Urogynaecology Assessment Flashcards
1
Q
History of Urinary Symptoms
A
- Number of voids
>8/ day abnormal
>1/night abnormal - Urgency
- stress
- Coital incontinence
- Insensible incontinence
- Continence aids
- dysuria, frequency, haematuria
- Hesitancy and incomplete emptying
- previous treatment
- Affect on quality of life, ability to work
2
Q
History of bowel symptoms
A
- Constipation/diarrhoea
- Incontinence/Urgency
- Tenesmus
- Digitation for defaecation
3
Q
Prolapse symptoms
A
- lump
- Pressure sensation
- heaviness
- Dragging
4
Q
Fluid
A
- Total intake
- Alcohol
- Caffeine
- Soft drinks
- Timing
5
Q
Sexual dysfunction
A
- Changes in sexual function
- Dyspareunia/anorgasmia/poor sensation
6
Q
Oestrogen deficiency
A
Vaginal dryness
7
Q
Other relevant past history
A
o Obs – number of deliveries, mode and weights
o Gynae – menopause, HRT, pelvic surgery
o Med – diabetes, cardiac failure, neurological condition, UTI, chronic cough,
functional impairment (immobility)
o Psych – depression
o Drugs – Diuretics, cholinergics (for myasthenia gravis, Alzheimers), sedatives
8
Q
Relevant Examination
A
- General: BMI, vitals, mobility, urine dipstick
- Abdomen: Faecal loading, pelvic mass
- Cardiovascular: Evidence of cardiac failure, suitability for surgery
- Gynaecological
o External genitalia: atrophy, prolapse, provoked stress incontinence
o Speculum: POP-Q (assessment of each compartment with Valsalva and at rest), vaginal atrophy
o Bimanual: Uterine size, mobility, suitability for VH, tone of pelvic floor muscles - Consider Q-tip test for urethral hypermobility (change in angle >30° significant)
- PR/rectovaginal examination for tone/sensation
- Consider assessment of post void residual with in-out catheter
9
Q
Investigations
A
- Bladder diary for 3 days (do not have to be consecutive)
- UEC
- Urine MCS or cytology
- Imaging
o Pelvic/renal ultrasound
o CT IVP
o Endoanal ultrasound - Urodynamic studies
