Urogynae

Question 1

Cystometry

Answer 1

Measures debris or pressures as bladder is filled and provoked with coughing
Transducers in rectum and bladder
Bladder P - abdo P = detrusor activity

Question 2

Pharmacological management of detrusor instability aka urge incontinence

Answer 2

Anticholinergics: oxybutynin, solifenacin, tolteridone
SE: headache, dry mouth
Desmopressin (synthetic ADH) reduces urine production
Useful for nocturia

Question 3

Transvaginal tape

Answer 3

Under general or local
Mid urethral sling inserted to limit urethral descent
Provide support to pubourethral ligaments + reinforce ant vaginal wall

Question 4

Bladder training

Answer 4

For OAB aka detrusor instability
1st line = 6 wks bladder training
Medical
Oxybutynin, warn re anti muscarinic side effects
Botulinum toxin A injections into bladder
(Willing and able to self cath if needed)
Last line: sacral nerve stimulation, cystoplasty

Question 5

Cystocele

Answer 5

Descent of bladder through superior anterior vaginal wall

Urinary sx due to change of uterovesical angle: stress incontinence, freq, urgency, incomplete bladder emptying -> UTI

Question 6

Urethrocele

Answer 6

Descent of first 3-4cm of anterior vaginal wall
Urinary sx
Dragging sensation

Question 7

Prolapse and predisposing factors

Answer 7

Weakened pelvic tissues secondary to pregnancy/ vaginal delivery
+ menopausal oestrogen deficiency -> loss of connective tissue strength
Prev suprapubic surgery
Obesity, cough, constipation, heavy lifting, ascites, large pelvic mass

Question 8

Procidentia

Answer 8

Cervix, uterus and vaginal wall prolapse through introitus

Question 9

Vault prolapse

Answer 9

Prolapse of vagina following hysterectomy

Question 10

Rectocele

Answer 10

Prolapse of rectum into lower posterior vaginal wall
Tenesmus
Rectocele may need to be pushed back in order to defecate