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Gynaecology > Urogynaecology and prolapses > Flashcards

Urogynaecology and prolapses Flashcards

1
Q

What are risk factors for incontinence- particularly stress incontinence?

A

age (especially post-menopause), parity, obesity, smoking

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2
Q

Why is menopause a risk factor for incontience?

A

Tissues become thinner around urethra

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3
Q

What causes stress incontinence?

A

sphincter weakness

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4
Q

What causes an overactive bladder/ urge incontinence?

A

Detrusor overactivity because of neurological damage eg MS, spinal cord compression

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5
Q

What are the types of bladder incontinence?

A

stress incontinence, overactive, fistula, prolapse, overflow, functional, mixed incontinence

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6
Q

What causes a fistula?

A

caused by cervical cancer, obstructive labour, surgical complication

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7
Q

What is a fistula?

A

fistula is a hole between two epithelial surfaces

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8
Q

What is a cystocele?

A

prolapse type where the bladder bulges into the vagina

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9
Q

What are symptoms of an overactive bladder?

A 
Urgency 
Frequency 
Nocturia 
Nocturnal enuresis- wetting the bed 
“key in the door” 
“handwashing” 
intercourse causes incontinence
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10
Q

What can trigger stress incontinence?

A

Leakage due to a:

Cough 
Laugh 
Lifting 
Exercise 
movement
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11
Q

What investigations do you do for incontinence?

A

Frequency volume chart- bladder diary
MSU
U/S for residual urine - if incomplete emptying or voiding issues
EPAQ questionaiire to evaluate QOL
urodynamics (if OAB, voiding dysfunction, prolapse, or surgery failed)

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12
Q

What is urodynamics?

A

use to differentiate whether diagnosis is stress or overactive, catheter is inserted to back passage and bladder to calculate pressure

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13
Q

What do the results on a MSU mean?

A

look at nitrites and leukocytes (UTI), blood (nephropathy, cancer, infection), protein (renal and heart disease), glucose (nephropathy, DM, IGT)

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14
Q

What is the management for incontinence?

A

Lifestyle- lose weight, smoking cessation, less caffeine, avoid straining

Physiotherapy

Containment- catheter (if is going to be permanent do suprapubic), leakage barrier eg pads, skin care, odour control

Oestrogen PV especially if post-menopausal

Beta-3 agonist

Anticholinergics

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15
Q

How fo the beta 3 agonists works for incontinence?

A

relaxes SM of detrusor and so increases bladder capacity

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16
Q

How fo the anticholinergics work for incontinence?

A

works as bladder is innervated by sacral parasympathetic with Ach

17
Q

What are some examples of anticholinergics?

A

oxybutynin, trospium, tolterodine, solefenacin (1st line)

18
Q

What are the SE of anticholinergics?

A

dry mouth, drowsiness, constipation, confusion, blurry vision, sweating, tachycardia

19
Q

What management would you specifically do for an overactive bladder?

A

1st line: Bladder drill (bladder training - slowly stretch the bladder)
2nd line: Anticholinergics / Mirabegron
3rd line: Botox
4th line: Bypass - surgery to put in catheter

20
Q

What management would you specifically do first line for stress incontinence?

A

PT- pelvic floor (increases pressures on urethra), electric stimulation, vaginal cones

21
Q

What is second line management for stress incontinence?

A

Surgery- sling or suspension

22
Q

What is a pelvic floor prolapse?

A

where muscle/fascia/ligaments in pelvis fail causing the uterus, bladder and bowel descend from the normal anatomic position towards or through the vaginal opening.

23
Q

What are the causes of a prolapse?

A

connective tissue disorder, CHILDBIRTH, age, obesity, chronic constipation

24
Q

Wht are the symptoms of a prolapse?

A

Lump, pain (if prolpase outside vagina and can become irritated and ulcerated), dragging sensation, dyspareunia and sexual symptoms

25
Q

What are the investigations for a prolapse?

A

Examine with a speculum

Investigations normally unnecessary but may do urodynamics, MRI and U/S

26
Q

What is the management for a prolapse?

A

Repair prolapse if symptomatic or severe

Management= reassure, treat symptoms, pessary (ring/Gellhorn/shelf- keeps uterus in place), hysterectomy

27
Q

What should you ask the woman to do whilst examining a prolapse?

A

Cough- makes prolapse easier to see and may show urianry leakage

Gynaecology (12 decks)

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