Urogynae Flashcards
Red flags for urogynae
Visible haematuria- bladder cancer
Abdominal swelling- mass
Qs to ask in urogynae Hx
leakage of urine and when frequency of micturition difficulty passing urine and emptying bowel faecal leakage impact on sexual activity full obs and gynae history other medical conditions drug history affect on QoL
Surgical interventions of stress urinary incontinence
Mid urethral slings
Colposuspension
Urethral bulking agents
Fascial sling
Types of urinary incontinence
Functional incontinence
Stress incontinence
Overactive bladder/urge incontinence
Functional incontinence
physiological factors unimportant
patient caught short and too slow in finding toilet due to immobility or unfamiliar surroundings
Stress incontinence
Leakage from incompetent sphincter
Loss of small amount of urine when coughing etc.
RF for stress incontinence
Age
Obesity
Pregnancy
Following birth
Overactive bladder/urge incontinence
Urge to urinate quickly followed by uncontrollable and sometimes complete emptying of bladder as detrusor muscle contracts
Causes of OAB
Detrusor overactivity or bladder muscle problem
Organic brain damage- stroke, Parkinson’s, dementia
Other- UTI, diabetes, diuretics, atrophic vaginitis, urethritis
Management of stress incontinence
Pelvic floor exercise- 1st line Intravaginal electrical stimulation Ring pessary Surgery- tension free vaginal tape Meds- duloxetine
Investigations for all incontinence
check for UTI, DM, diuretic use, faecal impaction, palpable bladder, GFR
Management for urge incontinence
Incontinence chart for 3 days examine for spinal cord and CNS signs, vaginitis Vaginitis- topical oestrogen Bladder training Weight loss Drugs Aids e.g. absorbent pads
Urinary Hx
Daytime voids- normal 4-7 Nocturia- up to 70y >1x is abnormal Nocturnal enuresis Urgency Voiding difficulties- hesistency, intermittent stream, straining etc Feeling of incomplete emptying Pain, haematuria Recurrent UTI Prolapse or bowel symptoms QoL
Prolapse
Weakness of supporting structures which allows pelvic organs to protrude within the vagina
RF for prolapse
Prolonged labour Trauma from instrumental delivery Lack of postnatal pelvic floor exercise Obesity Chronic cough Constipation
