Urogynaecology Flashcards
Define Stress Incontinence and give three risk factors
Involuntary leakage of urine due to increased intra-abdominal pressure
Child Birth, Oestrogen Deficient States, Pelvic Surgery
Define Urge Incontinence and give three risk factors
Presence of urgency in the absence of other pathology, usually due to detrusor overactivity and associated with Nocturia/Frequency
Spina Bifida, MS, Pelvic Surgery
Other than Stress and Urge, name three other causes of incontinence
Bladder Fistulae
Ectopic Ureter
Functional Incontinence
How should Stress Incontinence be investigated?
Exclude Infection
Frequency/Volume chart (normal)
Urodynamic
How should Urge Incontinence be investigated?
Exclude Infection
Frequency/Volume chart (increased frequency)
Urodynamic (Detrusor Overactivity)
Describe the conservative and medical management for Stress Incontinence
Conservative: Pelvic Floor Exercises, Weight Loss, Smoking Cessation
Medical: Duloxetine
Describe the three surgical management options for Stress Incontinence
Burch Colposuspension (sutures between paravaginal fascia and coopers ligament)
TVT (Sling around urethra)
Urethral Bulking (Under LA)
Describe the conservative and medical management for Urge Incontinence
Conservative: Bladder training, reduce caffiene/alcohol
Medical: Botox, Oxybutinin (Anticholinergics), Mirabegron (B3 agonists)
Give two side effects and two contraindications to Oxybutinin
SE: Xerostomia, Constipation
CI: Closed Angle Glaucoma, Myasthenia Gravis
Describe the two surgical management options for Urge Incontinence
Detrusor Myomectomy
Augmentation Cystoplasty
Describe De Lancey’s three levels of Pelvic Support
I - Suspension - Uterosacral/Cardinal Ligaments
II - Attachment - Condensed sheets of pelvic tissue suspending vaginal walls and other organs
III - Fusion - Posteriorly (Perineal Body), Anteriorly (Pubourethral Ligaments)
What is the cause of a Urethrocoele?
Damage to level III support (Pubourethral Ligaments)
What is the cause of a Cystocoele?
Damage to level II support (Pubovesicoversical Fascia)
What is the cause of a Rectocoele?
Herniatiom of rectum through fasciae defeat and lateral detachment of level II support
What is the cause of an Enterocoele?
Prolapse of small bowel through PoD (Rectouterine Pouch)
A Uterine prolapse occurs when level I support is inefficient, describe the three degrees
1st : Retroversion of uterus and descent of cervix in vagina
2nd: Descends to Vaginal Opening
3rd: AKA Procidentia, descends through opening
Describe four features of Uterine Prolapse
Vaginal Pressure
Sacral Backache
Dysparenuria
Vaginal Discharge
Describe three features of a Cystocoele
Double Voiding
Stress Incontinence
Recurrent UTI
How would a Rectocoele present?
Difficult Defeacation
GU Prolapse can be due to congenital weakness. Give three acquired causes
High Parity
Raised Intra Abdo Pressure
Hormonal Changes
How can GU Prolapses be prevented?
Encouraging Pelvic Floor Exercises
Appropriate Episiotomies
Avoiding prolonged second stage of labour
The conservative management of prolapse is a pessary, name two different types and give a disadvantage
Ring (inserted into posterior fornix behind symphysis)
Shelf (coat hook)
Can cause ulcerations and fistulas
Describe the surgical repair of a GU Prolapse
Fasciae Repair Graft Repair (with Synthetic Mesh, Sacrocolpoplexy)
Name three pieces of lifestyle advice to give to women with UG prolapse
Lose weight (where relevant) Avoid heavy lifting Avoid constipation
Other than a pessary, give two non surgical managements of UG prolapse
Pelvic Floor Exercises
Vaginal Oestrogen
Name three adverse effects of Pessaries that the patient needs to be warned about
Bleeding
Discharge
Expulsion
Needs to be removed every 6 months
Mesh procedures are rarely carried out for UG prolapse due to adverse erosions and side effects. Name three other procedures
Vaginal Sacrospinous Hysteropexy
Manchester Procedure
Hysterectomy
What is the Vaginal Sacrospinous Hysteropexy procedure?
Uterus sutured to Sacrospinous ligament
What is the Manchester Procedure?
removal of the cervix and formation of cervical stump
