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Year 4 OBGYN > Urogynaecology > Flashcards

Urogynaecology Flashcards

1
Q

Define Stress Incontinence and give three risk factors

A

Involuntary leakage of urine due to increased intra-abdominal pressure

Child Birth, Oestrogen Deficient States, Pelvic Surgery

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2
Q

Define Urge Incontinence and give three risk factors

A

Presence of urgency in the absence of other pathology, usually due to detrusor overactivity and associated with Nocturia/Frequency

Spina Bifida, MS, Pelvic Surgery

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3
Q

Other than Stress and Urge, name three other causes of incontinence

A

Bladder Fistulae
Ectopic Ureter
Functional Incontinence

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4
Q

How should Stress Incontinence be investigated?

A

Exclude Infection
Frequency/Volume chart (normal)
Urodynamic

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5
Q

How should Urge Incontinence be investigated?

A

Exclude Infection
Frequency/Volume chart (increased frequency)
Urodynamic (Detrusor Overactivity)

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6
Q

Describe the conservative and medical management for Stress Incontinence

A

Conservative: Pelvic Floor Exercises, Weight Loss, Smoking Cessation

Medical: Duloxetine

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7
Q

Describe the three surgical management options for Stress Incontinence

A

Burch Colposuspension (sutures between paravaginal fascia and coopers ligament)

TVT (Sling around urethra)

Urethral Bulking (Under LA)

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8
Q

Describe the conservative and medical management for Urge Incontinence

A

Conservative: Bladder training, reduce caffiene/alcohol

Medical: Botox, Oxybutinin (Anticholinergics), Mirabegron (B3 agonists)

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9
Q

Give two side effects and two contraindications to Oxybutinin

A

SE: Xerostomia, Constipation
CI: Closed Angle Glaucoma, Myasthenia Gravis

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10
Q

Describe the two surgical management options for Urge Incontinence

A

Detrusor Myomectomy

Augmentation Cystoplasty

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11
Q

Describe De Lancey’s three levels of Pelvic Support

A

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)

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12
Q

What is the cause of a Urethrocoele?

A

Damage to level III support (Pubourethral Ligaments)

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13
Q

What is the cause of a Cystocoele?

A

Damage to level II support (Pubovesicoversical Fascia)

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14
Q

What is the cause of a Rectocoele?

A

Herniatiom of rectum through fasciae defeat and lateral detachment of level II support

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15
Q

What is the cause of an Enterocoele?

A

Prolapse of small bowel through PoD (Rectouterine Pouch)

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16
Q

A Uterine prolapse occurs when level I support is inefficient, describe the three degrees

A

1st : Retroversion of uterus and descent of cervix in vagina

2nd: Descends to Vaginal Opening
3rd: AKA Procidentia, descends through opening

17
Q

Describe four features of Uterine Prolapse

A

Vaginal Pressure
Sacral Backache
Dysparenuria
Vaginal Discharge

18
Q

Describe three features of a Cystocoele

A

Double Voiding
Stress Incontinence
Recurrent UTI

19
Q

How would a Rectocoele present?

A

Difficult Defeacation

20
Q

GU Prolapse can be due to congenital weakness. Give three acquired causes

A

High Parity
Raised Intra Abdo Pressure
Hormonal Changes

21
Q

How can GU Prolapses be prevented?

A

Encouraging Pelvic Floor Exercises
Appropriate Episiotomies
Avoiding prolonged second stage of labour

22
Q

The conservative management of prolapse is a pessary, name two different types and give a disadvantage

A

Ring (inserted into posterior fornix behind symphysis)
Shelf (coat hook)

Can cause ulcerations and fistulas

23
Q

Describe the surgical repair of a GU Prolapse

A 
Fasciae Repair
Graft Repair (with Synthetic Mesh, Sacrocolpoplexy)
24
Q

Name three pieces of lifestyle advice to give to women with UG prolapse

A 
Lose weight (where relevant)
Avoid heavy lifting
Avoid constipation
25
Q

Other than a pessary, give two non surgical managements of UG prolapse

A

Pelvic Floor Exercises

Vaginal Oestrogen

26
Q

Name three adverse effects of Pessaries that the patient needs to be warned about

A

Bleeding
Discharge
Expulsion

Needs to be removed every 6 months

27
Q

Mesh procedures are rarely carried out for UG prolapse due to adverse erosions and side effects. Name three other procedures

A

Vaginal Sacrospinous Hysteropexy
Manchester Procedure
Hysterectomy

28
Q

What is the Vaginal Sacrospinous Hysteropexy procedure?

A

Uterus sutured to Sacrospinous ligament

29
Q

What is the Manchester Procedure?

A

removal of the cervix and formation of cervical stump

Year 4 OBGYN (15 decks)

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