments)
What is procidentia?
This is when the uterus descends so far that it actually lies outside of the vagina.
What are the urinary symptoms associated with genital prolapse?
Frequency
Incomplete emptying of the bladder
Frequent UTI
Overflow incontinence
Stress incontinence
What are the non-surgical management options for genital prolapse?
Weight loss
Smoking cessation
Pelvic floor exercises
Constipation treatment
HRT
Vaginal pessary
What are the main complications of a vaginal pessary?
Vaginal erosions (presents with bleeding and irritation)
Discharge
Interference with sexual intercourse
Difficulty with bowel movements
UTIs
Bacterial vaginosis
How often should a pessary be cleaned?
Every 1-2 weeks
What are the clinical features of detrusor instability?
Urgency
Increased frequency
Nocturnal polyuria
+/- incontinence (not necessary for diagnosis - differentiates overactive bladder from urge incontinence)
What is the pathophysiology of detrusor instability?
Abnormal bladder contraction during the filling phase
For which type of incontinence is bladder training most useful?
Urge
Pelvic organ prolapse is most likely to cause which type of incontinence?
Stress (urethral hypermobility)
What procedure is performed for apical or vaginal vault prolapse?
Sacrocolpopexy
What surgical procedure is performed for a cystocele?
Anterior colporrhaphy
What investigation is ordered if there is diagnostic uncertainty of the cause/type of a woman’s incontinence?
Urodynamic studies
The bladder is filled with sterile fluid. Changes such as first sensation, desire to void and bladder capacity are recorded electronically during the filling and storage phase. Urinary loss from the urethra during provocative manoeuvres such as coughing is documented
