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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
prevention of vault prolapse during TAH or VH
suturing of cardinal and uterosacral ligaments to cuff
26
prevention of vault prolapse at VH if vault descends to introitus
SSF
27
primary POP repair: at 6y, what % will have leakage
41%
28
primary POP repair: at 6y, what % will have bulge
18%
29
primary POP repair, at 6y what % will have fecal incontinence
15%
30
PHVP - first line management for stage I-II
pelvic floor muscle training
31
PVHP - first line management for stage III-IV
vaginal pessaries
32
PVHP - when to offer surgical treatment
if symptomatic
33
PVHP - first line surgical option
abdominal sacrocolpoplexy (78-100%)
34
PVHP - recurrent vault prolapse
MDT
35
PVHP - risk of sexual dysfunction and short vaginal length
SSF
36
urinary incontinence overall prevalence
25% of women | after menopause, 50%
37
urinary incontinence: breakdown of types
49% stress 29% mixed 22% OAB
38
pelvic floor training for UI
3 months, 8 contractions 3x per day
39
pelvic floor training for prolapse
16 weeks
40
OAB: follow-up schedule if starting anitcholinergics
4 weeks then 12/12 at GP if established or 6/12 if >75yo
41
anticholinergics contraindicated in:
``` myasthenia gravis UC toxic megacolin GI or bladder obstruction Dementia ```
42
SUI: surgical options
ALL MUST BE AGREED AT MDT 1) colposuspension = gold standard 2) autologous rectus fascial sling 3) intramural bulking agents
43
SUI: medication option
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
OAB: botox options
1) 100 units 2) review in 12 weeks 3) increase to 200 units if inadequate
45
anticholinergics for OAB:
oxybutinin tolteridone darifenacin trospium
46
do not use these anticholinergics for OAB
flavoxate propantheline imipramine
47
colposuspension: urge or urge UI
up to 17%
48
colposuspension: exacerbation of recto-enterocele
14%
49
colposuspension: dyspareunia
1/20-25
50
symptomatic women with + leukocytes and + nitrites
prescribe abx
51
symptomatic women with - leukocytes/nitrites
consider abx
52
asymptomatic women with + leukocytes and nitrites
do not give abx, await C+S
53
OAB first line
bladder retraining 6 weeks

part 2 (21 decks)

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