Urinary Incontinence and Prolapse

Question 1

what are the layers that make up the pelvic floor

Answer 1

pelvic diaphrgam

muscles of perineal pouches

perineal membrane

Question 2

what muscles make up the pelvic diaphragm?

Answer 2

levator ani

coccygeus

Question 3

anterior gap between medial borders of pelivc diaphragm allows for?

Answer 3

urogenital hiatus → passage for urethra and vagina

Question 4

what openings are present in the perineal membrane?

Answer 4

urethra (and vagina in females)

Question 5

what are the three muscles that form the levator ani?

Answer 5

iliococcygeus

pubococcygeus

puborectalis

Question 6

is the levator ani relaxed or tense in during urination and defecation?

Answer 6

relaxed

Question 7

what nerves innervate the levator ani?

Answer 7

pudendal nerve (S2,3,4)

nerve to levator ani

Question 8

describe a vaginal prolapse?

Answer 8

herniation of urethra, bladder or rectum into vagina

presents as lump in vaginal wall

Question 9

what is uterine prolapse?

Answer 9

descent of the uterus

can be 1st, 2nd or 3rd degree

Question 10

how does uterine prolapse present?

Answer 10

dragging sensation, feeling of a lump

urinary incontinence

Question 11

how can uterine prolapse be repaired?

Answer 11

supraspinous fixation

Question 12

explain sacrospinous fixation?

Answer 12

sutures plced in sacrospinous ligament and then to cervix or vaginal wall

repairs cervical/vault descent

Question 13

sacrospinous fixation carries risk to which nerves?

Answer 13

pudendal nerve

sciatic nerve

Question 14

what surgical option is available for urinary incontinence?

Answer 14

trans-obturator approach

mesh through obturator canal- creates sling around urethra

Question 15

Name some anti-muscarinic agents used in urinary incontince

Answer 15

Oxybutynin

Tolterodine

Darifenacin

Question 16

what are the SE’s of antimuscarinic agents?

Answer 16

dry mouth

constipation

blurred vision

Question 17

how do B3 agonists help manage urinary incontinence?

Answer 17

relaxes bladder smooth muscle through activation of B3 adrenoreceptor

(low intrinsic activity for B1, B2)

Question 18

what are some additional therpaies for urinary incontince used alongside anitmuscarinics and B3 agonists?

Answer 18

desmopressin

topical oestrogen

botox

augmentation cystoplasty

Question 19

which drug therapy works by

1) delayed voiding
2) inc storage capacity and decreased voiding frequency

Answer 19

1) antimuscarinics
2) B3 agonists

Question 20

which drug therapy works by increasing relaxation of detrusor muscle as oppsoed to inhibiting involuntary contractions?

Answer 20

B3 agonists → relaxation of detrusor muscle

antimuscarinics → inhibits involuntary contractions

Question 21

antimuscarincs work using cholinergic or adrenergic control?

Answer 21

antimuscarinics = cholinergic control (parasympathetic)

B3 agonsits = adrenergic control (sympathetic)

Question 22

what are anterior, middle and posterior prolapses known as?

Answer 22

anterior- cystocele

middle- enterocele

posterior- retrocele

Question 23

how are prolpases repaired?

Answer 23

vaginal repair in anterior and middle

vaginal or abdominal repair in posterior

Question 24

if all compartments prolapse this is known as?

Answer 24

complete eversion

Question 25

how is prolpase qauntified?

Answer 25

Pelvic Organ Prolapse Quantification System (POP-Q)

Question 26

how many sites are tested for POP-Q with the patient straining and at rest?

Answer 26

straining- 6 sites tested

rest- 3 sites tested

Question 27

each site tested in POP-Q is measured in relation to what?

Answer 27

hymenal ring

above= -ve number

below = +ve number

Question 28

what are the 5 stages of prolapse?

Answer 28

Stage 0 → no prolpase

Stage I → 1cm above hymen

Stage II → -1cm and +1cm in relation to hymen

Stage III → >1cm beond hymen

Stage IV → compete vaginal eversion

Question 29

other than surgery what is amore conservative management of prolapse?

Answer 29

pessaries

Question 30

who qualifies to use a pessarie?

Answer 30

mild to moderate prolapse

family not complete

patient request

Question 31

what are complications of pessaries?

Answer 31

discharge

ulcerations

fibrous bands

Question 32

how often must pessaries be changed?

Answer 32

6 months