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
Outline the degrees of uterine prolapse from 1st to 3rd
1st degree: cervix descends within vagina but doesn’t pass outside
2nd degree: cervix protrudes beyond opening
3rd degree: total prolapse of uterus outside vagina
Give 4 conservative management options for prolapse
- Weight loss
- Smoking cessation
- Physiotherapy
- Pessaries
Where anatomically are ring pessaries placed?
Between posterior symphysis pubis and posterior fornix of vagina
Give 3 complications of a pessary
- Infection
- Interfere with sex
- Ulceration
What is a Manchester repair?
Removes part of cervix and pushes uterus into place by shortening holding ligaments
In vaginal vault prolapse, which ligament can be used to suture the vaginal vault to to hold it in place?
Sacrospinous ligament
What procedure closes the opening of the vagina completely?
Colpocleisis
Give 3 methods used to prevent prolapse
- Weight loss
- Treatment of chronic constipation
- Smoking cessation
