Urogynaecology Flashcards
Urge incontinence?
Overactivity of detrusor muscles (wet self before reach toilet)
Overflow incontinence?
Chronic retention due to obstruction of urinary outflow
Stress incontinence?
Weakness of pelvic floor and sphincter muscles (leak when cough, laugh, surprised)
Mixed incontinence?
Urge and stress incontinence combination
What investigation should be ordered for an urge incontinence patient unresponsive to 1st line treatment?
Urodynamic testing
Catheter into rectum and bladder (which is filled with fluid) - what is assessed?
Cystometry, uroflowmetry, leak point pressure, post-void residual bladder volume, video urodynamic testing
Management options for stress incontinence?
Avoid caffeine, diuretics, too much liquid, WL Pelvic floor exercise Surgery Duloxetine (2nd line) Artificial urinary sphincter
Management options for urge incontinence?
Bladder retraining
Anticholinergic medication (Oxybutynin, Tolterodine, Solifenacin)
Invasive procedure
What is a CI for anticholinergic medication in the elderly?
Dementia - due to further cognitive decline risk.
What is pelvic organ prolapse?
Descent of the pelvic organs into the vagina
Why does pelvic organ prolapse occur?
Weakness and lengthening of ligaments and muscles surrounding the uterus, rectum and bladder.
Vault prolapse?
Occurs in hysterectomy patients where the top of the vagina (vault) descends into the vagina.
Rectocele?
Posterior vaginal wall defect; rectum prolapse into vagina.
Cystocele?
Anterior vaginal wall defect; bladder prolapse into vagina.
What is the examination for a pelvic organ prolapse?
Sim’s speculum (cough or bear down to assess full descent of prolapse)
