Urogynaecology Flashcards by Maria Keriakos

What are the risk factors for pelvic floor disorders?

increasing age
obesity
increased parity
smoking

How well did you know this?

Not at all

Perfectly

What type of urinary incontinence is more common in women of middle age?

Stress

How well did you know this?

Not at all

Perfectly

What type of urinary incontinence is more common in women of older age?

urge (remember older pt who struggles to get to toilet in time)

How well did you know this?

Not at all

Perfectly

What are the important aspects of pt assessment in pelvic floor disorders?

Mainly clinical diagnosis with history and examination

Investigations are rarely used

How well did you know this?

Not at all

Perfectly

Define incontience

Involuntary leakage of urine that is objectively demonstrable

How well did you know this?

Not at all

Perfectly

What are the two most important conditions to know about?

OAB

Stress incontience

How well did you know this?

Not at all

Perfectly

What is the pathophysiology of OAB?

Involuntary bladder contractions

How well did you know this?

Not at all

Perfectly

What is the pathophysiology of stress incontienence?

Sphincter weakness

How well did you know this?

Not at all

Perfectly

What are the types of incontienence?

Stress 
Urge
Mixed 
Overflow 
Functional 
Fistula (true)

How well did you know this?

Not at all

Perfectly

How does an OAB present?

Urgency 
urinary incontienence 
frequency 
nocturia 
nocturnal enuresis 
key in the door, handwashing 
intercourse

How well did you know this?

Not at all

Perfectly

How does stress incontienence present?

Involuntary leakage during: 
Cough
Laugh
Lifting
Exercise
Movement
Running 
Sexual activity 
Vomiting

How well did you know this?

Not at all

Perfectly

What investigations would you do for urinary incontience?

Frequency volume chart (the bladder diary)
Urinalysis (MSU)
Residual urine measurement
Questionnaire (ePAQ - electronic personal assessment questionnaire)

How well did you know this?

Not at all

Perfectly

What are the causes of urianry fistula?

cancer 
radiotherapy
surgery
congenital 
spontaneous

How well did you know this?

Not at all

Perfectly

What are the causes of overflow incontience?

BPH/prostate cancer
large prolapse
childbirth
incontinence surgery

How well did you know this?

Not at all

Perfectly

What are the signs of overflow incontienence?

These are the signs of obstruction:

poor flow
hesitancy
post void dribbling
intermitenency (stopping and starting during urination)
incomplete emptying

How well did you know this?

Not at all

Perfectly

Name two systemic causes of urinary incontience

Heart failure

Diabetes

How well did you know this?

Not at all

Perfectly

What measurements can you get from a frequency volume chart?

Voided volume 
Frequency of urination 
Quantity and frequency of leakage 
Fluid intake 
Diurnal variation

How well did you know this?

Not at all

Perfectly

How can the frequency volume chart be used?

As part of initial assessment

Planning treatment and behavioural therapy

What do nitrites indicate in an MSU?

Infection

What do leucocytes indicate in an MSU?

Infection

What does microscopic haematuria indicate in an MSU?

GN
Nephropathy 
Cancer 
Infection 
Calculus

What do proteinuria indicate in an MSU?

Renal disease

Cardiac disease

What do glycosuria indicate in an MSU?

Diabetes

Nephropathy

How can residual urine measurement be measured?

Pelvic exam - palpable bladder
In and out catheter
USS

What are the domains of the ePAQ questionnaire?

urinary bowel vaginal sexual function

What is urodynamic testing and how often is it done?

Measure relationship between pressure and volume in the bladder Rectal catheter measures abdominal pressure Then do MINUS the bladder pressure with a urinary catheter The pt coughs and washes their hands and see whether the bladder contracts during this to signify urge or stress incontience It is not done often

How do we treat stress incontinence?

Remember stress incontience is a problem with the pelvic floor muscles that are too weak 1. Physiotherapy - to strengthen muscles 2. Surgery - sling or suspension

How do we treat OAB?

1. Lifestyle advice 2. Bladder training 3. Anticholinergic drugs 4. Botox (Botulinum toxin) 5. Augmentation 6. Bypass eg catheters

What are the lifestyle adaptations that need to be made in incontinence

Weight loss Smoking cessation Reduced caffeine intake Avoidance of straining and constipation

What are the supportive measures for living with incontinence?

``` Bladder bypass - catheter Pads and pants Vaginal support devices Skin care and vaginal oestrogen Odor control ```

How is the bladder innervated

Parasympathetic NS: S2-S4 Sympathetic NS: T11-L2 External anal sphincter - voluntary control under S2-S4

What does the parasympathetic nerve innervation do?

Voiding | Produces bladder contraction and sphincter relaxation

What does the sympathetic nerve innervation do?

Storage | Bladder relaxation

What neurotransmitter is used by the parasympatheitc NS?

Ach

What type of receptors are there in the parasympathetic NS?

Muscarinc M2 and M3

What drugs act as antagonists of the parasympathetic NS and therefore stop excessive voiding?

Oxybutinin Solifenacin Trospium (act in the same way as atropine, but we don't give atropine)

What are the side effects of oxybutinin?

``` (sympathetic effects as antagonises the parasympathetic NS) - dry mouth - blurred vision - drowsiness/cognitive impairment - constipation - tachycardia - ```

Name another drug that can also be used to relax the bladder to treat urge incontienence

Mirabegron - but not as widely used in the UK as Oxybutinin

How does botox work as a treatment for urge incontienece?

Blocks release of Ach at nerve endings

What type of catheters are there?

Indwelling Suprapubic Intermittent (CISC - clean intermittent self-catheterisation)

WHat does physiotherapy involve?

Pelvic floor exercises Biofeedback Electrical stimulation Vaginal cones - like a tampon and have to hold it in place

What are the symptoms of prolapse?

something coming down Lump incontienence Dyspareunia

How are prolapses graded?

1. first degree 2. second degree 3. third degree 4. fourth degree = complete procidentia

What are the treatment options for prolapse?

pessaries - ring, shelf, gellhorn Surgery - anterior/posterior repair - sacrospinous fixation