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Obs & Gyn > Urogynaecology > Flashcards

Urogynaecology Flashcards

1
Q

state the 4 stages of the micturition cycle

A

1- bladder fills

2-first sensation to void

3-normal desire to void

4-micturition

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2
Q

what happens at stage one (bladder fills) of the micturition cycle 3

A

detrusor mucle relaxes

urethral sphincter contracts

pelvic floor contracts

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3
Q

what happens at stage two (first sensation to void) of the micturition cycle 3

A

bladder half full

-urinarition voluntarily

-inhibited until appropriate time

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4
Q

what happens at stage three (normal desire to void) of the micturition cycle

A

nothing- just says normal desire to void

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5
Q

what happens at stage four (micturition) of the micturition cycle 2

A

detrusor muscle contracts

pelvic floor relaxes

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6
Q

what nerves are involved in mictrution 2

A

pelvic nerve

pudendal nerve

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7
Q

what are some types of urinary incontience in women 3

A

overactive bladder

mixed incontinence stress + urgency

stress incontience- bladder outlet closure defect

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8
Q

what types of bladder outlet closure defects are there 2

A

anatomical defect in urethral support

sphincter muscle weakness

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9
Q

define urinary intontience

A

involuntary loss of urine which is objectively demonastre and which is a social or hygienic problem

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10
Q

define overactive bladder

A

syx of urgency with or without urgen incontinence
-usually with frequency & nocturia

DUE TO DETRUSOR OVERACTIVITY

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11
Q

define urge inctonience

A

leakage of urine in response to an involuntary contraction of the detrusor muscle

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12
Q

define stress urinary incontience (SUI)

A

leakage occurs with rise in intra-abdominal pressure WITHOUT a detrusor contraction (coughing, laughing, running, walking)

-signs or symptoms of urinary leakage with increased intra-abdominal pressure

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13
Q

define urodynamic stress incontience (USI)

A

urodynamic proven leakage of urine with increased intra-abdominal pressure

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14
Q

define mixed incontience

A

co-exisiting SUI (stress urinary inctontience) and OAB (overactive bladder)

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15
Q

causes of overactive bladder 9

A

neurologcial -parkions, stroke, MS, cognitive function

constipation

previous surgery

acute UTI

caffiene

alcohol

bladder abnormlaites- tumour, stones

high urine production
-medication, excess fluid intake, diabetes, poor kidney function

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16
Q

basic pathophys of stress urinary intoneitnece

A

loss of suburtheal suppot -> increased urethral mobiltiy -> movement of proximal urethral sphincter out of abdominal space-> therefore increased intraabodminal pressure not spread evenly throughout bladder

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17
Q

what is a major consideration with urinary incontinence

A

the impact on quality of life

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18
Q

main symptoms of urinary incontience 10

A

stress incontience

requency

urgency

urge incontinence

nocturia

enuresis

haematuria

dysuria

voiding porvelsm

pain

prolapse syx

19
Q

risk factors of urinary incontinece 10

A

mobility

mental agility

renal system

cardiac system

chest problems

drug therapies

previous pelvic surgery

obstertic hsiotry

menopausal status

20
Q

examinations for urianry incotinence 2

A

abdominal/bimanual examination

vaginal examination

21
Q

what to check for in abdominal/bimanual exmainaiton in urinary incontinence 3

A

pelvic masses

palbable bladder

imporession of pelvic floor tone

22
Q

what to check for in vaginal examination in urinary incontinence

A

bivalve speculum

check walls in turn for:
-prolapse, atorphy, fistulae, ulceration

23
Q

investigations for urinary incontience 4

A

urinary dip ± culture EVERY WOMEN
-leucocytes & nitries- UTI
-haematuria- further investigation
-glucose- ?diabetes

bladder diary
-minimun 3 days
-input/ output/ times of leaking

cystoscopy & renal tract imaging
-haematuria
-recurrent UTIs

Urodynamic testing
-expensive and time consuming

24
Q

define urodynamic testing

A

dynamic study of bladdr funciton

-uroflowmetry (measuirng flow)
0filling and voiding cystinetry (measuring pressures in bladder and abdomen and calculating detrusor pressure

25
Q

why and who gets urodynmaic testing

A

why-obtain dx, choose correct operation, predict complications, understand treatment failures

who-failed conservative management, prior to surgery
,previous failed surgery

26
Q

types of managment for urinary incontience 3

A

conservative

medical

surgical

27
Q

what does conservative managemnt of urinary incontinece consist off 3

A

contience advice & lifestyle changes

physiotherapy

bladder retraining

28
Q

medical managemnt of urinary inconteince 4

A

antibotics

anticholinergics

B3 agonists

duloxetine

29
Q

what consists of continence advice and lifestyle

A

education - how the bladder works

good habits- starting bladder retraing

fluids - normalise intake (at least 1.5l/day but not excess)
what to drink- avoid caffeine, alcohol, carbonated drinks

lifestyle
-diet, weight loss, smoking cessation, treat chorionic cough and chronic constipation

30
Q

first line mangemtn of stress urinary incontienec

A

physiotherapy -pelvic floor muscle training

-also has a role in Overactive bladder

31
Q

apsects of physiotherapy for urinary incontinence

A

pelvic floor excersies w reuglar voluntary contraction and relaxating of pelvic floor muscles

biofeedback

use of weighted conses

32
Q

first line for overactive bladder
-describe it

A

bladder retraining

-minimum 6 weeks

-relearning higher cortical control of detrusor muscle

patient empties bladder to strict time schedule (usually hourly) with time between voids increasing gradually

33
Q

techniques to retraining bladder 3

A

disraction- do soemthing else

sitting on a hard seat

pelvic floor squeezes

34
Q

when is conservaive mangemtn not suitable for urinary incontinence 3

A

haemutira, infecitons, pain

previously failed

patinet cant engage w therapy

35
Q

first line medical mangemnt of urinary incontinence
-exxamples

A

anitcholinergic drugs
-oxybutynin, tolterodine, solfenacin

36
Q

what is used instead of anticholingerics for medical urinary incontinence management and why

A

B3 adrenoreceptor agonits
-only if antimuscarinic CI, lcinically ineeefective or SEs unacceptable

37
Q

why is use of anticholigernics limited for management of urinary incontinence
-how is this managed

A

has v common side effects
-dry mouth, dry eyes, constipation

-try a different anticholinergic
-4-6wk treatment to assess response

38
Q

how is anticholienrgic for unriary incontience prescibred

A

4-6wks treatemtn to assess respponse

3-4monthly trial of withdrawal of treatment

39
Q

medical managemnt for stress urinary incontience

A

vaginal oestroegen if post menopausal- dubious evidence

duloxetine - SNRI

40
Q

how does duloxetine work for stress urinary incontinence

A

stimulartes pudenal motor nueornes
-increasing contracting of urethrela striated muscel of sphincter

high side effect profile
-GI disturbances, dry mouth, headache, sucidal ideology, SSRI withdrawal effect

41
Q

surgical managemnt of overatice bladder 5

A

botox injeciton to detrusor muscle
-effects last 3-13 months

need to be able to perform self catheterization

percutaneous sacral nerve stimulation

augmentation cystoplasty

urinary diversion

42
Q

surgical managemnt of stress urinary incontinence 4

A

syntehtic tapes-mid urethral sling

colposuspection

biological slings

intramural bulking agents

43
Q

define wet vs dry overactive bladder

A

wet- urge urianry incontience
-urinary urgeency that leads to leakage of urine

dry-urinary urgency and frequency without leakage of urine

Obs & Gyn (23 decks)

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