Urogynaecology Flashcards
Define stress incontinence
Rise in intra-abdominal pressure without detrusor muscle contraction causing urine leakage e.g. laughing
Define urgency incontinence
Leakage of urine due to involuntary contraction of detrusor
Give 4 causes of an overactive bladder/urgency incontinence
Parkinson’s
MS
Acute UTI
Alcohol
Give 4 risks of stress incontinence
Anatomical abnormality
Drugs
Menopause
Cognitive impairment
What is urodynamic stress incontinence?
Stress incontinence which has been proven by urodynamic testing
Give 4 symptoms of incontinence
Frequency
Urgency
Nocturia
Voiding problems
Give 4 risks of incontinence
Reduced mobility
Renal pathology
Cardiac pathology
Pelvic surgery
Which 2 examinations may be done in the investigation of incontinence?
Abdominal and bimanual
Which investigation MUST be carried out in all women presenting with incontinence symptoms
Urine dip and culture
Give 2 investigative tests used in incontinence
Cystoscopy
Renal tract imaging
Give 3 conservative management options for incontinence
Continence advice
Physiotherapy
Bladder retraining
What is 1st line medical treatment for overactive bladder/urgency incontinence?
Anticholinergic (e.g. Oxybutynin)
What is 1st line medical treatment for stress incontinence?
Duloxetine (serotonin and noradrenaline reuptake inhibitor)
Give 1 surgical option for overactive bladder
Botox injection of detrusor
Give 1 surgical option for stress incontinence
Mid-urethral sling
Define uterovaginal prolapse
Protrusion of uterus and/or vagina beyond normal anatomical confines
Give 3 structures in the pelvic floor which support the uterus
- Vaginal walls
- Transverse cervical ligaments
- Round and broad ligaments
What are the 3 main components of the pelvic floor?
- levator ani muscles
- coccygeus muscle
- fascial coverings of muscles
Which 2 ligaments support the cervix and upper 1/3 of vagina?
Transverse cervical ligament
Uterosacral ligament
Give 3 risks of prolapse
- Age
- Vaginal deliveries
- Raised intra-abdominal pressure
Give 6 ways in which a prolapse may present
- Bulging from vagina
- Bleeding
- Dyspareunia
- Constipation
- Urinary incontinence
- Pressure sensation in vagina
Give 3 things that should be done during speculum examination of a prolapse
- Check walls for descent or atrophy
- Check for ulceration
- Ask pt. to cough
What does the pelvic organ prolapse quantification assess?
Based on position of most distal part of prolapse during straining
Briefly define the stages of prolapse (0-4)
0 = no prolapse 1 = more than 1cm above hymenal ring 2 = prolapse from 1cm above to 1cm below hymenal ring 3 = 1cm or more below hymenal ring 4 = vagina completely everted
