Urogynae

Question 1

Symptoms of overactive bladder

Answer 1

Urgency!
Frequency
Nocturia
Need wee with ‘key in door’ ‘handwashing’

Question 2

Stress incontinence symptoms

Answer 2

Involuntary leakage on increased abdominal pressure. Detrusor contractions on cough, laugh, heavy lifting, exercise.
Detrusor = parasympathetic, Ach neurotransmitter, muscarinic receptors.

Question 3

Investigations for incontinence

Answer 3

Frequency volume chart/bladder diary
Urinalysis
Residual urine measurement with catheter or bladder scan.
ePAQ (electronic personal assessment questionnaire)

Question 4

Components of a frequency volume chart

Answer 4

Voided volume
Frequency of voiding
Quantity and frequency of any leakage
Fluid intake
Diurnal variation

Question 5

Components of ePAQ

Answer 5

Urinary, bowel, sexual and vaginal

Question 6

Treatment for incontinence

Answer 6

Lifestyle - weight loss, smoking cessation, reduce caffeine intake, avoid straining.
Physiotherapy for pelvic floor exercises.
Bladder drilling or training.
Surgical = sling, suspension
Pharmacological = Botox, anticholinergic meds e.g. Oxybutinin (block muscarinic receptors).

Question 7

3 types of prolapse

Answer 7

Cystocele
Rectocele
Enterocele
Uterine prolapse

Question 8

Prolapse associated with urinary symptoms

Answer 8

Cystocele

Question 9

Cystocele prolapse

Answer 9

Bulging of anterior wall of vagina and bladder

Question 10

Rectocele prolapse

Answer 10

Lower posterior wall of vagina and rectum bulging

Question 11

Enterocele prolapse

Answer 11

Upper posterior wall of vagina and may contain intestine and pouch of Douglas

Question 12

uterine prolapse

Answer 12

Uterus protrudes below vagina

Question 13

Uterine prolapse in hysterectomy women

Answer 13

Vagina vault prolapse.

Question 14

Pelvic Organ Prolapse Quantification (POP-Q)

Answer 14

Based on distal portion of the prolapse and on straining.
0 = no prolapse
1 = more than 1cm above hymen
2 = within 1cm of the hymen (either above or below).
3 = Does not protrude further than 2cm less than total vagina length but lies 1cm below hymen.
4 = Complete eversion (procidentia)

Question 15

Risk factors for genitourinary prolapse

Answer 15

Increasing age
Vaginal delivery
Multiparity
Previous hysterectomy
Prolonged labour
Constipation
Weak pelvic floor muscles after non-adherence to pelvic floor exercises postnatally.
are more!

Question 16

Clinical feature of a prolapse

Answer 16

Asymptomatic
Dragging sensation
Lump coming down sensation
Dyspareunia
Backache
Urinary frequency, retention.
Constipation, poor defaecation (rectocele)

Question 17

Examination for prolapse

Answer 17

Sim’s speculum

Examine in standing,straining and left lateral position

Question 18

Management of a prolapse

Answer 18

Conservative = lifestyle modifications (loose weight, diet, stop smoking)
Vaginal pessary (shelf, ring, gelhorn)
Surgical - hysterectomy.

Question 19

Treatment of vaginal vault prolapse

Answer 19

Sacrocolpoplexy

Question 20

Overactive bladder definition

Answer 20

Urinary urgency that occurs with or without urge incontinence and usually with frequency and nocturia.

Urge incontinence is a type of over active bladder

Question 21

Which women would be suitable for pre-surgical intervention Urodynamic studies e.g. multichannel filling and voiding cystometry?

Answer 21

Symptoms suggest voiding dysfunction.
Prolapse
Previous surgery for incontinence
Unclear type of incontinence.

Do not need to routinely do urodynamic studies in stress incontinence.

Question 22

Overflow incontinence

Answer 22

From chronic renal retention and obstruction to urine outflow. The patient can not fully void all the urine so small volumes can leak out.