Urogynaecology assessment of pelvic floor disorders Flashcards
Define Incontinence and OAB
Incontinence: Involuntary leakage of urine
OAB: Involuntary detrusor contractions –> Urgency
What are the main symptoms of OAB?
1) Urgency
2) Frequency
3) Nocturia
4) “key in door” urgency
Define stress incontinence
Anything that leads to increased I-A pressure w/ weak urethral sphincter e.g. coughing, laughing,
What is the functional bladder capacity?
400ml
What is the epithelium and innervation of the detrusor muscle?
Ep: Smooth muscle w/ transitional epithelium
In: Sacral parasympathetic
What investigations would you do in an incontinent patient?
1) Urinalysis
2) ePAQ
3) Bladder diary (frequency vol. chart)
4) Residual urine measurement e.g. catheter/USS
What is ePAQ?
Questionnaire about urinary, bowel, vaginal and sexual symptoms
What information does a bladder diary present?
1) Diurnal variation
2) Fluid intake
3) Quantity of urine
4) Frequency
What are the non-pharmacological treatments for OAB?
1) Pads
2) Bladder drill training
3) LS changes e.g. W. Loss, stop smoking, reduce caffeine, avoid straining
What are the non-pharmacological treatments for stress incontinence?
1) Physiotherapy e.g. Pelvic Floor/Kegel
2) LS changes e.g. weight loss, stop smoking, reduce caffeine, avoid straining
How do pelvic floor exercises help treat SI?
PF Musc cont -> Urethra compression -> ^ urethral compression -> reduced leakage
What drugs can treat OAB?
1) Botulinum Toxin
2) Mirabegron
3) Oxybutynin
What surgical options for SI?
1) Sling
2) Suspension: Restores pressure to urethra and restores urethra
How do Mirabegron and Botox work in treating OAB?
Botox: Blocks Ach release, so V detrusor contraction
Mirabegron: Beta 3 agonist, relaxes detrusor and increases bladder capacity
How does Oxybutynin work and what are the side effects?
Anticholinergic as M2/3 agonist, V detrusor innervation and activity
SE: Blurred vision, constipation, dry mouth and cognitive impairment
What are the main symptoms of prolapse?
1) Sexual symptoms
2) Discomfort
3) Pain
4) Lump
What is the management for prolapse?
1) Reassurance
2) Symptom management
3) Vaginal pessaries e.g. ring
4) Surgery
What state is the detrusor in during storage and void?
Storage: Relax
Voiding: Contract
What is the physiology of micturition?
1) Bladder fills, stimulating stretch receptors
2) Detrusor PS stimulation by afferent impulse and contracts
3) Urethral sphincter relaxes by inhibition of neurones
4) PAG stimulated
