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Reproduction > Urogynaecology > Flashcards

Urogynaecology Flashcards

1
Q

What is prolapse?

A

Protrusion of an organ or structure beyond its normal anatomical confines. Female POP refers to the descent of the pelvic organs towards or through the vagina

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2
Q

Describe the pathophysiology of POP

A

Prolapse occurs due to progressive weakness of pelvic floor muscles and stretching of endopelvic fascia/ligaments, which usually supports viscera, so organs fall out of place

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3
Q

What is a urethrocele?

A

Prolapse of the lower anterior vaginal wall involving the urethra only

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4
Q

What is a cystocele?

A

Prolapse of the upper anterior vaginal wall involving the bladder

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5
Q

What is a uterovaginal prolapse?

A

This term is used to describe prolapse of the uterus, cervix and upper vagina

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6
Q

What is a enterocele?

A

Prolapse of the upper posterior wall of the vagina usually containing loops of small bowel

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7
Q

What is a rectocele?

A

Prolapse of the lower posterior wall of the vagina involving the rectum bulging towards into the vagina

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8
Q

Give risk factors for POP

A

Pregnancy and vaginal birth

  • Forceps
  • Large baby
  • Prolonged secondary stage
  • Parity

Advancing age:Muscles and ligaments weaken

Obesity: Increased pressure on pelvic floor

Previous pelvic surgery: Heals with fibrous tissue which is weaker

Hormonal/Menopause

Quality of connective tissue

Constipation

Occupation with heavy lifting

Exercise

Anything that involves pushing on ligaments/endoplasmic fascia and muscles

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9
Q

Give vaginal symptoms of POP

A

Sensation of a bulge/protrusion

Seeing or feeling a bulge or protrusion

Pressure

Heaviness

Difficulty in inserting tampons

Difficulty in having sex

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10
Q

Give urinary symptoms of POP

A

Urinary incontinence

Frequency

Urgency

Weak or prolonged urinary stream

Manual reduction of prolapse to start or complete voiding

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11
Q

Give bowel symptoms of POP

A

Incontinence of flatus, liquid or solid stool

Feeling of incomplete emptying/straining

Urgency

Digital evacuation to complete defecation

Splinting or pushing on or around the vagina to start or complete defecation

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12
Q

What investigations can be used in POP diagnosis?

A

USS/MRI: Allow identification of fascial defects/measurement of levator ani thickness

Urodynamics: Concurrent urinary incontinence

IVU or renal USS: If suspect ureteric obstruction

Only do investigations if think there is associated conditions

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13
Q

What non surgical management is available for POP?

A

Pelvic floor muscle training: Mild prolapse, increase pelvic strength and bulk and relieve the tension on the ligaments

Perinometer: Measures strength of voluntary contractions

Biofeedback: Monitors if doing contraction right

Vaginal cones

Electrical stimulation: Helps patient find muscle and contract if weak

Pessaries: Late stage, just as good as surgery

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14
Q

What is surgery used for in POP?

A

Maintains vaginal capacity for sexual function

Restore/maintains bladder and bowel function

Relieves symptoms

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15
Q

What preventative measures are used in POP?

A

Avoid constipation

Effective management chronic chest pathology

Smaller family size

Improvements in antenatal and intra-partum care

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16
Q

What is urgency?

A

The complaint of a sudden, compelling desire to pass urine that is difficult to defer

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17
Q

What is urge incontinence?

A

The complaint of involuntary leakage of urine accompanied or immediately preceded by urgency

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18
Q

What is frequency?

A

Usually accompanies urgency with or without urge incontinence and is the complaint by the patient who considers that he/she voids too often by day

19
Q

What is nocturia?

A

Usually accompanies urgency with or without urge incontinence and is the complaint that the individual has to wake at night one or more times to void

20
Q

What is stress incontinence?

