Urogaenocology Flashcards
Sx cystitis (6)
Freq + nocturia Dysuria Urgency Haematuria Smelly urine Strangury
Sx pyelonephritis (6)
Loin pain Rigors Vomiting Fever Dysuria TachyC
Why is pregnancy is predisposing factor to cystitis?
Progesterone –> marked dilation of calyces, renal pelvis + ureters
VUR occurs >
Why must you treat UTI’s in pregnancy ASAP?
--> premature labour Sepsis Anaemia LBW Incr perinatal morbiidity, mortality
Why are post partum women particularly vulnerable to UTI’s? (3)
Trauma to bladder
Incomplete emptying
Intro of bacteria via catheter
What must be done to women’s urine if post partum and you suspect UTI?
MSU
Ix Upper UTI (5)
Urine dipstick Midsstream MCS USS (scarring/obstruction) CT/IV urography MSU
General advice for Tx UTIs (5)
Drink plenty of fl Wipe - front --> back Don't wear occlusive underwear Do not delay urination D-mannose, cranberry / urine alkalising products
1st line Mx - non-pregnant women - UTI
PO nitrofurantoin - 100mg b.d 3 days
2nd line Mx - non-pregnant women - UTI
Fosfomycin
1st line Mx - pregnant women - UTI
Immediate Abx prescription nitrofurantoin 100mg b.d 7 days
2nd line Mx - pregnant women - UTI
Amoxicillin or cefalexin
Clinical relevance of round ligament - compositino
No mm fibres
Buut lymphatic - spread cancer to vulva
Inn of urinary continence
Pudendal nn S2-4
What are the pelvic floor muscle names (5)
Levator ani
Internal obturator
Piriform mm
Superficial + deep perineal mm
Urethrocoele
Prolapse of urethra into vagina
Cystocoele
Prolapse of upper anterior wall of vagina
Enterocoele
True hernia of the pouch of Douglas
Rectocoele
Weakness in levator ani mm –> bulge in mid post vaginal wall
1st degree uterine descent
If cervix is half way down vagina
2nd degree uterine descent
If cervix reaches vaginal opening
3rd degree uterine descent
If out of body
Where must the bladder neck be in order for a woman to be continent?
Above levator ani muscle
what are the 5 things a woman must have to have urinary continence?
Functioning sphincter Properly positioned bladder neck Thick urethral mucosa Compliant bladder Higher centre control
RF genuine stress incontinence (5)
Increasing age Increasing parity Genital prolapse Postmenopausal status Prev pelvic floor surgery
RF - destrusor instability (5)
Age Hx of nocturnal eneuresis Neurological Hx Previous incontinence surgery Dx Hx
Central neurological causes of voiding difficulties (2)
CVA
PD
Spinal neurological causes of voiding difficulties (2)
SC injury
MS
Peripheral neurological causes of voiding difficulties (2)
Prolapsed IV disc
Peripheral autonomic neuropathy
Which places are the ureters most commonly damaged following hysterectomy?
Segment closest to bladder + in pelvis (distal 1/3 ureter)
Congenital causes of genital prolapse (2)
Spina bifida
Connective tissue disorder
Acquired causes of genital prolapse
Obstetric factors
PM atrophy
Chronically raised IAP
Iatrogenic
q to ask - stress incontinence
Do you leak when you cough/sneeze?
q to ask - urge incontinence
Do you struggle to get to the toilet in time?
q to ask - dribbling incontinence?
Is it coming out all the time?
What is a red flag with urinary incontinence?
Haematuria
What is the key phrase with prolapse
Something coming down/dragging
PS cystocoele
UTI
Have to pee uphill
NO haematuria
PS uterine prolapse
Pain on sex
Back ache
Lower abdo dragging pain
No PMB
PS rectocoele
Constipation
Digitation
No rectal bleeding or tenesmus
Obstetric factors - prolapse (5)
Prolonged labour Precipitate labour Instrumental delivery Fetal macrosomia Incr parity
Which 2 drugs should you think about when pt has affected destrusor function
AntiD - Imipramine
Major tranqs
Ix - urinary continence
Urodyanmics - mainstay
Cystoscopy
If suspect fistula - radio + dye
Complications urinary incontinence (3)
Psychological issues
Excoriation/soreness bulba
Overdistention bladder –> denervation + necrosis detrusor mm
Ix prolapse
MSU
Urodtamics
Conservative Mx - stress incontinence (4)
Decr wt
Stop smoking/address chronic cough
Decr fl intake if excessive
Pelvic floor mm training
Medical Mx stress incontinence
Duloxetine
Injectable periurethral bulking agents
Surgical Mx stress incontinence
TVT
TOT
(mid-urethral sling procedure)
What is TVT
Tension-free vaginal tape
tape in U shape under mid-urethra
Tension adjusted to prevent leakage
minimally invasive
What is TOT
Trans-obturator tape
Benefit TOT over TVT
TOT - < chance bladder perf
Conservative Mx - destrusor instability (3)
Decr fl/avoid caffiene
Review meds
Bladder training
Medical Mx - destrusor instability
Anticholinergics
oestrogens
Botulinum toxin A
Surgical Mx destrusor instability
Clam augementation ileocystoplasty
Mx - prolapse prevention
early recognition obstructed labour
Avoid long 2nd stage labour
Pelvic floor exercises post birth
Tx - prolapse
Lose weight
Stop smoking
Physiotherapy
Pessaries
Risks - pessaries (4)
Ulceration
Painful
Urinary retention
Fall out
Apical/uterine prolapse - surgical Mx (2)
Vaginal hysterectomy
Hysteropexy
Vaginal vault prolapse - surgical Mx (2)
Sacrocolpopexy
Sacrospinous fixation
Vaginal wall prolapse - surgical Mx
Colporrhapy - anterior for cystoecoele
Posterior for rectocoele
