Urogynaecology Flashcards
What is the pelvic floor?
A group of muscles and ligaments that support the bladder, uterus and bowel
What 4 areas do you need to ask questions about if you suspect a problem with the pelvic floor?
Vaginal
Bowel
Urinary tract
Sexual function
List some causes of bladder incontinence?
Overactive bladder: involuntary bladder contractions
Stress incontinence: weak sphincter
Mixed overactive and stress
Fistula: connection between ureter and vagina
Neurological
Overflow
Functional
How would you investigate urinary incontinence?
- Frequency and volume chart: a diary of how much urine they pass and how often
- Urinalysis
- Residual urine measurement
- Questionnaire asking about 4 dimensions
- Urodynamics
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?
Overactive bladder
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?
Stress incontinence
Not going too frequently, but leaking
What is analysed in urinalysis?
Nitrites Leukocytes Haematuria Proteinuria Glycosuria
Why do diabetic women have problems with their urinary continence?
Neuropathy of detrusor muscle
Frequent UTIs due to glucose in urine
How would you measure the residual urine in the bladder? (2 ways)
Use an in+out catheter
Or use USS
What is meant by urodynamics?
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?
What type of incontinence does overactive bladder cause?
Urge
You see a woman who is having continuous leakage of urine, what’s the most likely cause?
Fistula
Management of stress incontinence?
Initially conservative:
- Physio, pelvic floor exercises
- Lifestyle changes
- Pads
- Odour control
- Skin care
Drugs (not really recommended):
- duloxetine
Surgery:
- TVT
- Colposuspension
What is TVT?
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
What is colposuspension?
Using stitches to lift up and fix the neck of the bladder, so it is stronger preventing stress incontinence
Management of overactive bladder?
Conservative first:
- avoid caffeine, alcohol
- avoid excessive fluids
- bladder training
- pads
- catheters
Drugs:
- anti-cholinergics
- adrenergic agonist
Botox injection into detrusor to paralyse it
List an anti-cholinergic used to treat overactive bladder? How does it work?
Oxybutinin
Smooth muscle relaxant
List an adrenergic agonist used to treat overactive bladder? How does it work?
Mirabegron
Increases bladder capacity
What is utero-vaginal prolapse?
When the pelvic organs (uterus) protrude down into the vagina due to weakness in pelvic floor and other supportive structures
Presentation of utero-vaginal prolapse?
Feeling of a lump coming down
Discomfort, dragging sensation
Dyspareunia
Pain, backache
Investigations of utero-vaginal prolapse?
Examination:
- using sims speculum
None other necessary
Risk factors of utero-vaginal prolapse?
Prolonged labour Trauma from instrumental delivery Obesity Chronic cough Constipation
Management of utero-vaginal prolapse?
Conservative:
- reassure
- lose weight
- stop smoking
- stop straining
Pessaries
Surgery: repair the prolapse
What are pessaries?
A device that is inserted into the vagina to support the uterus
