Urinary incontinence and Prolapse Flashcards
What muscle is responsible for an overactive bladder?
Detrusor
What drug treatment is used in stress incontinence?
Duloexetine (combined noradrenaline and serotonin reuptake inhibitor)
What drug treatment is used in treating an overactive bladder?
- Antimuscarinic (oxybutynin) as these block detrusore muscarinic receptors and decrease the ability of the detrusor muscles to contract.
- B3 receptor antagonist
Which patients with OAB should be offered oestreogen and how should this be given?
Should only be given intravaginally to postmenopausal women with vaginal atrophy.
What surgical treatments are available for stress incontinence?
- Synthetic mid urethral tape
- Open colposuspension
- Autologous rectus fascial sling
What is the most common cause of overactive bladder?
Detrusor overactivity
What are the two muscle groups that make up the pelvic diaphragm?
Levator Ani
Cocygeua
Which lies more medially; coccygeus or levator ani?
Levator Ani
What are the attachments of the levator ani muscle?
Pubic bones Ischial spines Tendinous arch of levator ani In the midline... Perineal body Coccyx Walls of organs in the midline
What are the three parts of levator ani?
Puborectalis
Pupococcygeus
Iliococcygeus
What two nerves innervate the levator ani muscle?
Pudendal nerve
Nerve to leavator ani
What structure lies above the perineal membrane and contains the bulbourethral glands in the male and the neurovascular bundle for the penis and clitoris?
Deep perineal Pouch
What kind of epithelium lines the bladder?
Transitional epitheliym
List the investigations that can be used when assessing urinary incontinence?
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
What is the minimum void of urine required to determine flow rain is uroflometry?
200ml
What does cystometry measure?
The pressure/volume relationship of the bladder is measured during filling, provocation and voiding
On cystometry you see high detrusor pressure but a low flow rate on voiding. What is the most likely diagnosis?
Bladder outlet obstruction
On cystometry you see involuntary detrusor contractions and the patient complains of urgency
Overactive bladder
What surgical techniques are used in the treatment of stress urinary incontinence?
Low tension vaginal tape
Intraurethral injections
Artificial sphinters
Colposuspension
What is the mainstay of surgical interventions used in the treatment of an overactive bladder?
Botox injections
What is meant by a 1st degree uterine prolapse?
Uterus has descended into vagina
What is meant by a 2nd degree uterine prolapse?
Prolapse into the interiotus
What is meant by a 3rd degree uterine prolapse?
Uterus is visible outside the vagina
What is meant by a 4th degree uterine prolapse?
The uterus is entirely outside the vagina
What is a rectocele?
Prolapse of the rectum into the vagins
What is an enterocele?
Prolapse of the pouch of douglas containing small bowel into the vagina
What is a cytocele?
Prolapse of the bladder into the vagina
How might a rectocele present?
Constipation
Painful passing of faeces
How might a cysourethrocele present?
Stress incontinence
Recurrent UTI
Urinary retention
What is the treatment of atrophic vaginitis?
Vaginal oestrogens
What would you give to a women who had a 2nd degree prolapse but who was strongly against surgery?
Pessary such as a ring
What is a vault prolapse?
After a hysterectomy has been performed the top (vault) of the vagina may bulge down
What is the most common symtpoms of a uterine prolapse?
Feeling of a lump “coming down”
Dragging disccomfort
Backache
How is a uterine prolapse diagnosed?
Vaginal examination
What is the treatment of uterine prolapse in women who want to have children?
Pessary
What kind of prolapse is usually not treated with a pessary?
Posterior wall prolapse
Discuss the surgical options used in the treatment of a cystocele or a rectocele?
Pelvic flow repair. The walls of the vagina are tightened using mesh sewn into the vaginal walls. This is performed vaginally.
Discuss the surgical options used in the treatment of a uterine prolapse?
Sarcocolpopexy
Sacrospinous fixation.
Mainly done by keyhole surgery the uterus if lifted and attached to the sacrum or sacrospinous ligament.
Vaginal hysterectomy
