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Urinary incontinence and Prolapse Flashcards

1
Q

What muscle is responsible for an overactive bladder?

A

Detrusor

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2
Q

What drug treatment is used in stress incontinence?

A

Duloexetine (combined noradrenaline and serotonin reuptake inhibitor)

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3
Q

What drug treatment is used in treating an overactive bladder?

A
  • Antimuscarinic (oxybutynin) as these block detrusore muscarinic receptors and decrease the ability of the detrusor muscles to contract.
  • B3 receptor antagonist
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4
Q

Which patients with OAB should be offered oestreogen and how should this be given?

A

Should only be given intravaginally to postmenopausal women with vaginal atrophy.

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5
Q

What surgical treatments are available for stress incontinence?

A
  • Synthetic mid urethral tape
  • Open colposuspension
  • Autologous rectus fascial sling
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6
Q

What is the most common cause of overactive bladder?

A

Detrusor overactivity

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7
Q

What are the two muscle groups that make up the pelvic diaphragm?

A

Levator Ani

Cocygeua

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8
Q

Which lies more medially; coccygeus or levator ani?

A

Levator Ani

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9
Q

What are the attachments of the levator ani muscle?

A 
Pubic bones
Ischial spines
Tendinous arch of levator ani 
In the midline...
Perineal body
Coccyx
Walls of organs in the midline
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10
Q

What are the three parts of levator ani?

A

Puborectalis
Pupococcygeus
Iliococcygeus

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11
Q

What two nerves innervate the levator ani muscle?

A

Pudendal nerve

Nerve to leavator ani

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12
Q

What structure lies above the perineal membrane and contains the bulbourethral glands in the male and the neurovascular bundle for the penis and clitoris?

A

Deep perineal Pouch

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13
Q

What kind of epithelium lines the bladder?

A

Transitional epitheliym

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14
Q

List the investigations that can be used when assessing urinary incontinence?

A

Urinalysis (look for nitrites for UTI, glucose for diabetes)
Blood for renal function (U & E’s) if impairment suspected
Bladder chart
Pad test (quantifies urine leakage
Urodynamics

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15
Q

What is the minimum void of urine required to determine flow rain is uroflometry?

A

200ml

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16
Q

What does cystometry measure?

A

The pressure/volume relationship of the bladder is measured during filling, provocation and voiding

17
Q

On cystometry you see high detrusor pressure but a low flow rate on voiding. What is the most likely diagnosis?

A

Bladder outlet obstruction

18
Q

On cystometry you see involuntary detrusor contractions and the patient complains of urgency

A

Overactive bladder

19
Q

What surgical techniques are used in the treatment of stress urinary incontinence?

A

Low tension vaginal tape
Intraurethral injections
Artificial sphinters
Colposuspension

20
Q

What is the mainstay of surgical interventions used in the treatment of an overactive bladder?

A

Botox injections

21
Q

What is meant by a 1st degree uterine prolapse?

A

Uterus has descended into vagina

22
Q

What is meant by a 2nd degree uterine prolapse?

A

Prolapse into the interiotus

23
Q

What is meant by a 3rd degree uterine prolapse?

A

Uterus is visible outside the vagina

24
Q

What is meant by a 4th degree uterine prolapse?

A

The uterus is entirely outside the vagina

25
Q

What is a rectocele?

A

Prolapse of the rectum into the vagins

26
Q

What is an enterocele?

A

Prolapse of the pouch of douglas containing small bowel into the vagina

27
Q

What is a cytocele?

A

Prolapse of the bladder into the vagina

28
Q

How might a rectocele present?

A

Constipation

Painful passing of faeces

29
Q

How might a cysourethrocele present?

A

Stress incontinence
Recurrent UTI
Urinary retention

30
Q

What is the treatment of atrophic vaginitis?

A

Vaginal oestrogens

31
Q

What would you give to a women who had a 2nd degree prolapse but who was strongly against surgery?

A

Pessary such as a ring

32
Q

What is a vault prolapse?

A

After a hysterectomy has been performed the top (vault) of the vagina may bulge down

33
Q

What is the most common symtpoms of a uterine prolapse?

A

Feeling of a lump “coming down”
Dragging disccomfort
Backache

34
Q

How is a uterine prolapse diagnosed?

A

Vaginal examination

35
Q

What is the treatment of uterine prolapse in women who want to have children?

A

Pessary

36
Q

What kind of prolapse is usually not treated with a pessary?

A

Posterior wall prolapse

37
Q

Discuss the surgical options used in the treatment of a cystocele or a rectocele?

A

Pelvic flow repair. The walls of the vagina are tightened using mesh sewn into the vaginal walls. This is performed vaginally.

38
Q

Discuss the surgical options used in the treatment of a uterine prolapse?

A

Sarcocolpopexy
Sacrospinous fixation.
Mainly done by keyhole surgery the uterus if lifted and attached to the sacrum or sacrospinous ligament.
Vaginal hysterectomy

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