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Y3 OBS AND GYNAE > Urinary Incontinence and Prolapse > Flashcards

Urinary Incontinence and Prolapse Flashcards

1
Q

What are the 3 main categories of pelvic floor disorders?

A

Urinary incontinence
Pelvic organ prolapse
Anal incontinence

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2
Q

List the 4 main types of urinary incontinence

A

Stress
Urge
Overflow or OAB
Mixed

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3
Q

List risk factors for urinary incontinence

A 
Being female
Increasing age
Parity (vaginal delivery)
Obesity
Obstetric History
Menopause
UTI 
Family history
Smoking
Kidney disease
Diabetes
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4
Q

What is stress incontinence?

A

Leakage of urine on exertion as the urethra is not supported

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5
Q

When does stress incontinence occur?

A

Sudden movements or increases in intrabdominal pressure

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6
Q

Stress incontinence does not involve urgency. True/False?

A

True

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7
Q

What is urinary urgency?

A

Sudden compelling desire to pass urine that is difficult to resist

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8
Q

What is urge incontinence?

A

Leakage and immediately preceded by urgency (sudden compelling desire to urinate)

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9
Q

Does involuntary urine leakage occur in urge incontinence?

A

Yes

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10
Q

What is mixed incontinence?

A

Leakage associated with both urgency and stress

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11
Q

What is overflow incontinence?

A

Urgency +/- incontinence due to chronic urinary retention (bladder outflow obstruction)

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12
Q

How is overactive bladder different from stress incontinence?

A

OAB involves involuntary detrusor contraction; stress can be caused by pressure or urethral hypermotility

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13
Q

When is overactive bladder dry and when is it wet?

A

Wet when urge incontinence is present, dry when it is not

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14
Q

What specific symptom do patients often complain about with overflow incontinence?

A

Frequency

Nocturia

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15
Q

List symptoms to ask about in urinary incontinence

A

Storage (frequency, nocturia, urgency, incontinence)
Incontinence (exacerbating factors, timing, volume)
Voiding (hesitancy, straining, poor flow)
Post-micturation (dribbling, incomplete emptying)

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16
Q

List other important features of the history to ask about in urinary incontinence

A

PMHx (prolapse, DM, fistula)
Obstetric history
DHx (bladder stimulants, psychoactive meds)
SHx (sex, diet)

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17
Q

How can incontinence be tested for on examination?

A

General: BMI, age, cognitive assessment
Abdominal: masses, pain
Vaginal: atrophy, prolapse, incontince (‘cough’)
PR: masses, tone

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18
Q

Atrophy of the vagina is typically due to…

A

Menopause

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19
Q

How can incontinence be investigated?

A 
Bladder diary for 3 days
Urinalysis (UTI, blood)
Post void residual
Urodynamics (catheter in rectum and bladder)
Cystoscopy (tumour, stones)
Imaging (kidney, bladder)
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20
Q

What is classified as a normal amount of urine to void a day?

A

Less than 8 times a day

Less than 2800 ml a day

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21
Q

What does cystometry measure?

A

Pressure-volume relationship of the bladder during filling, provocation and voiding

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22
Q

List the spectrum of treatments for overactive bladder, from least to most invasive

A 
Lifestyle advice
Bladder retraining (6 weeks)
Pelvic floor exercises/physio (3 months)
Drugs
Botulinum toxin
Neuromodulation
Reconstructive surgery
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23
Q

List lifestyle advice given in OAB

A 
Remove bladder stimulants (caffeine, alcohol)
Fluid intake (1.5-2.5l)
Weight loss (BMI <30)
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24
Q

Which drug class is the most commonly used for overactive bladder? Name the most used agents

A

Antimuscarinics

Oxybutynin, tolterodine, darifenicin

25
Q

What is the mode of action of antimuscarinics? When should they be reviewed?

A

Reduce intravesical pressure
Iincreasing volume threshold for micturation
Reduces uninhibited contractions
After 4-6 weeks

26
Q

List side effects of antimuscarinics

A 
Dry mouth
Constipation
Blurred vision
Somnolence
Confusion
Dementia
27
Q

What drug class can help relax the bladder? Give an example

A

B3 adrenoceptor agonist

Mirabegron

28
Q

What is the mode of action of B3 agonists?

A

Relaxes bladder by targeting B3 receptor
Increase voiding interval
Inhibit spontaneous bladder contractions

29
Q

List other options for management in OAB

A 
Desmopressin
Topical oestrogen
Botox (short-term)
Percutaneous sacral nerve stimulation
Augmentation cystoplasty
30
Q

What symptom can be managed well with desmopressin in OAB?

