Urogynecology Flashcards
1
Q
What is the minimal acceptable preoperative assessment for urinary incontinence?
A
- Focused Hx
- Pelvic examination
- Demonstrate UVJ mobility
- Objective evidence SUI (including assessment for latent)
- PVR
- Urine R+M, C+S
(SOGC127)
2
Q
What are the goals of pelvic examination when assessing urinary incontinence?
A
1, Identify masses impinging on the urinary tract structures
2, Quantify degree of POP - ant/middle/posterior vaginal compartments
3. Detect latent SUI
4. Assess strength and voluntary control of levator Ani muscles
5. Determine health of urogenital mucous
(SOGC127)
3
Q
What are the more common and rare complications of TVT?
A
More common:
- bleeding, hematoma
- erosion of mesh into the urethra or vagina
- bladder perforation, retention
- de novo urge symptoms, voiding dysfunction
- infection
Rare case reports
- delayed bowel erosion/injury/obstruction
- urethral diverticulum
- urethral erosions
- paraurethral abcess
- vesical calculi
- Fistulas
- Nec Fasc
- Nerve damage
4
Q
What are the causes of urinary incontinence following pelvic floor surgery? (Early and Late causes)
A
Early Causes of Urinary Incontinence
- Surgical correction of stress incontinence either unsuccessful or not sustained
- Latent (occult) stress incontinence not recognized preoperatively in a patient with pelvic organ prolapse
- An intraoperative or postoperative complication of surgery (eg fistula)
- Surgery was inappropriate therapy or an inappropriate procedure used
- Pre-existing or de novo overactive bladder causing urgency incontinence
- Urinary tract infection causing urgency incontinence
- Voiding dysfunction causing urgency/frequency or overflow incontinence
Long-term Progressive Causes of Urinary Incontinence
- Deficiency of pelvic floor support either through genetic predisposition or other medical condition
- Predisposing medical condition (eg COPD, obesity, chronic constipation)
- Urogenital aging and estrogen deficiency
