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urogyn Flashcards

1
Q

prevalence of bladder pain syndrome

A

2.3-6.5%

RCOG GTG 70. Management of bladder pain syndrome. BJOG 2016; 124: e46–e72.

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2
Q

ratio of BPS in women vs men

A

2-5x more common in women

RCOG GTG 70. Management of bladder pain syndrome. BJOG 2016; 124: e46–e72.

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3
Q

BPS: voiding relieves in pain in ___%

A

57-73%

RCOG GTG 70. Management of bladder pain syndrome. BJOG 2016; 124: e46–e72.

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4
Q

BPS: stress aggravates pain in ___%

A

61%

RCOG GTG 70. Management of bladder pain syndrome. BJOG 2016; 124: e46–e72.

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5
Q

BPS: sex aggravates pain in ___%

A

50%

RCOG GTG 70. Management of bladder pain syndrome. BJOG 2016; 124: e46–e72.

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6
Q

BPS: constrictive clothing aggravates pain in ___%

A

49%

RCOG GTG 70. Management of bladder pain syndrome. BJOG 2016; 124: e46–e72.

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7
Q

BPS: foods that aggravate pain and percentages

A

Acidic beverages 54%
Coffee 51%
Spicy foods 46%

RCOG GTG 70. Management of bladder pain syndrome. BJOG 2016; 124: e46–e72.

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8
Q

BPS: overall, pain worsened with certain food or drink, bladder filling and improved with voiding in ___% of patients

A

97%

RCOG GTG 70. Management of bladder pain syndrome. BJOG 2016; 124: e46–e72.

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9
Q

BPS: 12% of women have history of ____

A

chlamydia

RCOG GTG 70. Management of bladder pain syndrome. BJOG 2016; 124: e46–e72.

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10
Q

BPS: detrusor overactivity present in ____% of BPS patients

A

14%

RCOG GTG 70. Management of bladder pain syndrome. BJOG 2016; 124: e46–e72.

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11
Q

BPS management: dietary modification improved ___%

A

87.6%

RCOG GTG 70. Management of bladder pain syndrome. BJOG 2016; 124: e46–e72.

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12
Q

BPS management: relaxation improved

A

7 6.4%

RCOG GTG 70. Management of bladder pain syndrome. BJOG 2016; 124: e46–e72.

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13
Q

BPS: 2nd line management

A

AFTER FAILED PRIMARY CARE
PO amitryptiline 10-100mg over 4 months
PO cimetidine 400mg over 3 months

RCOG GTG 70. Management of bladder pain syndrome. BJOG 2016; 124: e46–e72.

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14
Q

BPS: 3rd line management

6 main points

A

AFTER MDT

1) Lidocaine - 5 day course 200mg, 30% improvement
2) Hyaluronic acid 4-10 weeks
3) Botox
4) DMSO two sessions per week x 2 weeks
5) 10 000 units heparin x 3 months
6) 2% chondroitin sulfate

RCOG GTG 70. Management of bladder pain syndrome. BJOG 2016; 124: e46–e72.

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15
Q

BPS: % of women requiring ISC after botox treatment

A

7%

RCOG GTG 70. Management of bladder pain syndrome. BJOG 2016; 124: e46–e72.

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16
Q

BPS: 4th line management

5 main points

A
  1. cystoscopic fluguration
  2. neuromodulaiton
  3. oral cyclosporin A
  4. cystoscopy +/- hydrodistention
  5. major surgery

RCOG GTG 70. Management of bladder pain syndrome. BJOG 2016; 124: e46–e72.

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17
Q

BPS: do not do

A
  • PO Hydroxyzine
  • PO pentosan polysulfate
  • Longterm abx
  • Intravesical resinferation
  • Intravesical BCG
  • High pressure/long duration hydrodistention
  • long-term PO steroids

RCOG GTG 70. Management of bladder pain syndrome. BJOG 2016; 124: e46–e72.

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18
Q

incidence of vault prolapse

A

0.2-43%

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19
Q

incidence of vault prolapse requiring surgical repair

A

6-8%

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20
Q

Prolapse stage: most distal point >cm above hymen

A

stage 1

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21
Q

prolapse stage: most distal point between 1cm above and 1 cm below hymen

A

stage 2

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22
Q

prolapse stage: most distal point >1cm below hymen by <2cm of TVL

23
Q

prolapse stage: leading edge equal or greater than TVL; or <2cm still above hymen

24
Q

prevention of vault prolapse during VH

A

McCall culdoplasty or SSF

25
Q

prevention of vault prolapse during TAH or VH

A

suturing of cardinal and uterosacral ligaments to cuff

26
Q

prevention of vault prolapse at VH if vault descends to introitus

27
Q

primary POP repair: at 6y, what % will have leakage

28
Q

primary POP repair: at 6y, what % will have bulge

29
Q

primary POP repair, at 6y what % will have fecal incontinence

30
Q

PHVP - first line management for stage I-II

A

pelvic floor muscle training

31
Q

PVHP - first line management for stage III-IV

A

vaginal pessaries

32
Q

PVHP - when to offer surgical treatment

A

if symptomatic

33
Q

PVHP - first line surgical option

A

abdominal sacrocolpoplexy (78-100%)

34
Q

PVHP - recurrent vault prolapse

35
Q

PVHP - risk of sexual dysfunction and short vaginal length

36
Q

urinary incontinence overall prevalence

A

25% of women

after menopause, 50%

37
Q

urinary incontinence: breakdown of types

A

49% stress
29% mixed
22% OAB

38
Q

pelvic floor training for UI

A

3 months, 8 contractions 3x per day

39
Q

pelvic floor training for prolapse

40
Q

OAB: follow-up schedule if starting anitcholinergics

A

4 weeks
then 12/12 at GP if established
or 6/12 if >75yo

41
Q

anticholinergics contraindicated in:

A 
myasthenia gravis
UC
toxic megacolin
GI or bladder obstruction
Dementia
42
Q

SUI: surgical options

A

ALL MUST BE AGREED AT MDT

1) colposuspension = gold standard
2) autologous rectus fascial sling
3) intramural bulking agents

43
Q

SUI: medication option

A

duloxetine (SNRI):
increases urethral sphincter tone
56% reduction in incontinence
17-22% discontinuation rate (usually due to nausea, but resolves 1 month in 88%)

44
Q

OAB: botox options

A

1) 100 units
2) review in 12 weeks
3) increase to 200 units if inadequate

45
Q

anticholinergics for OAB:

A

oxybutinin
tolteridone
darifenacin
trospium

46
Q

do not use these anticholinergics for OAB

A

flavoxate
propantheline
imipramine

47
Q

colposuspension: urge or urge UI

48
Q

colposuspension: exacerbation of recto-enterocele

49
Q

colposuspension: dyspareunia

50
Q

symptomatic women with + leukocytes and + nitrites

A

prescribe abx

51
Q

symptomatic women with - leukocytes/nitrites

A

consider abx

52
Q

asymptomatic women with + leukocytes and nitrites

A

do not give abx, await C+S

53
Q

OAB first line

A

bladder retraining 6 weeks

part 2 (21 decks)

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