Urogynae Flashcards
What are the storage symptoms’
FUNN
Frequency
Urgency
Nocturia
Nocturnal enuresis
What are storage symptoms indicative of?
Urge incontinence
What are the voiding symptoms?
Hesitancy
Intermittent stream
Poor stream / dribbling / spitting and spraying
Slow stream
What are the two key tissues controlling micturition?
Detrusor muscle
Urethral sphincter
What nerve fibres innervate the detrusor?
Muscarinic cholinergic muscles of PNS
What nerve fibres innervate the urethral sphincter?
Noradrenergic fibres of SNS
What is stress incontinence?
Involuntary leakage of urine due to increased pressure (effort, exertion, sneezing, coughing)
What is stress incontinence due to?
An incompetent urethral sphincter, due to weakness and hypermovility
what is the key RF for stress incontinence?
CHILDBIRTH
Why is childbirth a major RF?
Causes overstretching of pelvic floor muscles , damage to pudendal nerves, loss of pelvic floor support
What are conditions that increase childbirth causing stress incontinence?
Multiparity Forceps delivery Perineal trauma Long labour Epidural high birth weight increased age postmenopause obesity
What is urge incontinence?
sudden spontaneous urge to urinate
What is urge incontinece caused by?
Detrusor overactivity
So involuntary detrusor contractions during the filling stage of micturition
What are modifiable RF for detrusor overactivity?
Obesity
Smoking
Continence surgery
What Ix should be done in someone reporting incontinece?
MSU Bladder diary (3 days) Pad test Urodynamic testing USS Kidney / Pelvis (if pelvic pain, mass, haematuria act) Cystoscopy is Red flag sx
How do you treat urge incontinece?
Bladder training
Anticholinergic drugs
Botulinum toxin
How do you treat stress incontinence’
Pelvic floor muscle training
Anticholinergics
Surgery (Midurethral tape procedure/Burch colposuspension)
What is important conservatives mx for incontinence=?
Fluid balance (don’t over drink)
Avoid caffeine / alcohol / artifically sugar drinks
Bladder retraining
Pelvic floor exercise
What are examples of anticholinergics?
Oxybutinin
What is given as second line med to anticholinergics?
Mirabegron (beta - 3 adrenergic agonist, enhances detrusor relaxation)
What is mirabegron given for?
Urge incontiunence
What surgeries are done for stress incontinence?
Midurethral tape
Burch colposuspension
How is urge incontinence surgically treated?
Botukinum injecgion
What is a prolapse?
Displacement of an organ or part of an organ from its normal position
What are sx of vaginal prolapse
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
How many levels of vaginal descent are there?
3
What is level 1 of vaginal prolapse?
descent of uterus into vagina
DOES NOT REACH HYMEN
Level 2 of vaginal prolapse?
Prolapse of vaginal wall into vaginal lumen (anterior / posterior vaginal prolapse)
REACHES HYMEN
Level 3 of vaginal prolapse?
Lower posterior vaginal wall prolapse
THROUGH HYmen
What are the types of vaginal prolapse in the anterior vagina?
Cystocoele - upper half of vagina, from bladder
Urethrocoele - Lower half of vagina
What are the types of vaginal prolapse in the posterior vagina?
Enterocoele - upper third of vagina
Rectocoele - lower 2/3 of vagina
What is conservative treatment for prolapse?
pelvic floor exercises
Vaginal pessaries
How often do you replace vaginal pessaries?
6 months
