Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

ΩΩ 3a Bateman - Obs and Gynae > Urogynaecology > Flashcards

Urogynaecology Flashcards

1
Q

WHAT ARE THE RISK FACTORS FOR URINARY INCONTINENCE?

A
  1. Advancing age
  2. Previous pregnancy and childbirth
  3. High body mass index
  4. Hysterectomy
  5. Family history
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

WHAT IS STRESS INCONTINENCE?

A

Unintentional loss of urine.

Physical movement or activity — such as coughing, laughing, sneezing, running or heavy lifting — puts pressure (stress) on your bladder, causing you to leak urine.

Stress incontinence is not related to psychological stress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the cause of stress incontinence?

A

Stress incontinence occurs when the muscles and other tissues that support the urethra (pelvic floor muscles) and the muscles that control the release of urine (urinary sphincter) weaken

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the symptoms of stress incontinence?

A

Leak urine when you:

  1. Cough or sneeze
  2. Laugh
  3. Bend over
  4. Lift something heavy
  5. Exercise
  6. Have sex
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the diagnosis for stress incontinence?

A
  1. Bladder diary for a minimum of 3 days
  2. Physical exam, which may include a rectal exam and a pelvic exam in women
  3. Urine sample/Urinalysis to test for infection, traces of blood or other abnormalities
  4. Brief neurological exam to identify any pelvic nerve problems
  5. Urinary stress test, in which the doctor observes urine loss when you cough or bear down
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the treatment for stress incontinence?

A

1) Pelvic floor muscle retraining, 8x3 per day
2) Surgical procedures: e.g. retropubic mid-urethral tape procedures
3) Duloxetine may be offered to women if they decline surgical procedures

a combined noradrenaline and serotonin reuptake inhibitor

mechanism of action: increased synaptic concentration of noradrenaline and serotonin within the pudendal nerve → increased stimulation of urethral striated muscles within the sphincter → enhanced contraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

WHAT IS URGE INCONTINENCE?

A
  1. Due to detrusor overactivity
  2. The urge to urinate is quickly followed by uncontrollable leakage ranging from a few drops to complete bladder emptying
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the symptoms of urge incontinence?

A
  1. Leak urine or have “urge incontinence.” This means urine leaks when you feel the sudden urge to go.
  2. Urinate frequently. You may need to go to the bathroom many times during the day.
  3. Wake up at night to pass urine.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How do you diagnose urge incontinence?

A
  1. Bladder diaries should be completed for a minimum of 3 days
  2. Vaginal examination to exclude pelvic organ prolapse and ability to initiate voluntary contraction of pelvic floor muscles (‘Kegel’ exercises)
  3. Urine dipstick and culture
  4. Urodynamic studies
  5. Cystometry
    • Spikes of increased intravesical pressure appearing without the specific instruction to void, and which cannot be inhibited.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the treatment for urge incontinence?

A
  1. First bladder retraining for a minimum of 6 weeks
  2. FIRST LINE - ANTIMUSCARINICS
    Oxybutynin - avoid in frail old ladies
    Tolterodine or
    Darifenacin
  3. Mirabegron (a beta-3 agonist) may be useful if there is concern about anticholinergic side-effects in frail elderly patients
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How is stress incontinence different from urgency incontinence/overactive bladder (OAB)?

Who is stress incontinence more common in?

A

If you have urgency incontinence or OAB, your bladder muscle contracts, causing a sudden urge to urinate before you can get to the bathroom.

Stress incontinence is much more common in women than in men.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

WHEN SHOULD A VESICOVAGINAL FISTUAL BE SUSPECTED?

A

Vesicovaginal fistulae should be suspected in patients with continuous dribbling incontinence after prolonged labour and from an area with limited obstetric services.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How do you diagnose a vesicovaginal fistula?

A

Urinary dye studies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is overflow incontinence?

A

Overflow incontinence: due to bladder outlet obstruction, e.g. due to prostate enlargement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What investigations suggest overflow incontinence?

A

Normal bladder function should have a voiding detrusor pressure rise of < 70 cm H20 with a peak flow rate of > 15 ml/second

A high voiding detrusor pressure with a low peak flow rate is indicative of bladder outlet obstruction.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

WHAT ARE THE DIFFERENT TYPES OF PELVIC ORGAN PROLAPSE?

A

Cystocele

Uterine prolapse

Rectocele

17
Q

What is a uterine prolapse?

A

Uterine prolapse occurs when pelvic floor muscles and ligaments stretch and weaken and no longer provide enough support for the uterus.

As a result, the uterus slips down into or protrudes out of the vagina.

18
Q

What are the symptoms of a uterine prolapse?

A

Pressure in the pelvis

Vaginal symptoms e.g. bulging, pressure

Urinary symptoms e.g. incontinence, frequency

Bowel symptoms e.g. incontinence, incomplete emptying

Sexual symptoms e.g. decreased sensation

19
Q

What are the causes of a uterine prolapse?

A
  1. Pregnancy
  2. Difficult labor and delivery or trauma during childbirth
  3. Delivery of a large baby
  4. Being overweight or obese
  5. Lower estrogen level after menopause
  6. Chronic constipation or straining with bowel movements
  7. Chronic cough or bronchitis
  8. Repeated heavy lifting
20
Q

How is a uterine prolapse diagnosed?

