Urogynaecology

Question 1

What causes stress incontinence?

Answer 1

Incontinence on laughing/coughing and increased intra-abdominal pressure 
Smoking/obesity
Weak pelvic floor
Childbirth
Weak sphincter 
Repeated lifting/high impact sports

Question 2

What tests are done for stress incontinence?

Answer 2

MSSU

Urodynamics

Question 3

What treatments are done for stress incontinence?

Answer 3

Conservative –> eliminate caffeine and alcohol, pelvic floor exercises, weight loss
Medical –> Duloxetine
Surgical –> tension free vaginal tape, colposuspension, urethral bulking agents

Question 4

What is urge incontinence and the causes?

Answer 4

urge incontinence: involuntary loss of urine through involuntary detrusor activity
overactive bladder: symptoms of urgency and frequency with or without the incontinence
associated with nocturia + frequency
older adults
women who have had a C-section or other pelvic surgery
obese
Prostate surgery or BPH
people who have nerve damage from conditions such as diabetes, stroke, or injury
bladder and prostate cancer
urinary tract infections

Question 5

What are the treatments of urge incontinence?

Answer 5

Conservative: bladder training, lifestyle modifications, physiotherapy
Medical: anticholinergics
Surgical: Botox injections, urinary diversion, clam cystoplasty

Question 6

What is a uterovaginal prolapse?

Answer 6

Caused by weak pelvic floor muscles secondary to childbirth

Question 7

What are the S+S of prolapse?

Answer 7

A bulge down below
A dragging sensation 
May have incontinence 
May need to digitally reduce to open bowels 
Dyspareunia

Question 8

What tests should be done and grading for prolaple?

Answer 8

Sims speculum from left lateral or standing
1st degree- prolapse in vagina
2nd degree- prolapse beyond intraoitis
3rd degree - uterus completely out of vagina

Question 9

What are the treatments for prolapse?

Answer 9

Non-surgical - pelvic floor exercises
ring pessary
Surgical - vaginal hysterectomy
anterior and posterior vaginal wall repair