Urogynae Flashcards
Before OAB treatment, discuss with women that they may not see the full benefits until they have been taking them for
a) 3 weeks
b) 4 weeks
c) 5 weeks
d) 6 weeks
e) 8 weeks
B - 4 weeks
B - urine dip
(First thing to do and act on when patient is in front of you in clinic)
A - send MSU
URINE DIP RULES
With symptoms
- Urine dip positive ⟶ Antibiotics + MSU
- Urine dip negative ⟶ MSU + Consider Abx pending results
Without symptoms
- Urine dip positive ⟶ MSU only
- Recurrent: consider if recurrent or u
- Microscopic would be >= 60
Bladder Cancer
more or = 45 years old
- Visible haematuria (unexplained, without UTI) ⟶ 2ww
- Visible haematuria that persists after UTI treatment ⟶ 2ww
more or = 60 years old
- unexplained microscopic haematuria + dysuria OR raised WCC ⟶ 2ww
- Consider if recurrent or persistent unexplained UTI (non-urgent referral)
Renal Cancer
- Unexplained visible haematuria without UTI
- Visible haematuria that persists after UTI treatment
A 47-year-old woman presents to urogynaecology clinic with a third episode of visible haematuria lasting for over a week. She attended her GP on the first two occasions and completed one course of antibiotics after each visit. Today, urine dip is negative for leucocytes and nitrates. What is the most important next step in management:
a) CTKUB
b) Abdominal ultrasound
c) MSU
d) Urgent referral to urology (2 week wait)
e) Repeat course of antibiotics
D
RED FLAGS
Bladder Cancer
more or = 45 years old
- Visible haematuria (unexplained, without UTI) ⟶ 2ww
- Visible haematuria that persists after UTI treatment ⟶ 2ww
more or = 60 years old
- unexplained microscopic haematuria + dysuria OR raised WCC ⟶ 2ww
- Consider if recurrent or persistent unexplained UTI (non-urgent referral)
Renal Cancer
- Unexplained visible haematuria without UTI
- Visible haematuria that persists after UTI treatment
A 61-year-old woman attends urogynaecology clinic to review her symptoms of mixed urinary incontinence after a course of supervised pelvic floor exercise. She has a history of 4 previous vaginal deliveries, well-controlled hypertension and is an ex-smoker. She has noticed some improvement on her stress incontinence symptoms, but reports that her symptoms of dysuria persist. Urine dip today shows ++ blood, no leucocytes and no nitrates. When reviewing her notes, you notice that two of her previous MSUs were negative. What is the most important step in management?
a) Empirical course of antibiotics
b) Urodynamics
c) Urgent referral to urology (2ww)
d) Repeat MSU
e) Start oxybutinin
C
RED FLAGS
Bladder Cancer
more or = 45 years old
- Visible haematuria (unexplained, without UTI) ⟶ 2ww
- Visible haematuria that persists after UTI treatment ⟶ 2ww
more or = 60 years old
- unexplained microscopic haematuria + dysuria OR raised WCC ⟶ 2ww
- Consider if recurrent or persistent unexplained UTI (non-urgent referral)
Renal Cancer
- Unexplained visible haematuria without UTI
- Visible haematuria that persists after UTI treatment
A 42-year-old woman attends urogynae clinic with a symptoms consistent with an overactive bladder. She is a P1, with a previous caesarean delivery, and usually healthy. She takes no regular medication, except for over the counter supplements. More recently, her symptoms have worsened and she is experiencing dysuria and increased frequency. She menrions that her urine looked “pink” throughout the past week. Urine dip today shows blood ++, leuc +++ and nitrates +. What is the most important next step in management:
a) Urinary tract ultrasound
b) Urodynamic assessment
c) Prescribe antibiotics, and if no improvement, arrange urgent referral to urology (2ww)
d) Request MSU today and prescribe antibiotics based on results
E) Urgent urology referral (2ww)
D
RED FLAGS
Bladder Cancer
more or = 45 years old
- Visible haematuria (unexplained, without UTI) ⟶ 2ww
- Visible haematuria that persists after UTI treatment ⟶ 2ww
more or = 60 years old
- unexplained microscopic haematuria + dysuria OR raised WCC ⟶ 2ww
- Consider if recurrent or persistent unexplained UTI (non-urgent referral)
Renal Cancer
- Unexplained visible haematuria without UTI
- Visible haematuria that persists after UTI treatment
URINE DIP RULES
With symptoms
- Urine dip positive ⟶ Antibiotics + MSU
- Urine dip negative ⟶ MSU + Consider Abx pending results
Without symptoms
- Urine dip positive ⟶ MSU only
E
A 48-year-old woman presents with symptoms of mixed incontinence, with urge predominance. She has two children, one born vaginally and one via caesarean section. Urine dip today is negative and she has been given a bladder diary to fill in. Examination is unremarkable. What is the next step in management?
a) Request MSU
b) Start oxybutinin and review in 6 weeks
c) Start oxybutinin and review in 4 weeks
d) Recommend a course of pelvic floor exercises for 3 months
e) Recommend a course of pelvic floor exercises for 4 months
C
- FIrst line treatment for stress, urge or mixed: pelvic floor exercise
- Should be for minumun of 3 months if no POP
- Minium of 4 months if POP
- When women are started on OAB treatment, advise they may not see benefits for the first 4 weeks