A

Leakage accompanying physical activity such as coughing, sneezing, heavy lifting, running, laughing etc

21
Q

Describe Oxford grade 0 of pelvic floor muscles

A

No muscle activity

22
Q

Describe Oxford grade 1 of pelvic floor muscles

A

Minor muscle activity

23
Q

Describe Oxford grade 2 of pelvic floor muscles

A

Weak muscle activity without circular contraction

24
Q

Describe Oxford grade 3 of pelvic floor muscles

A

Moderate muscle contraction

25
Q

Describe Oxford grade 4 of pelvic floor muscles

A

Good muscle contraction

26
Q

Describe Oxford grade 5 of pelvic floor muscles

A

Strong muscle contraction

27
Q

Give risk factors for incontinence

A

>Age: increasingly fibrotic bladder

>Parity

Menopause

Smoking

Medical problems

Obesity: Increased intraabdominal pressure

Pelvic floor trauma

Denervation

Connective tissue disease

Surgery

28
Q

How does incontinence present?

A

Irritation syndrome

  • Urgency
  • Increased daytime frequency (>7)
  • Nocturia (>1)
  • Dysuria
  • Haematuria

Incontinence

Voiding symptoms

  • Straining to void
  • Interrupted flow

Prolapse

Bowel

  • Anal incontinence
  • Constipation
  • Faecal evacuation
  • Dysfunction
  • IBS
29
Q

What investigations are used in incontinence diagnosis?

A

Urine dipsticka and culture, to rule out UTI and diabetes

3 day urinary diary

Post voiding residual volume assessment

  • Usually by bladder scanning, only if voiding difficulty symptoms

Urodynamics, only indicated if surgical treatment is contemplated

30
Q

What is noted in the 3 day urinary diary?

A

Fluid intake

Urine out put excluding nocturnal polyuria

Daytime frequency

Nocturia

Average voided volume

31
Q

What lifestyle changes are used in incontinence management?

A

Stop smoking

Lose weight

Eat healthy to avoid constipation

Stop drinking alcohol, caffeine, chocolate

32
Q

What non surgical methods are used in incontinence management?

A

Pelvic Floor Muscle Training: Reinforcement of cortical awareness of muscle groups

Yentreve (Duloxetine): Should be part of an overall management strategy that should include pelvic floor muscle training

33
Q

How often are pelvic floor muscle exercises done?

A

3 sets 5 x a day

34
Q

When is duloxetine used?

A

Use if pelvic floor muscle training has failed or would be enhanced in primary care

Use if not fit for surgery, failed surgery in secondary care

35
Q

Give adverse effects of duloxetine

A

Nausea

Mood change

36
Q

Give the procedural/surgical methods used in incontinence management

A

Colposuspension/Surgery

Tension-free Vaginal Tape (TVT): Reinforces structures supporting the urethra

37
Q

What is overactive bladder syndrome?

A

Symptom complex usually related to urodynamically demonstrable detrusor overactivity

38
Q

Give risk factors for overactive bladder syndrome

A

Advanced age

Diabetes

Urinary tract infections

Smoking

39
Q

What lifetsyle interventions are used in overactive bladder syndrome?

A

Normalise fluid intake,

Reduce caffeine/fizzy drinks/chocolate

Stop smoking

Weight los

40
Q

What non pharmacological method is used in overactive bladder syndrome management?

A

Bladder training programme: Timed voiding with gradually increasing intervals

41
Q

Give the pharmacological methods of overactive bladder syndrome management

A

Antimuscarinic/anticholinergic

Betmiga/Muscle relaxant

Tri-cyclic antidepressants used for nocturia

Botox: Injected into bladder to relax bladder/reduce contractions and reduce sensory pathway

Neuromodulation

42
Q

What is first line medical management for stress incontinence?

A

Duloxetine, after adequate trial of pelvic floor training

43
Q

What is first line medical management of urge incontinence?

A

Mucurinic antagonist, after trial of bladder retraining

Reproduction (18 decks)

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