Urinary Incontinance and POP

Question 1

6 common causes of pelvic organ prolapse

Answer 1

1. childbirth
2. chronic heavy lifting
3. prior surgery
4. obesity
5. aging
6. menopayse

Question 2

sx of prolapse

Answer 2

bulge or lump in vagina 
painful/difficult sex  
delayed or slow urinary stream 
incontinence  
BM difficulty

Question 3

cystocele

Answer 3

bladder fall into vagina

Question 4

enterocele

Answer 4

small bowel into vagina

Question 5

rectocele

Answer 5

rectum into vagina

Question 6

uterine prolapse

Answer 6

uterus into vagina

Question 7

vaginal vault prolapse

Answer 7

vaginal vault occurs when the upper portion of vagina (apex) descends into canal

Question 8

POP 3 steps to PE

Answer 8

1. speculum exam
2. bimanual exam
3. dorsal lithotomy position

Question 9

POP grade 0

Answer 9

no prolapse

Question 10

POP grade 1

Answer 10

mild defect, not visible without speculum

descent halfway to hymen

Question 11

POP grade 2

Answer 11

prolapse into hymen

Question 12

POP grade 3

Answer 12

prolapse beyond hymen (halfway past)

Question 13

POP grade 4

Answer 13

complete prolapse

Question 14

procidentia

Answer 14

aka complete prolapse

grade 4

Question 15

GH

Answer 15

gnital hiatus

Question 16

PB

Answer 16

perineal body

Question 17

TVL

Answer 17

total vaginal length

Question 18

POP Q scale 1-4

Answer 18

0 no pop
1 most distal prolapse is over 1 cm above hymen

2 most distal prolapse is between 1cm above to 1cm below hymen

3 most distal prolapse is over 1 cm belwo hymen but under 2 cm less than TVL

4: complete procidentia (more than 2 cm TVL)

Question 19

2 ways to strengthen pelvic floor

Answer 19

kegel exercises

vaginal cone weights

Question 20

besides exercises other POP tx option

Answer 20

pessaries with adjunctive vaginal estrogen therapy

Question 21

pessary complications

Answer 21

irritation, erosion, discharge, odor

Question 22

colporrhaphy

Answer 22

surgical repair of vaginal laxity

Question 23

4 reasons when to start tx POP

Answer 23

1. s/s bother pt
   2/ prolapse lead to tissue trauma or other effects
2. urinary incontinence
3. key! don’t discriminate against age

Question 24

experiencing overwhelming need to urinate, even if just went or cant hold it to make it the bathroom

Answer 24

urge inctontinence

Question 25

urge incontinence aka

Answer 25

overactive bladder

Question 26

causes of urge incontinence

Answer 26

Idiopathic detrusor instability

neuropathic detrusor hyperreflexia

Question 27

urine loss during episodes of increased abdominal pressure,

Answer 27

stress urinary incontinence

Question 28

causes of stress incontinence

Answer 28

1. urethral hypermobility

2. intrinsic sphincter deficiency (ISD)

Question 29

storage sx of incontinence

Answer 29

frequency
urgency
interruption of sleep

Question 30

voiding sx of incotinence

Answer 30

slow stream
dribbling
incomplete emptying
hesitancy

Question 31

average functional bladder capacity

Answer 31

largest vl voided in normal life

avg 400-600mL

Question 32

average # voids / day

Answer 32

7-8

about 250 ml

Question 33

what is q tip test?

Answer 33

about 1 cm in urethra then cough

more than 30 degress of mvmt = positive test

Question 34

urodynamics

Answer 34

assessment of bladder function

Question 35

3 urodynamic tests

Answer 35

1. cystometry
2. urethral profile pressure
3. leak point pressure

Question 36

pressure flow study

Answer 36

cystometry

Question 37

urethral closure pressure

Answer 37

urethral profile pressure

Question 38

lowest pressure at which leakage occurs w/ straining

Answer 38

leak point pressure

Question 39

occurs when nerve passages from bladder to brain are damaged.. causes sudden bladder contraction

Answer 39

detrusor contractions

sudden onset, larger volum

Question 40

tx for urge incontinence

Answer 40

conservative- time voids, diary
meds: muscarinic receptor antagonists
neural stim: sacral neuromodulation interstim

Question 41

sacral neuromodulation interstim is used to tx..

Answer 41

urge incontinence

Question 42

tx stress incontinence

Answer 42

kegel exercises

pessary divices

Question 43

pessary devices do what?

Answer 43

strengthen and support the levator ani muscles

compressive effect on urethra

Question 44

strengthening the levator ani muscles help with

Answer 44

improving support or proximal urethra

Question 45

strengthening the striated urogenital sphincter leads to

Answer 45

increases urethral closure force

Question 46

surgical opt for stress incontinence

Answer 46

sling shaped material placed below urethra

compresses urethral lumen at level of bladder neck as well as urethral support

success 90% of time

Question 47

3 ex of old stress incontinence surg options

Answer 47

anterior colporrhaphy
retropubic bladder neck surgery
needle suspensioun

Question 48

bulking agents tx what?

Answer 48

stress incontinence

into bladder neck via injection

Question 49

t/f there is currently no meds to treat stress urinary incontinence (SUI)

Answer 49

true

Question 50

incontinence occurring without urgency or stress

Answer 50

unconscious or overflow

Question 51

urethral hypermobility and/or instrinsic sphincter deficiency can cause..

Answer 51

stress or genuine stress urinary incontinence

Question 52

what 6 meds can make incontinence sx worse?

Answer 52

1. anticholinergics
2. alpha blockers
3. calcium channel blockers
4. sedatives
5. alcohol

Question 53

contents of void diary

Answer 53

24 hr log 
measure UOP (urine output), intake, leage times and amounts

Question 54

UOP

Answer 54

urine output