Urogynae

Question 1

What is overactive bladder syndrome?

Answer 1

Increased frequency and nocturia without incontinence

Question 2

What can continuous incontinence indicate?

Answer 2

Very severe incontinence or a fistula

Question 3

Describe pelvic floor muscle training?

Answer 3

Supervised training involving at least 8 contractions, 3 times a day for a minimum of 3 months

Question 4

When should follow up for all urogynae surgeries be completed?

Answer 4

Within 6 months

Question 5

What is the review period for duloxetine?

Answer 5

2-4 weeks

Question 6

What are the surgical methods for colposuspension?

Answer 6

• Open (bikini line incision, up to 4 days in hospital)
• Laparoscopic (1-2 days in hospital)

Question 7

What is the after care for colposuspension?

Answer 7

• Don’t drive until can comfortably make an emergency stop (usually 3-4 weeks)
• Refrain from sexual activitiy for 4-6 weeks
• Return to light job after 6 weeks
• Return to heavier or busy job after 12 weeks

Question 8

How is autologous rectal fascial sling performed?

Answer 8

Abdominal and vaginal incision + catheter

Question 9

What is the aftercare for rectus fascial sling?

Answer 9

Same as colposuspension

Question 10

How long is bladder retraining done in urge incontinence?

Answer 10

6 weeks, gradually increasing intervals between voiding

Question 11

What are the first line bladder stabilising drugs for urge incontinence?

Answer 11

• Oxybutynin (immediate release)
• Tolterodine (immediate release)
• Darifenacin (once daily preparation)

Question 12

Who should immediate release oxybutynin be avoided in?

Answer 12

Frail older women

Question 13

What is the medical management of urge incontinence in frail elderly women?

Answer 13

Mirabegron (beta-3-agonist)

Question 14

What are the 4th line surgical options for urge incontinenece?

Answer 14

• Botox injection
• Percutaneous tibial nerve stimulation (PTNS) or sacral nerve stimulation (SNS)

Question 15

How long is the course of pelvic floor exercises for vaginal prolapse?

Answer 15

16 weeks

Question 16

What is colpocleisis?

Answer 16

Surgery sewing together the vaginal walls to better support a vault prolapse

Question 17

When would colpocleisis be considered?

Answer 17

If the woman does not want to have penetrative sex or they’re at high surgical risk

Question 18

How often is a vaginal ring pessary changed?

Answer 18

Every 6 months

Question 19

What are the side effects of vaginal ring pessary?

Answer 19

Unpleasant discharge, irritation, UTI, interference with sex (if it’s a shelf pessary)

Question 20

What are the surgical options for uterine prolapse?

Answer 20

• Hysterectomy (+- vaginal sacrospinous fixation)
• Sacro-hysteropexy
• Vaginal sacrospinous hysteropexy
• Manchester repair

Question 21

What is the difference between a sacro-hysteropexy and a vaginal sacrospinous hysteropexy?

Answer 21

Sacro-hysteropexy:
- Uterus is fixed to the sacrum via a mesh or tape

Vaginal sacrospinous hysteropexy:
- Cervix/ uterus is fixed to the sacrospinous ligament using a mesh

Question 22

What is a manchester repair?

Answer 22

Shortening and stitching the cervix to surrounding structures to better support the uterus, not suitable if the woman wishes to have children in the future

Question 23

What are the surgical options for vaginal vault prolapse?

Answer 23

• Vaginal sacrospinous fixation
• Sacrocolpopexy
• Colpocleisis

Question 24

What is the difference between vaginal sacrospinous fixation and sacrocolpopexy?

Answer 24

Vaginal sacrospinous fixation:
- Stitching the top of the vagina to the sacrospinous ligaments

Sacrocolpopexy:
- Using a mesh to attach the top of the vagina to the sacrum

Question 25

Which ligament is the sling attached to in colposuspension?

Answer 25

Cooper’s ligament (pectineal ligament)