Urogynaecology

Question 0

Causes of prolapse

Answer 0

Weakness =Pregnancy and delivery / menopause / inherent / Pressure = Ovarian masses / straining

Question 1

Pelvic organ prolapse

Answer 1

Slipping down of the vagina and or the uterus

Question 2

Types of Prolapse

Answer 2

Cystocele, Rectocele, Uterus, Vault

Question 3

Symptoms of prolapse

Answer 3

Urinary symptoms / bowel symptoms / sexual dysfunction / pain / prolapse symptoms / none

Question 4

Prolapse symptoms

Answer 4

Lump down below / bearing down / fullness or heaviness (standing up makes it worse, laying down makes it better)

Question 5

Urinary symptoms

Answer 5

f (day or night) / urgency of micturation / voiding dysfunction (acute or chronic) / stress incontinence

Question 6

Bowel symptoms

Answer 6

Obstructed dedication / digitation / anal Incontinuance

Question 7

Pain

Answer 7

Backache

Question 8

Position for examination to see prolapse

Answer 8

Left lateral lie

Question 9

Grading prolapse

Answer 9

Halfway / Mild / Moderate / Severe

Question 10

Prolapse treatment

Answer 10

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

Question 11

Prolapse surgery

Answer 11

Medically fit and active / Pelvic floor repair (vaginal +/- vaginal hysterectomy) / Sacrospinous fixation (posterior repair) / Sacrohusteropexy / Sacroclopopexy (mesh is used and attached to the sacral…)

Question 12

Urinary incontinence

Answer 12

Stress (small drops) / Urgency (complete bladder contence) / Overflow / Fistula / Nocturnal Enuresis (normally children)

Question 13

What is stress incontinence?

Answer 13

Intrabdominal pressure > urethral pressure / weakness - pregnancy and child birth, menopause / pressure - bearing, smoking, high BMI

Question 14

Symptom of stress incontinence and investigations

Answer 14

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

Question 15

Urodynamics

Answer 15

Muscle contracture?

Question 16

Stress Incontinence - Treatment

Answer 16

Conservative - train to contract pelvic floor muscles, improve fluid intake, stop smoking, reduce BMI / Surgery

Question 17

Surgery stress incontinence

Answer 17

Mid-urethral tapes (stops tension under stress)

Question 18

Over active bladder

Answer 18

Nocturia / Frequency / Urgency Incontinence

Question 19

Causes of over active bladder

Answer 19

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)

Question 20

Destructor over activity

Answer 20

Urodynamics - increase in destrurosor muscle activity compared to the abdomen

Question 21

Over active bladder treatment

Answer 21

Conservative - fluid advice, bladder drill (also called bladder training ), weight loss, HRT or local oestrogen (build up transitional epithelium), Medication / Surgery

Question 22

Medication over active bladder

Answer 22

Anticholinergics (Anti-Muscarinic) - Oxybutinin (oral) / Selective ones = Tolterodine

Question 23

Surgery over active bladder

Answer 23

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)