Urogynae

Question 1

A 50 year old woman presented with LUTS and visible haematuria, udip is positive for blood only, what management if appropriate?

Answer 1

2ww to urology – frank haematuria in the absence of infection is cancer until proven overwise in >45yo.

Question 2

Initial management of predominantly stress incontinence?

Answer 2

Info, lifestyle (stop smoking, caffeine reduction, reduce weight, fluid management), 3/12 supervised pelvic floor exercises, skin care to avoid/treat chemical irritation. Referral to the continence advice service.

Question 3

2nd line management of stress incontinence if conservative management fails?

Answer 3

Refer to urogynae to discuss surgical options. Duloxetine if women refers to avoid surgery or unable to have surgery. Will need urodynamics pre surgery.

Question 4

Symptoms of stress incontinence?

Answer 4

Involuntary leakage on coughing, sneezing, exercising

Question 5

Symptoms of urge incontinence?

Answer 5

Have to go now! Frequency, urgency, nocturia, AOB

Question 6

Hx and examination points when assessing incontinence?

Answer 6

O&G, previous surgery, symptoms, caffeine, lifestyle, smoking, medications, neurological conditions, prolapse, tone of pelvic floor, skin assessment, Udip. Number of pads used, impact on life, bladder diary 3/7.

Question 7

Common medication types causing continence problems?

Answer 7

Anti Parkinson’s, diuretics, antipsychotics, alpha-1 adrenoreceptor antagonists.

Question 8

What % of women experience continence problems?

Answer 8

Up to 40%

Question 9

First line (non-pharmacolgoical) treatment of urge incontinence?

Answer 9

Bladder training, Lifestyle (stop smoking, caffeine reduction, reduce weight, fluid management), bladder diary

Question 10

First line medication for urge incontinence?

Answer 10

If under 65 and no cognitive impairment risk factors, oxybutinyin. Otherwise consider more selective agent such as solifenacin or fesoterodine.

Question 11

Which muscarinic receptor is predominately found in smooth muscle?

Answer 11

M3

Question 12

How often should a woman aged 80 on an anticholinergic for stress incontinence be reviewed and why?

Answer 12

6/12, anticholinergic burden and risk of cognitive decline. >75 = 6/12 r/v

Question 13

Side effects of oxybutynin?

Answer 13

Dry eyes/mouth, constipation UTI, headache, dizzy, GI upset

Question 14

What would you use first line in a woman age 78 with mild cognitive impairment for urinary stress in continence who has tried conservative measures without good effect?

Answer 14

consider Mirabegron

Question 15

Contraindications to Mirabegron?

Answer 15

Hypertension >180/110, severe hepatic impairment, end stage renal disease (eGFR <15)

Question 16

Cautions for Mirabegron use?

Answer 16

BP >160/100, moderate hepatic impairment and severe renal impairment, long QT syndrome, bladder outflow obstruction

Question 17

Mechanism of action of Mirabegron?

Answer 17

Beta 3 agonist

Question 18

Renal impairment and Mirabegron consideration?

Answer 18

Reduce dose to 25mg OD if eGFR 5-29

Question 19

90. Itraconazole and Mirabegron and eGFR of 65 – dose?

Answer 19

25mg OD

Question 20

Success rate of pessary for pelvic organ prolapse?

Answer 20

60%

Question 21

How often should a pessary be reviewed?

Answer 21

6/12 to look for fit, signs of erosion/ulceration

Question 22

Treatment options for pelvic organ prolapse in a sexually active woman?

Answer 22

Lifestyle, ring pessary, surgery

Question 23

Recurrence rate following surgery for pelvic organ prolapse?

Answer 23

1/3

Question 24

Conservative treatment options for pelvic organ prolapse?

Answer 24

Lifestyle, tx constipation, treat cough if present, reduce BMI, local oestrogen, nothing, pessary

Question 25

Define grade 3 prolapse? l

Answer 25

Lowest part beyond the introitus

Question 26

Define grade 1 prolapse?

Answer 26

Lowest part less than half way down the vagina

Question 27

Define grade 2 prolapse?

Answer 27

Lowest part above introitus

Question 28

Symptoms of pelvic organ prolapse?

Answer 28

Lump, dragging, ache, sexual dysfunction, urinary and bowel problems.