Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MRCOG Part 2 Urogynaecology > Urinary incontinence and pelvic organ prolapse - NICE 2019 > Flashcards

Urinary incontinence and pelvic organ prolapse - NICE 2019 Flashcards

1
Q

3 main types of incontience

A

Stress UI
Mixes
Urgency/Overreactive bladder OAB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

History for urinary incontience

A
  • Frequency/nocturia
  • Urgency, urge UI
  • Stress UI, ?continous (fistula)
  • Voiding - hesitant, poor stream, intermittent stream
  • Post-micturation - incomplete empty, dribbling
  • Haematuria, pain (bladder/urethral)
  • Bowel Sx
  • medical Hx
  • Surgical Hx
  • O&G Hx - ?completed family, sexual dysfunction
  • Drug Hx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Examination

A

AMTS
Abdo examination (masses
Bimanual +/- PR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Investigations for incontience

A

MSU
Residual volume - USS or catheter post void
Bladder diary for 3/7
Symptom score

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

If urinalysis shows leukocytes and nitrites +ve

A

Await MSU, if +ve treat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

When to perform urodynamic testing?

A

Do not perform for primary stress incontinence before surgery

Perform if stress and :
- Urge-predominant, or unclear
- Voiding dysfunction
- Anterior or apical prolapse
- Hx of previous surgery for SUI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Lifestyle advice to give for urinary incontience

A

Less caffeine
Drink 1-2 L fluid/day
If BMI >30 lose weight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How long and how often should pelvic floor muscle training for stress/mixed UI

A

3 months
8 contractions at least TDS

4 months if POP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

For how long should bladder retraining take place for OAB or mixed

A

Minimum 6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

2 terms used with overactive bladder if accompanied with incontinece or not

A

OAB dry or wet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

If urodynamic being used how is detrusor overactivity diagnosed?

A

Diagnosis is therefore made at filling cystometry:


a) Rise in detrusor pressure of >15cm H2O

b) Rise in detrusor pressure of <15cm H2O in the presence of urgency or urge incontinence



How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What drugs are offered 1st line in OAB

A

Oxybutynin
Tolteradone
Solifenacin/Darifenacine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What proportion of women have improve symptoms after anticholinergics?

A

57-71% of women,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Side effects of anti-cholinergics

A

Nausea, constipation, diarrhoea and abdominal discomfort

Dry mouth (88%)

Blurred vision

Voiding difficulties

Headache, dizziness, drowsiness, restlessness and disorientation

Rash, dry skin, photosensitivity

Arrhythmia

Angioedema



How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

When are anticholinergics contraindicated?

A

Glaucoma
Ulcerative colitis
Myasthenia gravis
Intestinal obtruciton

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

When should you not given oxybutynin

A

Avoid if >80yrs or frail
Can consider transdermal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Which anticholinergic has the least confusion side effects and can be consider in women with dementia

A

Darifenacin

18
Q

When to review after start anticholinergic

A

4 weeks
Long term & >75 review every 6 months

19
Q

When to consider desmopressin

A

nocturia and nocturnal enuresis.

20
Q

When is desmopressin contraindicated and side effects

A

Congestive heart failure, caution if 65+ with CVD or HTN

Side-effects include fluid retention with hyponatraemia, epistaxis, nasal congestion and rhinitis with nasal spray


21
Q

If antimuscarinic contraindicated, what medication to consider?

A

Mirabegron

22
Q

What type of drug is mirabegron

A

Selective B-3 adrenergic agonist

23
Q

If medication not controlling overactive bladder symptoms what is the next step?

A

Refer to MDT to discuss

24
Q

What ti explain to patient before Bladder wall injection with botox A

A
  1. the likelihood of complete or partial symptom relief
  2. clean intermittent catheterisation, the risks, and how long it might need to be continued
  3. the risk of adverse effects, including an increased risk of urinary tract infection
  4. Not much evidence about how long the injections work for, how well they work in the long term and their long-term risks*
25
Q

How much botox to give at initially, when to review

A

100 units botox A
Review in 12 months

Can increase two 200 if limited response

26
Q

Whe to offer posterior sacral nerve stimulation

A

Declined or no response to botox

27
Q

What very rare surgical options can be considered for OAB

A

Augmentation cystoplasty - surgery to enlarge bladder

Urinary diversion

28
Q

What proportion of stress incontience can be managed with conservative measures

A

50%

29
Q

When should be referred to MDT

A

When conservative measures fail to work

30
Q

Main surgical treatments of stress incontience

A
  1. Open/Lap Burch Colposuspension
  2. Autologous recurs fascial sling/Retropubuic mid-urethral mesh sling

Bulking agents
Deloxetine

31
Q

Conservative treatments of prolapse

A

losing weight, if the woman has a BMI greater than 30 kg/m2
minimising heavy lifting
preventing or treating constipation
Topical oestrogen - if signs of atrophy or consider oestrogen ring
Pelvic floor training - 4months
Pessaries

32
Q

How often should pessaries be removed and inspected

A

6 months

33
Q

For prolapse and does not mind if retains uterus, what surgeries can be offered?

A

vaginal hysterectomy, with or without vaginal sacrospinous fixation with sutures or

vaginal sacrospinous hysteropexy with sutures or

Manchester repair.

34
Q

For prolapse would like to retain uterus, what surgeries can be offered?

A

vaginal sacrospinous hysteropexy with sutures or

Manchester repair (unless want children)

35
Q

What is a Manchester repair?

A

excision of the elongated cervix and approximation of the cardinal ligaments anterior to the cervix to elevate and retract it so that the uterus is both anteverted and supported

36
Q

What surgery can be offered to anterior or posterior repair?

A

Anterior: Anterior repair without mesh
Posterior: Posterior repair without mesh

Review in 6 months

37
Q

If women has mesh complication what can offer as management

A

Consider topical oestrogen cream if exposed area <1cm, FU 3 months

removal has limited benefits, may worsen pain, UI or prolapse may recur

Consider partial/complete removal if
- Does not want topical oestrogen, area of exposure >1cm, gainful mesh extrusion, no response in 3 months

38
Q

Sacrocolpopexy

A

Surgery to treat vault prolapse, plastic mesh used to attach vagina to sacrum

39
Q

Sacro-hysteropexy

A

Uterine prolapse, plastic mesh from womb to sacrum

40
Q

Vaginal sacrospinous fixation

A

Vaginal vault or uterine prolapse - top of vagin stitched to sacrospinous ligament

41
Q

Vaginal sacrospinous hysteropexy

A

Used to treat uterine prolapse - cervix stitched to sacrospinous ligament

MRCOG Part 2 Urogynaecology (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions