Urinary Incontinence and Prolapse Flashcards
what are the layers that make up the pelvic floor
pelvic diaphrgam
muscles of perineal pouches
perineal membrane
what muscles make up the pelvic diaphragm?
levator ani
coccygeus
anterior gap between medial borders of pelivc diaphragm allows for?
urogenital hiatus → passage for urethra and vagina
what openings are present in the perineal membrane?
urethra (and vagina in females)
what are the three muscles that form the levator ani?
iliococcygeus
pubococcygeus
puborectalis
is the levator ani relaxed or tense in during urination and defecation?
relaxed
what nerves innervate the levator ani?
pudendal nerve (S2,3,4)
nerve to levator ani
describe a vaginal prolapse?
herniation of urethra, bladder or rectum into vagina
presents as lump in vaginal wall
what is uterine prolapse?
descent of the uterus
can be 1st, 2nd or 3rd degree
how does uterine prolapse present?
dragging sensation, feeling of a lump
urinary incontinence
how can uterine prolapse be repaired?
supraspinous fixation
explain sacrospinous fixation?
sutures plced in sacrospinous ligament and then to cervix or vaginal wall
repairs cervical/vault descent
sacrospinous fixation carries risk to which nerves?
pudendal nerve
sciatic nerve
what surgical option is available for urinary incontinence?
trans-obturator approach
mesh through obturator canal- creates sling around urethra
Name some anti-muscarinic agents used in urinary incontince
Oxybutynin
Tolterodine
Darifenacin
what are the SE’s of antimuscarinic agents?
dry mouth
constipation
blurred vision
how do B3 agonists help manage urinary incontinence?
relaxes bladder smooth muscle through activation of B3 adrenoreceptor
(low intrinsic activity for B1, B2)
what are some additional therpaies for urinary incontince used alongside anitmuscarinics and B3 agonists?
desmopressin
topical oestrogen
botox
augmentation cystoplasty
which drug therapy works by
1) delayed voiding
2) inc storage capacity and decreased voiding frequency
1) antimuscarinics
2) B3 agonists
which drug therapy works by increasing relaxation of detrusor muscle as oppsoed to inhibiting involuntary contractions?
B3 agonists → relaxation of detrusor muscle
antimuscarinics → inhibits involuntary contractions
antimuscarincs work using cholinergic or adrenergic control?
antimuscarinics = cholinergic control (parasympathetic)
B3 agonsits = adrenergic control (sympathetic)
what are anterior, middle and posterior prolapses known as?
anterior- cystocele
middle- enterocele
posterior- retrocele
how are prolpases repaired?
vaginal repair in anterior and middle
vaginal or abdominal repair in posterior
if all compartments prolapse this is known as?
complete eversion