A

Nocturia

31
Q

List conservative options for management of stress incontinence

A

Weight loss
Physiotherapy
Incontinence pessary (rubber around urethra)
Bladder neck bulking agents (fillers around bladder)
Medication

32
Q

What surgical methods can be used for stress incontinence?

A

Low-tension vaginal tape
Colposuspension (laparotomy)
Autologous sling (laparatomy)

33
Q

Which drug can be used for stress incontinence?

A

Duloxetine

34
Q

What percentage of parous women develop a pelvic organ prolapse?

A

50%

35
Q

Which part of the vaginal wall does a cystocele come from? Which organ is involved?

A

Anterior

Bladder

36
Q

Which part of the vaginal wall does a enterocele come from? Which organ is involved?

A

Middle/Apical

Uterus/vault

37
Q

Which part of the vaginal wall does a rectocele come from? Which organ is involved?

A

Posterior

Bowel

38
Q

List risk factors for pelvic organ prolapse

A 
Age
Parity
Mode of delivery
Pelvic surgery
Menopause status
Obesity
Neurological disease
Chronic constipation/coughing/heavy lifting
Uterine fibroids
Connective tissue disorders (marfans, EDS)
39
Q

List symptoms to ask about in pelvic prolapse

A 
Prolapse (pressure, dragging)
Storage (frequency, urgency)
Incontinence (timing, volume)
Voiding (hesitance, straining)
Post-micturation (incomplete emptying)
Bowel (incomplete emptying)
Sexual dysfunction
40
Q

List a part of the history that is important to ask about in pelvic prolapse

A

Obstetric history

41
Q

How does a cystocele present?

A

Bulging pressure
Difficult voiding, incomplete bladder emptying
Urgency incontinence
Stress incontinence

42
Q

How does a uterine prolapse present?

A 
Dragging
Back pain
Mass
Difficulty inserting/ retaining tampon
Dyspareunia
43
Q

How does a rectocele present?

A

Bulging pressure
Difficulty emptying
Digitation
Difficulty voiding, incomplete emptying

44
Q

What is a complete eversion?

A

All compartments turned inside-out

45
Q

How are pelvic prolapses classified?

A

1st degree: in vagina
2nd degree: at interiotus
3rd degree: outside vagina
Procidentia: completely outside vagina

46
Q

What is the POP-Q system?

A

Pelvic organ prolapse quantification system

Measure each site of prolapse in relation to hymenal ring: if above hymen, -ve, if below hymen, +ve

47
Q

How is pelvic prolapse investigated?

A

USS
MRI
Anorectal manometry
Endoanal USS

48
Q

List conservative management options for pelvic prolapse

A

Weight loss
Pelvic floor exercises (3 months)
Improve constipation
Vaginal pessary

49
Q

What should be given if someone has pelvic prolapse with atrophic vaginitis?

A

Oestrogen

50
Q

What type of vaginal pessary is more suitable for young women who are sexually active?

A

Patient managed pessary

e.g. cube

51
Q

What type of vaginal pessary is more suitable for elderly women?

A

Permanent pessary
Change every 6 months
e.g. ring, shelf, gelhorn

52
Q

List common complications of vaginal pessaries

A

Failure
Discomfort
Discharge

53
Q

How can pelvic prolapse be managed surgically?

A

Pelvic floor repair (anterior or posterior)
Sacrospinous fixation (apical)
Calpocliesis (apical, close open vagina)
Sacrohysteropexy (laparoscopic/open, abdominal)

54
Q

What is calpocliesis?

A

Procedure involving closure of vagina

55
Q

What is sacrohysteropexy?

A

Resuspension of the prolapsed uterus by attaching it to the sacrum using a strip of synthetic mesh to lift the uterus and hold it in place

56
Q

List features of pelvic floor dysfunction

A

Incontinece of urine or faeces
Difficulty with defaecation
Chronic pain
Prolapse

57
Q

List types of chronic pain associated with pelvic floor dysfunction

A

Vulvodynia (burning or irritation in vulvar area)
Vaginismus (involuntary spams prevent penetration)
Pelvic pain

58
Q

Which grading sytem is used to determine pelvic floor muscle function and strength?

A 
Oxford grading system
0 - no contraction
1 - flicker
2 - weak squeeze, no lift
3 - fair squeeze, definite lift
4 - good squeeze with lift
5 - strong squeeze with a lift
59
Q

What is biofeedback training?

A

Computer-based technique, using a translabial or abdominal ultrasound
Help strengthens urethral and anal sphincter muscles and pelvic floor muscles and help gain control over the bladder

Y3 OBS AND GYNAE (44 decks)

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