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OB/GYN Boards by Subject > Urogynecology > Flashcards

Urogynecology Flashcards

1
Q

Most common type of urinary incontinence

A

Mixed (but closely followed by stress)

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2
Q

How is OAB different from urge incontinence?

A

Can be “dry” or “wet” – always includes urgency, frequency, and nocturia

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3
Q

What structure is weakened allowing urethral hypermobility?

A

Endopelvic fascia

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4
Q

Risk factors for SUI

A

Age (45-49)
White race
Obesity (BMI > 30 doubles risk)
Pregnancy and childbirth

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5
Q

How long can transient urinary incontinence typically last after childbirth?

A

3 months (92% of those still present then will still be problematic 5 yrs later)

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6
Q

When to do urodynamics

A
  1. Mixed incontinence
  2. Refractory incontinence
  3. Neurogenic bladder
  4. Incontinence after surgery
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7
Q

In urodynamics, Pves =

A

Pdet + Pabd

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8
Q

Urodynamics in urge incontinence is notable for…

A

Pdet (pressure in detrusor) increased at times not attempting to void… resulting in loss of urine

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9
Q

Urodynamics in stress incontinence is notable for…

A

Loss of urine when Pabd increases (ie. during cough)

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10
Q

Options for treatment of stress incontinence

A
  1. Do nothing
  2. PFPT
  3. Pessary / tampon
  4. Periurethral injections (urethral bulking)
  5. Sling (gold standard with 85% success rate)
  6. Artificial sphincter (not really a thing…)
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11
Q

Muscle tightened during Kegels

A

Pubococcygeus

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12
Q

Behavioral therapy for stress incontinence

A

Fluid management, timed void, bladder training, PFPT

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13
Q

Drug class of oxybutynin, tolterodine, solifenacin, trospium

A

Anticholinergic

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14
Q

Mechanism of anticholinergics

A

Antagonist to muscarinic receptors (including the ones that make the detrusor muscle contract)

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15
Q

Drug class of mirabegron and vibegron (Gemtesa)

A

Beta agonist

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16
Q

Mechanism of beta agonist

A

Promote bladder relaxation

17
Q

Side effects of anticholinergics

A

Dry mouth, constipation (more rarely somnolence, dry eyes)

18
Q

Contraindications to anticholinergics

A

Narrow angle glaucoma, gastroparesis

19
Q

Indication and protocol for posterior tibial nerve stimulation

A

For OAB; motor (toe) and sensory (sole of foot) to acupuncture needle in nerve, 12 weekly sessions of 30 minutes each

20
Q

Mechanism of Botox

A

Acetylcholine transmission blocked by cleaving SNAP25 molecule, which usually allows them to fuse to membrane

21
Q

Nerve impacted by Interstim

A

S3

22
Q

POP-Q staging criteria

A 
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
23
Q

Women’s lifetime risk of POP repair or UI surgery

A

11%

24
Q

Nerve at risk during sacrospinous ligament fixation and its location

A

Pudendal, passes by the ischial spine (trapping results in severe buttock pain and requires take-back)

25
Q

Vessels passing nearby location of sacrospinous ligament fixation

A

Internal obturator, inferior gluteal, and pudendal arteries

26
Q

Where does SSLS suture go?

A

2 cm medial to ischial spine on the ligament

27
Q

What is McCalls culdoplasty?

A

Purse-string to gather USL and peritoneum after vaginal hysterectomy

28
Q

How to diagnose interstitial cystitis

A

Diagnosis of exclusion

29
Q

Possible cystoscopic findings of interstitial cystitis

A

Glomerulations, Hunner’s ulcer

30
Q

Treatment of interstitial cystitis

A

Dietary modification, bladder analgesics, urothelial therapy

31
Q

Critical ingredient of bladder instillation for interstitial cystitis

A

Heparin (glycosaminoglycan that coats the bladder walls)

32
Q

Oral meds for interstitial cystitis

A

Phenazopyradine, TCA (like amitriptyline), antihistamine

33
Q

Typical timing for fistula presentation after hysterectomy

A

7-21 days

34
Q

Hyst with highest rate of bladder injury

A

LAVH and TVH

35
Q

How to repair bladder

A

Interrupted sutures of 2-0 or 3-0 Vicryl, in layers, water tight

OB/GYN Boards by Subject (22 decks)

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