Urogynaecology

Question 1

What are the different types of incontinence?

Answer 1

Urge Stress Overflow Mixed

Question 2

What is the 1st line Tx for:

• Urge incontinence
• Stress incontinence
• Mixed incontinence
• Overflow incontinence

Answer 2

Urge - Bladder training

Stress - Kegel exercise (pelvic floor muscle training)

Mixed - Kegel exercise (pelvic floor muscle training)

Overflow - Catheterisation

Question 3

What surgical options are available to patients suffering from stress incontinence?

Answer 3

Laporoscopic colposuspension

Autologous fascial sling

Mid-urethral mesh sling

Consider bulkamid injection to manage stress incontinence if alternative procedures are unavailable to the women

Remember: Sling/suspension for Stress

Question 4

What surgical procedures are available to patients with uterus prolapse

Answer 4

Manchester repair

Vaginal hysterectomy

Vaginal sacrospinous hysteropexy

Question 5

What surgical procedures are available for patients with vaginal vault prolapse?

Answer 5

Vaginal sacrospinous fixation with sutures

Sacrocolpopexy

Question 6

What surgical procedures are available for anterior and posterior vaginal wall prolapse?

Answer 6

Anterior wall repair

Posterior wall repair

Both do not involve the use of mesh

Question 7

A 64-year-old lady presents to the GP with urinary incontinence. On further questioning, she notes that the symptoms of incontinence are worst after she coughs or sneezes. She has had 4 children, all through vaginal delivery, the last of which was 30 years ago. These symptoms have been worsening for the last 6-weeks.

Given this woman’s presentation, which of the following investigations should be ordered?

A. Post-void residual volume

B. Cytoscopy

C. Urinary flow assessment

D. Urinalysis

E. USS of the kidneys

Answer 7

Urinalysis

Rules out possibility of UTI aggravating symptoms

Question 8

What are some risk factors for pelvic organ prolapse?

Answer 8

Childbirth

Abdominal surgery

Menopause

Multiparity

Obesity

Heavy lifting

Question 9

What is some lifestyle advice for patients with pelvic organ prolapse?

Answer 9

Treat chronic cough i.e stop smoking

Lose weight

Avoid heavy lifting

Avoid straining (i.e constipation)

Question 10

What is some lifestyle advice for patients with urge incontinence?

Answer 10

Avoid caffeinated beverages

Avoid alcohol

Lose weight if overweight