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Phase 3a Gynaecology > Urogynaecology > Flashcards

Urogynaecology Flashcards

1
Q

What are the risk factors for pelvic floor disorders?

A
  • increasing age
  • obesity
  • increased parity
  • smoking
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2
Q

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

A

Stress

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3
Q

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

A

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

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4
Q

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

A

Mainly clinical diagnosis with history and examination

Investigations are rarely used

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5
Q

Define incontience

A

Involuntary leakage of urine that is objectively demonstrable

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6
Q

What are the two most important conditions to know about?

A

OAB

Stress incontience

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7
Q

What is the pathophysiology of OAB?

A

Involuntary bladder contractions

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8
Q

What is the pathophysiology of stress incontienence?

A

Sphincter weakness

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9
Q

What are the types of incontienence?

A 
Stress 
Urge
Mixed 
Overflow 
Functional 
Fistula (true)
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10
Q

How does an OAB present?

A 
Urgency 
urinary incontienence 
frequency 
nocturia 
nocturnal enuresis 
key in the door, handwashing 
intercourse
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11
Q

How does stress incontienence present?

A 
Involuntary leakage during: 
Cough
Laugh
Lifting
Exercise
Movement
Running 
Sexual activity 
Vomiting
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12
Q

What investigations would you do for urinary incontience?

A

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

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13
Q

What are the causes of urianry fistula?

A 
cancer 
radiotherapy
surgery
congenital 
spontaneous
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14
Q

What are the causes of overflow incontience?

A

BPH/prostate cancer
large prolapse
childbirth
incontinence surgery

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15
Q

What are the signs of overflow incontienence?

A

These are the signs of obstruction:

  • poor flow
  • hesitancy
  • post void dribbling
  • intermitenency (stopping and starting during urination)
  • incomplete emptying
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16
Q

Name two systemic causes of urinary incontience

A

Heart failure

Diabetes

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17
Q

What measurements can you get from a frequency volume chart?

A 
Voided volume 
Frequency of urination 
Quantity and frequency of leakage 
Fluid intake 
Diurnal variation
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18
Q

How can the frequency volume chart be used?

A

As part of initial assessment

Planning treatment and behavioural therapy

19
Q

What do nitrites indicate in an MSU?

A

Infection

20
Q

What do leucocytes indicate in an MSU?

A

Infection

21
Q

What does microscopic haematuria indicate in an MSU?

A 
GN
Nephropathy 
Cancer 
Infection 
Calculus
22
Q

What do proteinuria indicate in an MSU?

A

Renal disease

Cardiac disease

23
Q

What do glycosuria indicate in an MSU?

A

Diabetes

Nephropathy

24
Q

How can residual urine measurement be measured?

A

Pelvic exam - palpable bladder
In and out catheter
USS

25
Q

What are the domains of the ePAQ questionnaire?

A

urinary
bowel
vaginal
sexual function

26
Q

What is urodynamic testing and how often is it done?

A

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

27
Q

How do we treat stress incontinence?

A

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
28
Q

How do we treat OAB?

A
  1. Lifestyle advice
  2. Bladder training
  3. Anticholinergic drugs
  4. Botox (Botulinum toxin)
  5. Augmentation
  6. Bypass eg catheters
29
Q

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

A

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

30
Q

What are the supportive measures for living with incontinence?

A 
Bladder bypass - catheter
Pads and pants 
Vaginal support devices 
Skin care and vaginal oestrogen
Odor control
31
Q

How is the bladder innervated

A

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

32
Q

What does the parasympathetic nerve innervation do?

A

Voiding

Produces bladder contraction and sphincter relaxation

33
Q

What does the sympathetic nerve innervation do?

A

Storage

Bladder relaxation

34
Q

What neurotransmitter is used by the parasympatheitc NS?

A

Ach

35
Q

What type of receptors are there in the parasympathetic NS?

A

Muscarinc M2 and M3

36
Q

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

A

Oxybutinin
Solifenacin
Trospium

(act in the same way as atropine, but we don’t give atropine)

37
Q

What are the side effects of oxybutinin?

A 
(sympathetic effects as antagonises the parasympathetic NS) 
- dry mouth 
- blurred vision 
- drowsiness/cognitive impairment 
- constipation
- tachycardia 
-
38
Q

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

A

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

39
Q

How does botox work as a treatment for urge incontienece?

A

Blocks release of Ach at nerve endings

40
Q

What type of catheters are there?

A

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

41
Q

WHat does physiotherapy involve?

A

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

42
Q

What are the symptoms of prolapse?

A

something coming down
Lump
incontienence
Dyspareunia

43
Q

How are prolapses graded?

A
  1. first degree
  2. second degree
  3. third degree
  4. fourth degree = complete procidentia
44
Q

What are the treatment options for prolapse?

A

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

Phase 3a Gynaecology (13 decks)

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