Urogynae Flashcards
Symptoms of overactive bladder
Urgency!
Frequency
Nocturia
Need wee with ‘key in door’ ‘handwashing’
Stress incontinence symptoms
Involuntary leakage on increased abdominal pressure. Detrusor contractions on cough, laugh, heavy lifting, exercise.
Detrusor = parasympathetic, Ach neurotransmitter, muscarinic receptors.
Investigations for incontinence
Frequency volume chart/bladder diary
Urinalysis
Residual urine measurement with catheter or bladder scan.
ePAQ (electronic personal assessment questionnaire)
Components of a frequency volume chart
Voided volume Frequency of voiding Quantity and frequency of any leakage Fluid intake Diurnal variation
Components of ePAQ
Urinary, bowel, sexual and vaginal
Treatment for incontinence
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).
3 types of prolapse
Cystocele
Rectocele
Enterocele
Uterine prolapse
Prolapse associated with urinary symptoms
Cystocele
Cystocele prolapse
Bulging of anterior wall of vagina and bladder
Rectocele prolapse
Lower posterior wall of vagina and rectum bulging
Enterocele prolapse
Upper posterior wall of vagina and may contain intestine and pouch of Douglas
uterine prolapse
Uterus protrudes below vagina
Uterine prolapse in hysterectomy women
Vagina vault prolapse.
Pelvic Organ Prolapse Quantification (POP-Q)
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)
Risk factors for genitourinary prolapse
Increasing age Vaginal delivery Multiparity Previous hysterectomy Prolonged labour Constipation Weak pelvic floor muscles after non-adherence to pelvic floor exercises postnatally. are more!
Clinical feature of a prolapse
Asymptomatic Dragging sensation Lump coming down sensation Dyspareunia Backache Urinary frequency, retention. Constipation, poor defaecation (rectocele)
Examination for prolapse
Sim’s speculum
Examine in standing,straining and left lateral position
Management of a prolapse
Conservative = lifestyle modifications (loose weight, diet, stop smoking) Vaginal pessary (shelf, ring, gelhorn) Surgical - hysterectomy.
Treatment of vaginal vault prolapse
Sacrocolpoplexy
Overactive bladder definition
Urinary urgency that occurs with or without urge incontinence and usually with frequency and nocturia.
Urge incontinence is a type of over active bladder
Which women would be suitable for pre-surgical intervention Urodynamic studies e.g. multichannel filling and voiding cystometry?
Symptoms suggest voiding dysfunction.
Prolapse
Previous surgery for incontinence
Unclear type of incontinence.
Do not need to routinely do urodynamic studies in stress incontinence.
Overflow incontinence
From chronic renal retention and obstruction to urine outflow. The patient can not fully void all the urine so small volumes can leak out.
