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3a Women's Health > Urogynaecology > Flashcards

Urogynaecology Flashcards

1
Q

What is a uterine prolapse?

A

Uterine prolapse is where the uterus itself descends into the vagina

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2
Q

What is a vault prolapse?

A

Vault prolapse = occurs in women that have had a hysterectomy (no longer have a uterus)

The top of the vagina (the vault) = descends into the vagina

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3
Q

What are rectoceles caused by?

A

A defect in the posterior vaginal wall
→ allowing the rectum to prolapse forwards into the vagina

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4
Q

What are rectoceles primarly associated with?

A

Constipation
* Women can develop faecal loading in the part of the rectum that has prolapsed into the vagina

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5
Q

What can faecal loading (in the case of a rectocele) cause?

A
  • Constipation
  • Urinary retention (due to compression of the urethra)
  • Palpable lump in the vagina

Women may use their fingers to press the lump backwards, correcting the anatomical position of the rectum, and allowing them to open their bowels.

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6
Q

What is a cystocele caused by?

A

Cystocele = caused by a defect in the anterior vagina → allowing the bladder to prolapse backwards into the vagina

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7
Q

What can prolapse due to a cystocele?

A
  • Bladder into the vagina
  • Urethra (urethrocele)
  • Bladder + urethra = cystourethrocele
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8
Q

What is the underlying reason for pelvic organ prolapses?

A

Weak + streched msucles and ligaments

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9
Q

What are the risk factors for pelvic organ prolapse?

Those that weaken + strech the muscles and ligaments

A
  • Multiple vaginal deliveries
  • Instrumental, prolonged or traumatic delivery
  • Advanced age and postmenopause status
  • Obesity
  • Chronic respiratory disease causing coughing
  • Chronic constipation causing straining
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10
Q

What are the symptoms of a pelvic organ prolapse?

A
  • A feeling of “something coming down” in the vagina
  • A dragging or heavy sensation in the pelvis
  • Urinary symptoms (incontinence, urgency, frequency, weak stream and retention)
  • Bowel symptoms (constipation, incontinence and urgency)
  • Sexual dysfunction (pain, altered sensation and reduced enjoyment)

The prolapse = will become worse on straining + bearing down

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11
Q

What system is used to grade the severity of a uterine prolapse?

A

Pelvic organ prolapse quantification (POP-Q) system

  • Grade 0: Normal
  • Grade 1: The lowest part is more than 1cm above the introitus
  • Grade 2: The lowest part is within 1cm of the introitus (above or below)
  • Grade 3: The lowest part is more than 1cm below the introitus, but not fully descended
  • Grade 4:** Full descent** with eversion of the vagina
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12
Q

What is a pelvic organ prolapse extending beyond the introitus called?

A

Uterine procidentia

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13
Q

What are 3 management options for a pelvic organ prolapse?

A
  • Conservative management
  • Vaginal pessary
  • Surgery
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14
Q

Name some conservative management options for pelvic organ prolapse

A
  • Physiotherapy (pelvic floor exercises)
  • Weight loss
  • Lifestyle changes for associated stress incontinence, such as reduced caffeine intake and incontinence pads
  • Treatment of related symptoms, such as treating stress incontinence with anticholinergic mediations
  • Vaginal oestrogen cream
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15
Q

Surgery = definitive option for treating a pelvic organ prolapse, name 2 options.

A
  • Hysteroectomy
  • Mesh repair
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16
Q

What are some complications of pelvic organ prolapse?

A
  • Pain, bleeding, infection, DVT and risk of anaesthetic
  • Damage to the bladder or bowel
  • Recurrence of the prolapse
  • Altered experience of sex
17
Q

What are mesh repairs and are they recommended by NICE?

A

Mesh repairs = involve inserting a plastic mesh to support the pelvic organs (after a prolapse) - they should be AVOIDED

18
Q

Name some complications of a mesh repair

A
  • Chronic pain
  • Altered sensatioon
  • Dyspareunia (pianful sex) for the women or her partner
  • Abnormal bleeding
  • Urinary or bowel problems
19
Q

What are the 2 types of urinary incontinence?

A
  • Urge incontinence
  • Stress incontinence
20
Q

What is urge incontinence caused by?

A

Urge incontinence = caused by overactivity of the detrusor muscle of the bladder

Urge incontinence = AKA overactive bladder

21
Q

How does urge incontinence present?

A

The typical description = of suddenly feeling the urge to pass urine, having to rush to the bathroom and not arriving before urination occurs

  • Women with urge incontinence are very conscious about always having access to a toilet, and may avoid activities or places where they may not have easy access.
  • Significant impact on their quality of life
22
Q

What is stress incontinence caused by?

A

Stress incontinence = caused by weakness of the pelvic floor + sphincter muscles

This allows urine to leak at times of increased pressure on the bladder

23
Q

How does stress incontince present?

A

Stress incontinence = urinary leakage when laughing, coughing or surprised

This allows urine to leak at times of increased pressure on the bladder

24
Q

What is mixed continence?

A

Urge continence + stress continence

25
Q

Management for stress incontinence

A
  • Lifestyle + modifiable reversible risk factors (weight loss, smoking cessation, fluid management, avoidance of bladder irritants e.g. caffeine)
  • First line: Pelvic floor muscle training (3 months of Kegal exercises to strenghten pelvic floor muscles)
  • Second line: SNRIs (duloxetine)
  • Surgery (tension-free vaginal tape)
26
Q

Management of urge incontinence

A
  • First line: Bladder retraining (at least 6 weeks)
  • Second line: anticholinergic meds (oxybutynin, solifenacin)
  • Mirabegron (if anticholinergics fail/unsuitable)
  • Invasive procedures (if medical treatment fails) - e.g. Botulinum toxin type A injection into the bladder wall
27
Q

Name some side effects of anticholinergic effects

A
  • Dry mouth
  • Dry eyes
  • Urinary retention
  • Constipation
  • Postural hypotension

Complications:
* Cognitive decline
* Memory problems
* Dementia
Therefore anticholinergics are problematic in older and frail patients

28
Q

What drug class is mirabegron and when is it contraindicated?

A
  • Mirabegron = beta-3 agonst
  • Mirabegron = contraindicated in uncontrolled hypertension

Works by stimulating the sympatheteic nervous system → leading to raised blood pressure → can lead to hypertensive crisis + increased risk of TIA + stroke

3a Women's Health (8 decks)

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