Urogynaecology

Question 1

Types of urinary incontinence

Answer 1

Stress incontinence - detrusor pressure exceeds closing pressure of urethra (cough, sneeze, laugh)

Urge incontinence -involuntary leakage with strong desire to pass urine (commonly coexists with frequency and nocturia)

Mixed incontinence

Question 2

Causes of continuous urinary leakage

Answer 2

Most common: vesicovaginal fistula

Or congenital - ectopic ureter

Question 3

Urogynae red flags

Answer 3

Visible haematuria (bladder cancer)

Pain associated with bladder filling

Abdominal swelling may indicate a pelvic mass

Question 4

What is overactive bladder syndrome (OAB)

Answer 4

Underlying detrusor overactivity (DO) - mostly idiopathic but may be associated with MS.

Diagnosis made in urodynamic testing

Question 5

Investigating urinary incontinence

Answer 5

Examine to exclude pelvic mass
(Neuro exam to exclude MS)

Urinanalysis - exclude UTI
Review medication
Lifestyle advice - weight loss, smoking cessation
Refer to physio for pelvic floor muscle training

Question 6

Types of prolapse

Answer 6

Posterior compartment (rectocele)
Anterior compartment (cystocele)
Uterine prolapse
Vaginal vault prolapse

Question 7

What is urodynamics?

Answer 7

Used to evaluate bladder function and determine cause of
leaking - looking at how the body stores and empties urine

Speed and pattern of bladder emptying (uroflometry)
Any urine left behind is measured by USS or catheter

Catheters inserted into bladder (to measure vesical pressure [a])
And vagina and rectum (to measure intra-abdominal pressure [b])
Bladder is filled with fluid
Detrusor pressure (b-a) is continually measured and provocations are made to reproduce the patient’s symptoms 
Patient voids at end of filling to measure pressure generated by bladder
Diagnosis of USI, DO or voiding dysfunction is made

Question 8

The lavator ani is innervated by:

Answer 8

The pudendal nerve which arises from S2, S3, S4

S2,3,4 KEEPS THE PELVIS OFF THE FLOOR

Question 9

Treatments for USI

Answer 9

Pelvic floor exercises
Tension free tape
Colposuspension

Question 10

Treatments for DO

Answer 10

Micrabegron
Botox
Sacral nerve stimulation