A

Pelvic examination

Speculum examination

DRE

21
Q

What is the treatement for a uterine prolapse?

A
  1. Self-care measures
    Kegel exercise
    Losing weight
    Teating constipation
  2. Pessary
  3. Repair of weakened pelvic floor tissues
  4. Hysterectomy
  5. Sacrohysteropexy
22
Q

What is a Rectocele?

A

Also called a posterior vaginal prolapse

A rectocele is when the thin wall of tissue that separates the rectum from the vagina weakens, allowing the vaginal wall to bulge

23
Q

What are the symptoms of a rectocele?

A

May cause no signs or symptoms.

Maybe:
A soft bulge of tissue in your vagina that might protrude through the vaginal opening

Difficulty having a bowel movement

Sensation of rectal pressure or fullness

A feeling that the rectum has not completely emptied

Sensing looseness in the tone of your vaginal tissue

24
Q

What are the causes of a rectocele?

A

Results from pressure on the pelvic floor.

Causes of increased pelvic floor pressure include:

  1. Chronic constipation or straining with bowel movements
  2. Chronic cough or bronchitis
  3. Repeated heavy lifting
  4. Being overweight or obese
  5. Pregnancy
25
Q

What is the diagnosis for a rectocele?

A
  1. Pelvic exam
  2. Filling out a questionaire
    Sensation of pressure, heaviness, ‘bearing-down’
  3. Bladder and urine
    Urinary symptoms: incontinence, frequency, urgency
26
Q

What is the treatment for a rectocele?

A
  1. Observation
  2. Simple self-care measures
    Such as performing Kegel exercises to strengthen your pelvic muscles
  3. Pessary
  4. Surgery
    • Posterior colporrhaphy
27
Q

What is a cystocele?

A

Anterior vaginal prolapse, also known as a cystocele (SIS-toe-seel) or a prolapsed bladder, is when the bladder drops from its normal position in the pelvis and pushes on the wall of the vagina.

28
Q

What is the cause of a cystocele?

A

Ligaments that hold your bladder up and the muscle between a woman’s vagina and bladder stretches or weakens, allowing the bladder to sag into the vagina

29
Q

What are the symptoms of a cystocele?

A
  1. A feeling of fullness or pressure in your pelvis and vagina
  2. In some cases, a bulge of tissue in your vagina that you can see or feel
  3. Increased pelvic pressure when you strain, cough, bear down or lift
  4. Problems urinating, including difficulty starting a urine stream, the feeling that you haven’t completely emptied your bladder after urinating, feeling a frequent need to urinate or leaking urine (urinary incontinence)
30
Q

How do you diagnose a cystocele?

A
  1. Pelvic exam
  2. Filling out a questionaire
    Sensation of pressure, heaviness, ‘bearing-down’
  3. Bladder and urine
    Urinary symptoms: incontinence, frequency, urgency
31
Q

What is the treatment for a cystocele?

A
  1. Pelvic floor exercises
  2. A supportive device (pessary)
  3. Surgery
    • Anterior colporrhaphy
    • Colposuspension
32
Q

WHAT ARE THE DIFFERENT TYPES OF VAGINAL FISTULAS?

A

Vesicovaginal fistula. Also called a bladder fistula, this opening occurs between your vagina and urinary bladder and is the type that doctors see most often.

Ureterovaginal fistula. This type of fistula happens when the abnormal opening develops between your vagina and the ducts that carry urine from your kidneys to your bladder (ureters).

Urethrovaginal fistula. In this type of fistula, also called a urethral fistula, the opening occurs between your vagina and the tube that carries urine out of your body (urethra).

Rectovaginal fistula. In this type of fistula, the opening is between your vagina and the lower portion of your large intestine (rectum).

Colovaginal fistula. With a colovaginal fistula, the opening occurs between the vagina and colon.

Enterovaginal fistula. In this type of fistula, the opening is between the small intestine and the vagina.

33
Q

What are the symptomas of vaginal fisutlas?

A

Fever

Belly pain

Diarrhea

Weight loss

Nausea

Vomiting

34
Q

What is the cause of a vaginal fistula?

A
  1. Childbirth
  2. Abdominal surgery (hysterectomy or cesarean section)
  3. Pelvic, cervical, or colon cancer
  4. Radiation treatment
  5. Bowel disease like Crohn’s or diverticulitis
  6. Infection (including after an episiotomy or a tear you had when you gave birth)
  7. Traumatic injury, such as from a car accident
35
Q

How do you diagnose a vaginal fistula?

A
  1. Dye test
  2. Cystoscopy
  3. Retrograde pyelogram - dye and x-rays
  4. Fistulogram - x-ray t.
36
Q

What is the treatment for a vaginal fistula?

A

Heal on their own

Special glue or plug

Surgery

37
Q

WHAT ARE THE LONG TERM COMPLICATIONS OF HYSTERSCOPY?

A

Common long term complications of vaginal hysterectomy with antero-posterior repair include enterocoele and vaginal vault prolapse

38
Q

What is a acute complication of hysterscopy?

A

Urinary retention may occur acutely following hysterectomy, but it is not usually a chronic complication.

ΩΩ 3a Bateman - Obs and Gynae (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions