Urogynae Flashcards
A 50 year old woman presented with LUTS and visible haematuria, udip is positive for blood only, what management if appropriate?
2ww to urology – frank haematuria in the absence of infection is cancer until proven overwise in >45yo.
Initial management of predominantly stress incontinence?
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.
2nd line management of stress incontinence if conservative management fails?
Refer to urogynae to discuss surgical options. Duloxetine if women refers to avoid surgery or unable to have surgery. Will need urodynamics pre surgery.
Symptoms of stress incontinence?
Involuntary leakage on coughing, sneezing, exercising
Symptoms of urge incontinence?
Have to go now! Frequency, urgency, nocturia, AOB
Hx and examination points when assessing incontinence?
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.
Common medication types causing continence problems?
Anti Parkinson’s, diuretics, antipsychotics, alpha-1 adrenoreceptor antagonists.
What % of women experience continence problems?
Up to 40%
First line (non-pharmacolgoical) treatment of urge incontinence?
Bladder training, Lifestyle (stop smoking, caffeine reduction, reduce weight, fluid management), bladder diary
First line medication for urge incontinence?
If under 65 and no cognitive impairment risk factors, oxybutinyin. Otherwise consider more selective agent such as solifenacin or fesoterodine.
Which muscarinic receptor is predominately found in smooth muscle?
M3
How often should a woman aged 80 on an anticholinergic for stress incontinence be reviewed and why?
6/12, anticholinergic burden and risk of cognitive decline. >75 = 6/12 r/v
Side effects of oxybutynin?
Dry eyes/mouth, constipation UTI, headache, dizzy, GI upset
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?
consider Mirabegron
Contraindications to Mirabegron?
Hypertension >180/110, severe hepatic impairment, end stage renal disease (eGFR <15)
Cautions for Mirabegron use?
BP >160/100, moderate hepatic impairment and severe renal impairment, long QT syndrome, bladder outflow obstruction
Mechanism of action of Mirabegron?
Beta 3 agonist
Renal impairment and Mirabegron consideration?
Reduce dose to 25mg OD if eGFR 5-29
- Itraconazole and Mirabegron and eGFR of 65 – dose?
25mg OD
Success rate of pessary for pelvic organ prolapse?
60%
How often should a pessary be reviewed?
6/12 to look for fit, signs of erosion/ulceration
Treatment options for pelvic organ prolapse in a sexually active woman?
Lifestyle, ring pessary, surgery
Recurrence rate following surgery for pelvic organ prolapse?
1/3
Conservative treatment options for pelvic organ prolapse?
Lifestyle, tx constipation, treat cough if present, reduce BMI, local oestrogen, nothing, pessary
