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Obstetrics & Gynaecology > Urogynaecology > Flashcards

Urogynaecology Flashcards

1
Q

What are the different types of chronic incontinence?

A
  1. Stress incontinence
  2. Urge incontinence
  3. Mixed
  4. Overflow incontinence
  5. Fistula
  6. Functional incontinence
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2
Q

What is the most common type of chronic incontinence?

A

Stress incontinence

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3
Q

What is the mnemonic for transient causes of incontinence?

A

DIAPPERS

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4
Q

What are the transient causes of incontinence?

A 
Delirium
Infection
Atrophic changes
Pharmacological
Psychological
Excessive urine output
Restricted mobility
Stool impaction
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5
Q

What is stress incontinence?

A

Involuntary leakage of urine upon exertion - i.e. an increase in intra-abdominal pressure

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6
Q

What is the cause of stress incontinence?

A

Urethral sphincter weakness

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7
Q

What are the risk factors for stress incontinence?

A
  1. Increasing age
  2. Increased parity
  3. Vaginal delivery - particularly deliveries that were instrumented, prolonged, or delivered a macrocosmic infant
  4. Obesity
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8
Q

How should suspected stress incontinence be investigated?

A
  1. Urine dip/culture
  2. Blood glucose
  3. Micturition diary
  4. Urodynamic evaluation with cystometry
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9
Q

What are the conservative methods of management, suitable for stress incontinence?

A
  1. Lifestyle modification - WL, smoking cessation, modify fluid intake, modify caffeine intake
  2. PRMT - e.g. vaginal cones
  3. Biofeedback
  4. Treat/prevent constipation
  5. HRT
  6. Pads
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10
Q

What is the medical management of stress incontinence?

A

Duloxetine - selective serotonin re-uptake inhibitor

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11
Q

What are the adverse effects of the medical management of stress incontinence?

A

Nausea (most commonly); dyspepsia; dry mouth; dizziness; drowsiness; insomnia

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12
Q

What examination should be performed when a woman is suspected to have stress incontinence?

A
  1. Patient cough
  2. Bimanual - to assess pelvic floor muscles by asking to squeeze
  3. Speculum (?prolapse)
  4. Abdominal examination
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13
Q

Of all the available treatments for stress incontinence, which is considered first-line?

A

Pelvic floor muscle training

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14
Q

Which is preferable - medical or surgical management of incontinence?

A

Surgical, due to the adverse effects of medical. Medical management should only be offered to women unsuitable for, or unwilling to undergo surgery

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15
Q

What are the surgical management options for stress incontinence?

A

1) Mid-urethral sling procedures
2) Injectable periurethral bulking agent
3) Artificial urinary sphincter

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16
Q

What is the first-line surgical management for stress incontinence?

A

Mid-urethral sling procedures

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17
Q

What are the two types of mid-urethral sling procedures?

A

1) Tension-free vaginal tape

2) Transoburator tape

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18
Q

What are the complications of mid-urethral sling procedures?

A

1) Bladder perforation
2) Postoperative voiding difficulty
3) Bleeding
4) Infection
5) Suture or mesh erosion

19
Q

What are the differences between Tension-free vaginal tape (TVT) and transoburator tape?

A

Mesh is used to elevate the mid-urethra in both procedures, but transoburator tape is fitted in a different way such that there is less risk of bladder damage

20
Q

What is urge incontinence?

A

Spontaneous OR provoked detrusor contraction results in bladder pressure>urethral pressure = incontinence

21
Q

What are the conservative forms of management suitable for urge incontinence?

A
  1. Lifestyle modification
  2. PFMT
  3. Biofeedback
  4. Use of pads
22
Q

How may an overactive bladder (due to detrusor contraction) be medically managed?

A
  1. Anticholinergics

2. Intravescial botox

23
Q

How may an overactive bladder (due to detrusor contraction) by surgically managed?

A
  1. Augmentation enterocystoplasty
  2. Autoaugmentation
  3. Urinary diversion
24
Q

What are the contraindications to anticholinergics?

A
  1. MG
  2. BOO
  3. Bowel disorders
  4. Uncontrolled narrow angle glaucoma
25
Q

What are the S/Es of anticholinergics?

A
  1. Dry mouth
  2. Constipation
  3. Blurred vision
  4. Urinary retention
26
Q

What are the contraindications to intravesical botox?

A
  1. MG
  2. Eaton-Lambert syndrome
  3. Breastfeeding
  4. Pregnancy
  5. Bleeding disorders
27
Q

What are the S/Es of intravesical botox?

A
  1. Urinary retention
  2. Haematuria
  3. UTI
  4. Bladder pain
  5. Dysphagia
  6. Diplopia
28
Q

What are the risk factors for overactive bladder?

A

Idiopathic
MS
Surgical treatment for stress incontinence

29
Q

What are the different types of anterior vaginal wall prolapse?

A
  1. Cystocele
  2. Urethrocele
  3. Cystourethrocele
30
Q

What are the different types of posterior vaginal wall prolapse?

A
  1. Rectotocele

2. Enterocele

31
Q

What is a uterus prolapse?

A

Descent of entire uterus

32
Q

What is a vaginal vault/apical prolapse?

A

Apex of the vagina, where the uterus used to be, can prolapse post-hysterectomy

33
Q

What is a cystocele?

A

Upper anterior vaginal wall, causing descent of the bladder only

34
Q

What is a urethrocele?

A

Lower anterior vaginal wall, causing descent of the urethra only

35
Q

What is a cystourethrocele?

A

Descent of both the bladder and the urethra

36
Q

What is a rectotocele?

A

Lower posterior vaginal wall, affecting the anterior wall of the rectum

37
Q

What is a enterocele?

A

Upper posterior vaginal wall, creating a pouch containing loops of bowel

38
Q

What are the risk factors for prolapse?

A
  1. Vaginal delivery
  2. Ageing - atrophy of connective tissues
  3. Obesity
  4. Raised intra-abdominal pressure - e.g. chronic cough from smoking
  5. Iatrogenic - poorly supported vaginal vault post-hysterectomy
  6. Congenital
39
Q

What is a 1st degree prolapse?

A

Cervix down into the vagina, but above the introitus

40
Q

What is a 2nd degree prolapse?

A

Cervix to introitus (opening that leads to the vaginal canal)

41
Q

What is a 3rd degree prolapse?

A

Cervix outside introitus

42
Q

How may prolapse be medically managed?

A
  1. HRT - when oestrogen withdrawal is responsible for the loss of tone
  2. Ring pessary
43
Q

What are the S/Es of ring pessaries?

A
  1. Pain
  2. Urinary retention
  3. Infection
  4. Displacement

Obstetrics & Gynaecology (14 decks)

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