Urogynecology Flashcards
Most common type of urinary incontinence
Mixed (but closely followed by stress)
How is OAB different from urge incontinence?
Can be “dry” or “wet” – always includes urgency, frequency, and nocturia
What structure is weakened allowing urethral hypermobility?
Endopelvic fascia
Risk factors for SUI
Age (45-49)
White race
Obesity (BMI > 30 doubles risk)
Pregnancy and childbirth
How long can transient urinary incontinence typically last after childbirth?
3 months (92% of those still present then will still be problematic 5 yrs later)
When to do urodynamics
- Mixed incontinence
- Refractory incontinence
- Neurogenic bladder
- Incontinence after surgery
In urodynamics, Pves =
Pdet + Pabd
Urodynamics in urge incontinence is notable for…
Pdet (pressure in detrusor) increased at times not attempting to void… resulting in loss of urine
Urodynamics in stress incontinence is notable for…
Loss of urine when Pabd increases (ie. during cough)
Options for treatment of stress incontinence
- Do nothing
- PFPT
- Pessary / tampon
- Periurethral injections (urethral bulking)
- Sling (gold standard with 85% success rate)
- Artificial sphincter (not really a thing…)
Muscle tightened during Kegels
Pubococcygeus
Behavioral therapy for stress incontinence
Fluid management, timed void, bladder training, PFPT
Drug class of oxybutynin, tolterodine, solifenacin, trospium
Anticholinergic
Mechanism of anticholinergics
Antagonist to muscarinic receptors (including the ones that make the detrusor muscle contract)
Drug class of mirabegron and vibegron (Gemtesa)
Beta agonist
Mechanism of beta agonist
Promote bladder relaxation
Side effects of anticholinergics
Dry mouth, constipation (more rarely somnolence, dry eyes)
Contraindications to anticholinergics
Narrow angle glaucoma, gastroparesis
Indication and protocol for posterior tibial nerve stimulation
For OAB; motor (toe) and sensory (sole of foot) to acupuncture needle in nerve, 12 weekly sessions of 30 minutes each
Mechanism of Botox
Acetylcholine transmission blocked by cleaving SNAP25 molecule, which usually allows them to fuse to membrane
Nerve impacted by Interstim
S3
POP-Q staging criteria
0 = anterior and posterior -3 1 = not stage 0 but also leading edge <-1 cm 2 = leading edge between -1 and +1 cm 3 = leading greater than + 1 cm 4 = leading edge maximum possible descent
Women’s lifetime risk of POP repair or UI surgery
11%
Nerve at risk during sacrospinous ligament fixation and its location
Pudendal, passes by the ischial spine (trapping results in severe buttock pain and requires take-back)
Vessels passing nearby location of sacrospinous ligament fixation
Internal obturator, inferior gluteal, and pudendal arteries
Where does SSLS suture go?
2 cm medial to ischial spine on the ligament
What is McCalls culdoplasty?
Purse-string to gather USL and peritoneum after vaginal hysterectomy
How to diagnose interstitial cystitis
Diagnosis of exclusion
Possible cystoscopic findings of interstitial cystitis
Glomerulations, Hunner’s ulcer
Treatment of interstitial cystitis
Dietary modification, bladder analgesics, urothelial therapy
Critical ingredient of bladder instillation for interstitial cystitis
Heparin (glycosaminoglycan that coats the bladder walls)
Oral meds for interstitial cystitis
Phenazopyradine, TCA (like amitriptyline), antihistamine
Typical timing for fistula presentation after hysterectomy
7-21 days
Hyst with highest rate of bladder injury
LAVH and TVH
How to repair bladder
Interrupted sutures of 2-0 or 3-0 Vicryl, in layers, water tight
