Urogyn

Question 1

Oxford score

Answer 1

1-6
1 = no contraction
6 = strong against resistance

Question 2

Vesicovaginal fistula

Answer 2

Post op complication
Obstetric
Radiation

Diagnosis
- MSU 
-Creatinine on fluid in vagina
-Tampon + methylene blue test
-Cystoscopy
-CT IV urogram 
Pelvic MRI 

Want to assess ureters

SURGICAL REPAIR
-Mackenrodt: vaginal approach
Abdo approach
Latzo - foley into fistula, mucosa excised in quadrants, 3 layer closure

Question 3

Urge incontinence

Answer 3

Overactive bladder
-contracting <30mL detrusor
Or any contracing during FILLING

1) Conservative: bladder diary/retraining/vaginal estrogen, modify irritants/meds

2) Medical:
antimuscarinic - oxybuytinin, solifenancin (dry mouth/eyes/constipation/dementia)

b3 agnoist - bitmega, less urinary retention, not funded nz

3)Periperhal tibial nerve stimulation
botox (risk - recurrence, retention, UTI, 6/12ly)
Sacral nerve stimulator

Question 4

Normal urodynamics

Answer 4

NO detrusor rise during filling
<50 during voiding
Peak flow >15mLs

If have detrusor rise during filling = OAB (urge)

Question 5

SUI

Answer 5

Conservative - PFMT, wt loss, 
Vaginal devices - tampon, contiform, ovestin
No meds
Botox/bulkamid
Sling - fascial or TVT
Burch colposuspension

Before proceeding surgery, exclude pathology, confirm diagnosis

Question 6

MUS

Answer 6

Retropubic - bottom to top
–> exit just above pubic symphysis
Higher objective cure rates, no diff retention, infection, less long term pain, easier to remove
Tranobturator sling - outside in or inside out same
–> inguinal gluteal folds

RISKS
Infection, voiding difficulty, fistula, osteitis pubis, nerve injury, OAB

Long term - detrusor overactivity, prolapse, pain, MESH COMPLICATIONS, voiding difficulty, recurrence of symptoms

Question 7

65yo POP w OAB

Answer 7

ACSQHC info document
Phsyio, constipation, caffeine
PVR, topical e2
Pharmacological may worsen
?Occult SUI

Question 8

Managing cystotomy

Answer 8

Cystoscopy, check proximity ureters
Suture 2-3 layers
Consider martius graft
Methylene blue in bladder to ensure watertight
Catheter 2/52
Cystogram prior to IDC removal

Question 9

Mesh controvery/inquiry

Answer 9

Mandatory reporting
Patients cards
Registry all devices
Informed consent
Autralis commission safety resources
Credentialing
Audit 
PReventoin industry incenstive
Post marketing monitoring

Question 10

Complications of mesh

Answer 10

Exposure - visible through vaginal epithelium
Erosion - exposed to adjacent structures (bladder, urethtra,rectum)
Persistent pain
Contraction
Infection
Voiding dysfunction
Fistula formation
Defecatory dysfunction