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O&G > Urogynaecology > Flashcards

Urogynaecology Flashcards

1
Q

see urogynae notes

A

anatomy

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2
Q

How common is stress incontinence?

A

50% of incontinence in females

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3
Q

What are the causes of stress incontinence?

A 
pregnancy and vaginal delivery esp prolonged labour and forceps delivery 
obesity 
age (esp postmenopausal) 
prolapse 
previous hysterectomy
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4
Q

What are the characteristic of stress incontinence?

A

involuntary leakage of urine on effort or exertion, on sneezing or coughing
many patients also complain of frequency, urgency or urge incontinence
faecal incontinence may also be present
may have cystocoele or urethrocoele

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5
Q

How common is urge incontinence?

A

35% of the cases of female incontinence

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6
Q

What are the causes of urge incontinence?

A

idiopathic
bladder neck obstruction
detrusor overactivity

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7
Q

What are the characteristics of urge incontinence?

A 
urgency 
frequency and nocturne 
stress incontinence common 
leak at night or at orgasm 
history of childhood enuresis common as well as faecal urgency
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8
Q

What are the causes of urinary frequency?

A 
high fluid intake 
caffeine and alcohol 
infections, UTIs and STIs
Prostate glad problems 
diuretics 
DM
DI 
pregnancy
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9
Q

What are the characteristics of urinary frequency?

A

Urinating more than 8 times a day
nosturia
bladder discomfort
strong urgent need to urinate

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10
Q

How common are UTIs in women?

A

1 in 3 women have had a UTI by the age of 24

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11
Q

What are the RFs for developing a UTI?

A 
female 
children 
elderly 
indwelling catheters 
immunosuppression 
urinary tract abnormalities 
antibiotic exposure
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12
Q

What are the characteristics of a UTI?

A 
strong persistent urge to urinate 
burning sensation when urinating 
frequent small amounts of urine 
cloudy strong smelling urine 
blood in urine 
pelvic pain
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13
Q

What is prolapse?

A

descent of uterus and/or vaginal walls beyond normal anatomical confines
result of weakness in supporting structures
herniation of bladder/urethra/rectum/small bowels
v common, present in most older porous women

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14
Q

What is a urethrocoele?

A

urethra prolapse only

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15
Q

What is a cystocoele?

A

bladder prolapse

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16
Q

What is an apical prolapse?

A

uterus, cervix and upper vagina prolapse

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17
Q

What is an enterocoele?

A

prolapse contains loops of small bowel

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18
Q

What is a rectocoele?

A

anterior wall of the rectum prolapse

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19
Q

What are the causes of prolapse?

A

vaginal delivery and pregnancy - mechanical injuries and denervation of the pelvic floor
congenital factors
menopause - deterioration of collagen due to lower oestrogen
chronic predisposing factors - obesity/chronic cough/constipation/heavy lifting/pelvic mass
Iatrogenic factors - hysterectomy and continence procedures

20
Q

What are the characteristics of prolapse?

A

dragging sensation/sensation of the lump
worse at end of the day and when standing
can interfere with intercourse/ulcerate/discharge
urinary frequency/incomplete bladder emptying with cystourethrocele
can have difficulty defecating if rectocele

21
Q

What are the indications for urodynamics investigation?

A

investigate symptoms of urinary incontinence

prior to surgery for stress incontinence/overactive bladder

22
Q

What are the methods of assessing urodynamics?

A

catheter measures vesicle pressure (pressure in bladder) whilst bladder is filled and provoked with coughing

pressure transducer also on rectum (or vagina) to measure abdominal pressure

true detrusor pressure = vesicle pressure - abdominal pressure

23
Q

for urodynamics interpretation

A

see notes

24
Q

What are the indications for cystoscopy?

A

exclude tumours, stones, fistulae and interstitial cystitis

25
Q

What are the method for cystoscopy?

A

inspection of the bladder cavity using cystoscope

inserted into urethra into bladder

26
Q

What are the indications for imaging (US and IV urography)?

A

evaluate or detect blood in urine, kidney or bladder stones or cancer in urinary tract

27
Q

What are the method of imaging the urinary tract?

A

IV urogram – IV contrast injected + X ray to look at kidneys, ureters, bladder + urethra

US – soundwaves to create image

28
Q

What coping advice can you give to women for coping with incontinence and retention?

A 
reduce excessive fluid intake 
avoid caffeinated products 
review medication 
if obese - lose weight 
reduce cause of chronic cough
29
Q

What pads and garments can be given?

A

pad and pull ups are temporary measures
bed and chair protection with washable bed pads
specially adapted clothing and swimwear

30
Q

What types of catheterisation can be used?

A

clean intermittent catheterisation - used to empty bladder at regular intervals

indwelling catheter

31
Q

What are the steps of bladder training?

A

1 - education
2 - timed voiding with systematic delay in voiding
3 - positive reinforcement
4 - at least 6 weeks

32
Q

What pelvic floor advice can be given?

A

Strengthing pelvic floor

First line treatment for 3+ months, taught by PT
>8 contractions, 3x/day

Poss use vaginal ‘cones’ or sponges – held in place in vagina by voluntary muscle
contraction

33
Q

How can duloxetine be used?

A

treatment of moderate severe stress incontinence

SNRI that enhances urethral striated sphincter activity

34
Q

How can antimuscarinics be used?

A

suppress detrusor overactivity in bladder overactivity

35
Q

How can oestrogens be used?

A

in postmenopausal women

improves symptoms of vaginal atrophy and reduces symptoms of urge incontinence

36
Q

How can botulinum toxin A be used?

A

blocks neuromuscular transmission

duration average 6 months

37
Q

When is a vaginal repair +/- hysterectomy indicated?

A

recommended for incontinence caused by anterior vaginal wall prolapse

bladder and urethra lifted back into place and secure with stitches

mesh may be part of repair

38
Q

How is tension-free vaginal tape used?

A

tape placed in U-shape under mid urethra via small

vaginal anterior wall incision, tension adjusted to prevent leakage as woman coughs

39
Q

How is a trans-obturator tape used?

A

tape passed via transobturator foramen, through transobturator + puborectalis

40
Q

What are the advantages of sling/tape procedures?

A

cure rates of up to 90%, minimally invasive

41
Q

What is colposuspension?

A

Incision on lower abdomen + stitching neck of bladder in lifted position

42
Q

What are the cons of colposuspension?

A

Can cause urinary retention, recurrent UTIs and discomfort during sex

43
Q

What are the non-surgical treatment options for incontinence?

A 
pads and garments 
catheterisation 
bladder retraining 
pelvic floor exercises 
drug treatment
44
Q

What are the surgical treatment options for incontinence?

A

vaginal repair with or without hysterectomy
sing procedure and tapes
colposuspension

45
Q

What are the investigations for incontinence?

A

urodynamics
cystoscopy
imaging including US and IV urography

46
Q

What is the easiest investigation for urinary infection?

A

microbiology Ix

Dipstick

O&G (25 decks)

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