urogyn Flashcards
prevalence of bladder pain syndrome
2.3-6.5%
RCOG GTG 70. Management of bladder pain syndrome. BJOG 2016; 124: e46–e72.
ratio of BPS in women vs men
2-5x more common in women
RCOG GTG 70. Management of bladder pain syndrome. BJOG 2016; 124: e46–e72.
BPS: voiding relieves in pain in ___%
57-73%
RCOG GTG 70. Management of bladder pain syndrome. BJOG 2016; 124: e46–e72.
BPS: stress aggravates pain in ___%
61%
RCOG GTG 70. Management of bladder pain syndrome. BJOG 2016; 124: e46–e72.
BPS: sex aggravates pain in ___%
50%
RCOG GTG 70. Management of bladder pain syndrome. BJOG 2016; 124: e46–e72.
BPS: constrictive clothing aggravates pain in ___%
49%
RCOG GTG 70. Management of bladder pain syndrome. BJOG 2016; 124: e46–e72.
BPS: foods that aggravate pain and percentages
Acidic beverages 54%
Coffee 51%
Spicy foods 46%
RCOG GTG 70. Management of bladder pain syndrome. BJOG 2016; 124: e46–e72.
BPS: overall, pain worsened with certain food or drink, bladder filling and improved with voiding in ___% of patients
97%
RCOG GTG 70. Management of bladder pain syndrome. BJOG 2016; 124: e46–e72.
BPS: 12% of women have history of ____
chlamydia
RCOG GTG 70. Management of bladder pain syndrome. BJOG 2016; 124: e46–e72.
BPS: detrusor overactivity present in ____% of BPS patients
14%
RCOG GTG 70. Management of bladder pain syndrome. BJOG 2016; 124: e46–e72.
BPS management: dietary modification improved ___%
87.6%
RCOG GTG 70. Management of bladder pain syndrome. BJOG 2016; 124: e46–e72.
BPS management: relaxation improved
7 6.4%
RCOG GTG 70. Management of bladder pain syndrome. BJOG 2016; 124: e46–e72.
BPS: 2nd line management
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.
BPS: 3rd line management
6 main points
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.
BPS: % of women requiring ISC after botox treatment
7%
RCOG GTG 70. Management of bladder pain syndrome. BJOG 2016; 124: e46–e72.
BPS: 4th line management
5 main points
- cystoscopic fluguration
- neuromodulaiton
- oral cyclosporin A
- cystoscopy +/- hydrodistention
- major surgery
RCOG GTG 70. Management of bladder pain syndrome. BJOG 2016; 124: e46–e72.
BPS: do not do
- 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.
incidence of vault prolapse
0.2-43%
incidence of vault prolapse requiring surgical repair
6-8%
Prolapse stage: most distal point >cm above hymen
stage 1
prolapse stage: most distal point between 1cm above and 1 cm below hymen
stage 2