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Y5 Gynae & Obstetrics > Urogynae > Flashcards

Urogynae Flashcards

1
Q

What are the storage symptoms’

A

FUNN

Frequency
Urgency
Nocturia
Nocturnal enuresis

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2
Q

What are storage symptoms indicative of?

A

Urge incontinence

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3
Q

What are the voiding symptoms?

A

Hesitancy
Intermittent stream
Poor stream / dribbling / spitting and spraying
Slow stream

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4
Q

What are the two key tissues controlling micturition?

A

Detrusor muscle

Urethral sphincter

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5
Q

What nerve fibres innervate the detrusor?

A

Muscarinic cholinergic muscles of PNS

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6
Q

What nerve fibres innervate the urethral sphincter?

A

Noradrenergic fibres of SNS

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7
Q

What is stress incontinence?

A

Involuntary leakage of urine due to increased pressure (effort, exertion, sneezing, coughing)

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8
Q

What is stress incontinence due to?

A

An incompetent urethral sphincter, due to weakness and hypermovility

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9
Q

what is the key RF for stress incontinence?

A

CHILDBIRTH

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10
Q

Why is childbirth a major RF?

A

Causes overstretching of pelvic floor muscles , damage to pudendal nerves, loss of pelvic floor support

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11
Q

What are conditions that increase childbirth causing stress incontinence?

A 
Multiparity 
Forceps delivery 
Perineal trauma 
Long labour 
Epidural 
high birth weight 
increased age
postmenopause 
obesity
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12
Q

What is urge incontinence?

A

sudden spontaneous urge to urinate

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13
Q

What is urge incontinece caused by?

A

Detrusor overactivity

So involuntary detrusor contractions during the filling stage of micturition

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14
Q

What are modifiable RF for detrusor overactivity?

A

Obesity
Smoking
Continence surgery

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15
Q

What Ix should be done in someone reporting incontinece?

A 
MSU 
Bladder diary (3 days) 
Pad test 
Urodynamic testing 
USS Kidney / Pelvis (if pelvic pain, mass, haematuria act)
Cystoscopy is Red flag sx
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16
Q

How do you treat urge incontinece?

A

Bladder training
Anticholinergic drugs
Botulinum toxin

17
Q

How do you treat stress incontinence’

A

Pelvic floor muscle training
Anticholinergics
Surgery (Midurethral tape procedure/Burch colposuspension)

18
Q

What is important conservatives mx for incontinence=?

A

Fluid balance (don’t over drink)
Avoid caffeine / alcohol / artifically sugar drinks
Bladder retraining
Pelvic floor exercise

19
Q

What are examples of anticholinergics?

A

Oxybutinin

20
Q

What is given as second line med to anticholinergics?

A

Mirabegron (beta - 3 adrenergic agonist, enhances detrusor relaxation)

21
Q

What is mirabegron given for?

A

Urge incontiunence

22
Q

What surgeries are done for stress incontinence?

A

Midurethral tape

Burch colposuspension

23
Q

How is urge incontinence surgically treated?

A

Botukinum injecgion

24
Q

What is a prolapse?

A

Displacement of an organ or part of an organ from its normal position

25
Q

What are sx of vaginal prolapse

A 
Sensation of vaginal bulge, heaviness, protrusion 
Dragging discomfort 
Lowe abdo / bacs pain 
Difficulty voiding urine 
Sensation of incomplete emptying 
Digitation for complete emptying 
Urinary / faecal incontinence 
Pain/discomfort / failure to achieve penetration during sex
26
Q

How many levels of vaginal descent are there?

A

3

27
Q

What is level 1 of vaginal prolapse?

A

descent of uterus into vagina

DOES NOT REACH HYMEN

28
Q

Level 2 of vaginal prolapse?

A

Prolapse of vaginal wall into vaginal lumen (anterior / posterior vaginal prolapse)

REACHES HYMEN

29
Q

Level 3 of vaginal prolapse?

A

Lower posterior vaginal wall prolapse

THROUGH HYmen

30
Q

What are the types of vaginal prolapse in the anterior vagina?

A

Cystocoele - upper half of vagina, from bladder

Urethrocoele - Lower half of vagina

31
Q

What are the types of vaginal prolapse in the posterior vagina?

A

Enterocoele - upper third of vagina

Rectocoele - lower 2/3 of vagina

32
Q

What is conservative treatment for prolapse?

A

pelvic floor exercises

Vaginal pessaries

33
Q

How often do you replace vaginal pessaries?

A

6 months

Y5 Gynae & Obstetrics (34 decks)

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