Urogynaecology Flashcards
Causes of prolapse
Weakness =Pregnancy and delivery / menopause / inherent / Pressure = Ovarian masses / straining
Pelvic organ prolapse
Slipping down of the vagina and or the uterus
Types of Prolapse
Cystocele, Rectocele, Uterus, Vault
Symptoms of prolapse
Urinary symptoms / bowel symptoms / sexual dysfunction / pain / prolapse symptoms / none
Prolapse symptoms
Lump down below / bearing down / fullness or heaviness (standing up makes it worse, laying down makes it better)
Urinary symptoms
f (day or night) / urgency of micturation / voiding dysfunction (acute or chronic) / stress incontinence
Bowel symptoms
Obstructed dedication / digitation / anal Incontinuance
Pain
Backache
Position for examination to see prolapse
Left lateral lie
Grading prolapse
Halfway / Mild / Moderate / Severe
Prolapse treatment
No treatment / Pessary (Ring, shelf and gellhorn [used in patients where the ring wasn’t sufficient]) - stretches the vagina wider than the hiatus, can cause ulceration, check and replace every 3-9 months, size may be incorrect, for pts who can’t have surgery or don’t wont to / Surgery
Prolapse surgery
Medically fit and active / Pelvic floor repair (vaginal +/- vaginal hysterectomy) / Sacrospinous fixation (posterior repair) / Sacrohusteropexy / Sacroclopopexy (mesh is used and attached to the sacral…)
Urinary incontinence
Stress (small drops) / Urgency (complete bladder contence) / Overflow / Fistula / Nocturnal Enuresis (normally children)
What is stress incontinence?
Intrabdominal pressure > urethral pressure / weakness - pregnancy and child birth, menopause / pressure - bearing, smoking, high BMI
Symptom of stress incontinence and investigations
Leak when coughing and sneezing / bladder dairy (types of drinks e.g coffee and tee and how much they actually drink) / urine dip (blood - bladder cancer) / urodynamics dynamics - cystometry / urodynamic stress incontinence
Urodynamics
Muscle contracture?
Stress Incontinence - Treatment
Conservative - train to contract pelvic floor muscles, improve fluid intake, stop smoking, reduce BMI / Surgery
Surgery stress incontinence
Mid-urethral tapes (stops tension under stress)
Over active bladder
Nocturia / Frequency / Urgency Incontinence
Causes of over active bladder
Menopause / Irritants (smoking, caffeine, alcohol) / Habitual (fear that they may leak, they get used to going to the toilet often) / masses + pregnancy (pressure) / Neurogenic (disc, spinal cord, Parkinsonism)
Destructor over activity
Urodynamics - increase in destrurosor muscle activity compared to the abdomen
Over active bladder treatment
Conservative - fluid advice, bladder drill (also called bladder training ), weight loss, HRT or local oestrogen (build up transitional epithelium), Medication / Surgery
Medication over active bladder
Anticholinergics (Anti-Muscarinic) - Oxybutinin (oral) / Selective ones = Tolterodine
Surgery over active bladder
Botulinum toxin A bladder wall injection (if the bladder becomes too paralysed, the patient will get urinary retention) / Percutaneous tibial nerve stimulation (positive -no retention of urine. Negative - it is a 12 session course)
