RNH- Pelvic floor dysfunction - BW3 Usama

Question 1

Pelvic floor dysfunction:

What does urogynae cover?

Answer 1

Question 2

Delancey levels of pelvic support:

Answer 2

Question 3

Delancey levels of support:

What symptoms are they presenting with? What does the patient describe?

Answer 3

• Pregnancy causes - pulling on uterosacral ligaments

Level 1 - Feeling of something coming down, dragging sensation,

Level two: Anterior: Cystocoele- Bladder —— Posterior:Rectocoele- Causes obstructed of passing stool, manually digitate. (do you need to manually put fingers in vagina to help you poo)

Level 3: Anterior: pubourethral ligament- Causes stress incontinence. Posterior: Pernieal body: Describes vaginal flatus/sexual dysfunction/ vaginal looseness

Question 4

Staging of Pelvic organ prolapse:

Whats

Answer 4

Question 5

Apical prolaspe:

Answer 5

*

Question 6

Anterior wall prolapse: Level 2-

Asking patient to cough- to see rectocoele. cystocoele.

Answer 6

Question 7

Genital hiatus

Answer 7

Question 8

LEvator avulsion: Level 3 injury:

Answer 8

Question 9

LEVEL 3_ dELANCEY

Answer 9

Question 10

Conservative management: Of prolapse

Lifestyle modifications? List 6 different methods

Answer 10

• Weight loss
• Avoid heavy lifting
• Bracing in anticipation
• avoid constipation
• Pessaries
• supportive underwear
• STOP smoking - wound dehsince - breakdown - prolapse
• Oestrogen replacement- assists

Question 11

Surgical management:

Surgery at level 1:? List 2 surgery types (apical)

Surgery at level 2: (vaginal and paravaginal) Cystolceole/rectocoele

Surgery at level 3: Urethral and perineal - Very low- Issues with stress incontinence (Sling/mesh- to support the urethra)

Answer 11

Question 12

Stress urinary incontinence:

Answer 12

Question 13

Prevalence of Stress urinary incontinence:

Risk factors for stress incontinence? : List 4

Answer 13

Question 14

History: Stress urinary incontinence vs urge incontinence?

Voiding? Quantification?

Answer 14

Question 15

Outline basics of examination:

General inspection?

Genitial examination?

Cough leak?

POP-q/Baden-walker? ( know baden walker)

Answer 15

• Skin excroiation, redness erythema
• COugh leak- Part labia- ask patient to cough- pts often embarassaed

Question 16

Investigations: For Stress incontinence:

What measures to- Voiding diary/ PAD test?

Intrinsic sphincter deficiency ???? Hypermobility????? (can see on examination)

Answer 16

Question 17

Consent: For Initimate genital examination:

Explain: read

Treatment options:

Answer 17

Two main types pof slings:

Retropubic sling:

Transobturator sling:

Mesh_ Cannot have tension- Can cause a bit of urgency:

Question 18

Tips and tricks:

Answer 18