Urogynaecology

Question 1

What is the pelvic floor?

Answer 1

A group of muscles and ligaments that support the bladder, uterus and bowel

Question 2

What 4 areas do you need to ask questions about if you suspect a problem with the pelvic floor?

Answer 2

Vaginal
Bowel
Urinary tract
Sexual function

Question 3

List some causes of bladder incontinence?

Answer 3

Overactive bladder: involuntary bladder contractions

Stress incontinence: weak sphincter

Mixed overactive and stress

Fistula: connection between ureter and vagina

Neurological

Overflow

Functional

Question 4

How would you investigate urinary incontinence?

Answer 4

1. Frequency and volume chart: a diary of how much urine they pass and how often
2. Urinalysis
3. Residual urine measurement
4. Questionnaire asking about 4 dimensions
5. Urodynamics

Question 5

A patient brings their frequency volume chart, she is passing small-ish amounts of urine every few hours. She is leaking quite often too.

What is the likely cause of this?

Answer 5

Overactive bladder

Question 6

A patient brings their frequency chart, she appears to have a normal capacity bladder and is not going too frequently.
She is leaking quite often.

What is the likely cause of this?

Answer 6

Stress incontinence

Not going too frequently, but leaking

Question 7

What is analysed in urinalysis?

Answer 7

Nitrites
Leukocytes
Haematuria
Proteinuria
Glycosuria

Question 8

Why do diabetic women have problems with their urinary continence?

Answer 8

Neuropathy of detrusor muscle

Frequent UTIs due to glucose in urine

Question 9

How would you measure the residual urine in the bladder? (2 ways)

Answer 9

Use an in+out catheter

Or use USS

Question 10

What is meant by urodynamics?

Answer 10

Measuring pressure in the abdomen and bladder and detrusor

Filling the bladder up quite quickly

Seeing when the detrusor pressure rises, what is making it rise? Hand washing, key-in-door, coughing?

Question 11

What type of incontinence does overactive bladder cause?

Answer 11

Urge

Question 12

You see a woman who is having continuous leakage of urine, what’s the most likely cause?

Answer 12

Fistula

Question 13

Management of stress incontinence?

Answer 13

Initially conservative:

• Physio, pelvic floor exercises
• Lifestyle changes
• Pads
• Odour control
• Skin care

Drugs (not really recommended):
- duloxetine

Surgery:

• TVT
• Colposuspension

Question 14

What is TVT?

Answer 14

Tension-free vaginal tape

Treats stress incontinence

A piece of tape that holds up urethra, the ends of the tape are stitched to the inside of the lower abdominal wall

Question 15

What is colposuspension?

Answer 15

Using stitches to lift up and fix the neck of the bladder, so it is stronger preventing stress incontinence

Question 16

Management of overactive bladder?

Answer 16

Conservative first:

• avoid caffeine, alcohol
• avoid excessive fluids
• bladder training
• pads
• catheters

Drugs:

• anti-cholinergics
• adrenergic agonist

Botox injection into detrusor to paralyse it

Question 17

List an anti-cholinergic used to treat overactive bladder? How does it work?

Answer 17

Oxybutinin

Smooth muscle relaxant

Question 18

List an adrenergic agonist used to treat overactive bladder? How does it work?

Answer 18

Mirabegron

Increases bladder capacity

Question 19

What is utero-vaginal prolapse?

Answer 19

When the pelvic organs (uterus) protrude down into the vagina due to weakness in pelvic floor and other supportive structures

Question 20

Presentation of utero-vaginal prolapse?

Answer 20

Feeling of a lump coming down

Discomfort, dragging sensation

Dyspareunia

Pain, backache

Question 21

Investigations of utero-vaginal prolapse?

Answer 21

Examination:
- using sims speculum

None other necessary

Question 22

Risk factors of utero-vaginal prolapse?

Answer 22

Prolonged labour
Trauma from instrumental delivery
Obesity
Chronic cough
Constipation

Question 23

Management of utero-vaginal prolapse?

Answer 23

Conservative:

• reassure
• lose weight
• stop smoking
• stop straining

Pessaries

Surgery: repair the prolapse

Question 24

What are pessaries?

Answer 24

A device that is inserted into the vagina to support the uterus

Question 25

How are utero-vaginal prolapses classified?

Answer 25

1st degree to 4th degree, with 4th being the most severe where the uterus is completely outside the vagina