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Gynae > Urogynae > Flashcards

Urogynae Flashcards

1
Q

What are the different types of incontinence

A

Stress- leak after coughing etc
Urge- bladder suddenly feels full and then leak
Mixed- combination of stress and urge
Functional- due to dementia, immobility etc
Overflow- from bladder outlet obstruction

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2
Q

Risk factors for incontinence

A

Multiple pregnancies
Obese
Fhx
Hysterectomy
Age

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3
Q

What is urge incontinence the same as

A

Overactive bladder

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4
Q

What causes OAB/urge incontinence

A

Detrusor overactivity

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5
Q

How should incontinence be investigated

A

Bladder diary for 3 days
Vaginal exam to assess for organ prolapse and ability yo initiate contraction of pelvic floor muscles
Dipstick

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6
Q

If in investigation for incontinence dipstick comes back positive for leukocytes and nitrites what do

A

Treat for UTI
Take MSU

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7
Q

If in investigation for incontinence dipstick comes back negative for leukocytes and nitrites but symptoms indicative what do

A

Treat UTI
Take MSU

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8
Q

Management of incontinence

A

Recommend less fluids and caffeine
Ascertain whether urge, stress or if mixed what is the predominant one
If stress, pelvic contractions 3x a day with 8 contractions for 3 months
If urge/predominant, bladder training for 6 weeks

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9
Q

Management of stress incontinence

A

Pelvic floor training for 3months, 3x a day 8 contractions
Second line- offer surgical options. First line colposuspension or autologous rectal fascial sling
If decline these or not appropriate then offer duloxetine

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10
Q

MOA of duloxetine

A

Combined noradrenaline and SSRI
Increased firing of pudendal nerve which stimulates muscle in the sphincter

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11
Q

Surgical options for stress incontinence

A

Colposuspension- lift neck of bladder up and stitch it
Retro-pubic mid-urethral mesh sling- sling is placed behind the urethra to lift it up
Autologous rectus fascial sling- sling is placed behind the urethra to lift it up made out of tissue from abdominal fascia

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12
Q

Management of urge incontinence

A

First line- bladder training for 6 weeks
Second line- anti-muscarinics like oxybutinin unless frail and old
If oxybutynin CI then use mirabregon a beta 3 agonist

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13
Q

Why cant use oxybutynin in an old frail person

A

Cognitive impacts

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14
Q

How can incontinence be further investigated

A

Urodynamic testing

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15
Q

Causes of overflow incontinence in a woman

A

Neurogenic from DM
Alcoholics
Surgery to pelvic area

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16
Q

In who are urine dips useless

A

Over 65
Catheter

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17
Q

When are urodynamic studies indicated

A

Diagnostic uncertainty or pre surgery

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18
Q

When are vesicovaginal fistulas suggested

A

Prolonged labour
Recent childbirth
Coming from a country with poor obstetric services
Lots of pelvic surgeries

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19
Q

How are vesicovaginal fistulas investigated

A

Urinary dye studies

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20
Q

Presentation of prolapses

A

Sensation of heaviness
Urinary sx- incontinence, frequency, urgency

21
Q

What happens in vaginal vault prolapse

A

Top half of vagina falls down- common after hysterectomy

22
Q

How does bartholins cyst present

A

Posterior labia mass
Redness around the area
Discomfort while walking or having sex

23
Q

How are bartholins cysts managed

A

If symptomatic then marsupalisation which involves drainage and suturing inner wall of bartholins gland to the skin

24
Q

Second line for a bartholins cyst

A

Surgical excision of bartholins gland however can lead to vulvar dryness and itching

25
Q

What is a sitz bath

A

A shallow warm bath

26
Q

What are the types of prolapse

A

Cystocele
Rectocele
Uterine prolapse

27
Q

What is first line management of symptomatic organ prolapses

A

Lifestyle including losing weight
Physiotherapy for 16 weeks
Can assess if need vaginal oestrogen for vaginal dryness

28
Q

Second line for symptomatic organ prolapses

A

Ring pessary

29
Q

Surgical management of cystocele

A

Anterior wall repair (anterior colporrhaply)

30
Q

Surgical management of rectocele

A

Posterior wall repair (posterior colporrhaply)

31
Q

Surgical management options for uterine prolapse

A

Manchester repair- shorten cervix
Vaginal hysterectomy
Vaginal sacrospinous hysteropexy- attaches cervix to sacrospinal ligament
Sacro hysteropexy- attach uterus to sacral bone

32
Q

How can cystocele present

A

Urinary symptoms
Recurrent UTIs
Fullness feeling

33
Q

How can rectocele present

A

Problems defaecating
Sense of fullness
Feeling of not fully emptying bowels

34
Q

Most common incontinence in women

A

Stress

35
Q

How are prolapses classified

A

Pelvic organ prolapse quantification
1- descent of uterus and cervix but doesnt reach introitus
2- cervix reaches introitus
3- protrusion outside of vagina
4- complete prolapse which may lead to cervical ulceration

36
Q

What is a urethrocele

A

When get descent of anterior part of vagina which attaches to urethra

37
Q

Operations for vaginal vault prolapse

A

Sacrocolpopexy with mesh
Vaginal sacrospinous fixation with sutures

38
Q

What is management of bartholins abscess

A

Abx- doxycycline
Marsupialisation

39
Q

What are non-surgical interventions for urge incontinence

A

Botulinum A toxin injection however need self catheterisation
Percutaneous sacral nerve stimulation

40
Q

What position on vagina are bartholins cysts

A

4 and 8 o’clock

41
Q

How are suspected prolapses examined

A

With Sims speculum

42
Q

When operate on a prolapse immediately

A

If very symptomatic and severe

43
Q

In developed world what is most common cause of vesicovaginal fistulas

A

Pelvic surgeries

44
Q

Cause of urine coming from the vagina

A

Vesico-vaginal fistula

45
Q

Difference between enterocele and rectocele on examination

A

Rectocele if do a digital exam the finger will protrude against the vaginal wall

46
Q

If frail and old what use after bladder retraining in urge incontinence

A

Non-oxybutynin anticholinergic like tolterodine or mirabregon

47
Q

Most suitable operation for uterine prolapse if wanting to perserve fertility

A

Vaginal sacrospinous hysteropexy or sacro hysteropexy

48
Q

What do for asymptomatic bartholins cysts

A

Warm compress and sitz baths

49
Q

Incontinence when is burning on urinating and pallor of vulva

A

Vaginal atrophy

Gynae (11 decks)

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