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Women's Health - GYN > Urology > Flashcards

Urology Flashcards

1
Q

________ and __________ hold the uterus and upper vagina in their proper place over the levator plate.

A

Cardinal and uterosacral ligaments

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2
Q

Signs/sx’s of pelvic organ prolapse

A

urgency, freq, urge incontinence, recurrent UTIs

obstructive voiding sx’s due to urethral kinking

need unusual positions to void

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3
Q

Sx’s of rectocele

A

constipation and difficult defecation with distal stool trapping

patient reports manually assisting evacuation with finger in vagina

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4
Q

Most common type of pelvic organ prolapse

A

cystocele (anterior compartment prolapse) where bladder protrudes into vagina

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5
Q

How to workup cystocele with recurrent UTIs?

A

PVR eval (post-void residual)

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6
Q

If patient has positive PVR, what should be checked next?

A

check upper urinary tract/ kidneys for hydronephrosis

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7
Q

Enterocele or middle compartment prolapse

A

intestines prolapse into vagina

post hysterectomy

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8
Q

When should uterine prolapse be referred to urology?

A

dyspareunia
extension past introitus
difficulty defecating or urinating

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9
Q

Non-surgical therapy for prolapse

A

treat associative factors: chronic cough, obesity, constipation

Pessary - device placed into vagina to support uterus or bladder and rectum

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10
Q

Can imperforate hymen obstruct urine flow? What does it obstruct?

A

No urine flow blockage, but does prevent vaginal secretions

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11
Q

hydrometrocolpos

A

expanded fluid filled vaginal cavity, usually from imperforate hymen

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12
Q

PE of labial fusion

A

labia minora fused together in newborn

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13
Q

Labial fusions can spontaneously resolve, but when should it be treated? With what?

A

urine pooling in vagina with voiding, freq UTIs, parent request

tx: topical estrogen cream, consider surgical or manual separation

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14
Q

Orgasmic disorder in women

A

APA guidelines necessitates that an acceptable and preferred form of sexual stimulation has occurred and orgasm has not resulted

** absence of climax from coitus should not be diagnosed as sexual dysfunction unless it represents a distressing change from a woman’s prior state of affairs

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15
Q

vaginismus

A

Recurrent or persistent involuntary spasm of musculature of outer third of vagina that interferes with sexual intercourse

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16
Q

Medications that may cause female arousal/orgasm disorders

A

SSRI

Oral contraceptives

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17
Q

Pharm therapy for female sexual dysfunction

A

topical estrogen - estriol (E3) has highest affinity for vagina

PDE-5I like Viagra

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18
Q

Muscles of pelvic floor

A

levator ani muscles: puborectalis, pubococcygeus, iliococcygeus

coccygeus

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19
Q

If patient has high PVR, what should be checked next?

A

check upper urinary tract/ kidneys for hydronephrosis

CT urogram or U/S

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20
Q

When can transient incontinence occur?

A

after childbirth

during an acute UTI

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21
Q

When to refer to urology for incontinence?

A 
Total incontinence
Incontinence associated with pain
Hematuria
Recurrent infection
Pelvic irradiation
Radical pelvic surgery
Suspected fistula
Significant post void residual (>200cc)
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22
Q

Involuntary urine leakage on effort or exertion (sneezing, coughing) =

A

stress urinary incontinence

23
Q

Majority of stress incontinence occurs in what women?

A

after middle-age

repeated vaginal deliveries and obstructed labor

24
Q

Pathophysiology of incontinence

A

weakness/disruption of pelvic floor muscle and ligaments

hypermobility of sphincteric unit - loses closing efficiency

25
Q

Medicine that can cause urinary incontinence

A

anti-cholinergics, opiates

26
Q

How to treat mild and moderate stress urinary incontinence?

A

weight loss
caffeine reduction
pelvic floor muscle training
alpha adrenergic agonist (eg. Sudafed)

If initial management fails, refer for surgery

27
Q

Possible causes of Overactive Bladder

A 
Neuro injuries
Radiation
Inflammation
Caffeine
Diabetes
BOO leading to bladder damage (detrusor m.)
28
Q

Symptoms of urge incontinence

A

sudden urge with uncontrolled loss of urine

“I pee before making it to the bathroom”

29
Q

Non-pharmaceutic treatment of urge incontinence

A

Lifestyle - fluids, caffeine, alcohol

Bladder training with scheduled voiding

PT for pelvic muscle training and relaxation techniques

30
Q

Medical treatment of OAB and urge incontinence

A

Anticholinergics 1st line

  • Oxybutynin (Ditropan)
  • Tolterodine (Detrol LA)

More selective muscarinic (M3) receptor antagonists

31
Q

Presence of stress incontinence and urge incontinence =

A

mixed urinary incontinene (MUI)

32
Q

Treatment of mixed urinary incontinence

A

Treat most bothersome aspect, or if equal treat with anticholingeric first

33
Q

Primary care provider’s role in treating Overflow incontinence?

A

refer, get cath

34
Q

84 yo male with 3 diapers daily for incontinence. He is unaware of when he leaks. HIs creatinine is 1.8 and takes no meds. Three diagnostic labs or studies to eval?

A

UA, U/S kidney, PVR

35
Q

Involuntary loss of urine associated with bladder over-distension =

A

overflow incontinence

36
Q

2 pathophysiologic causes of overflow incontinence and how they may occur?

A

atonic bladder - meds, nerve injury, chronic overdistention

outflow obstruction - BPH, bladder neck contracture or stricture, cystocele, pelvic organ prolapse, previous incontinence surgery

37
Q

How to dx overflow incontinence?

A

PVR of >200mL

38
Q

Lower UTI in females age 16-35 vs 36-65 vs > 65

A

16-35: Sexual intercourse, diaphragm use
36-65: Gynecologic surgery, bladder prolapse
>65: Incontinence, Chronic use of urinary catheters

39
Q

Host defenses of UTI

A

Unobstructed urinary flow
Urine components: osmolality, urea, organic acid, and pH, Tamm-Horsfall glycoprotein inhibit bacterial adherence
Normal flora of periurethral area (Lactobillus)
Urothelial cells express receptors - upon attachment of bacteria, inflamm mediators produced

40
Q

Risk factors for UTI

A

Recurrent UTIs
Alterations in periurethral environment damage flora (menopause, abx use)
Soiling of perineum from fecal incontinence
Neuromuscular diseases
Bladder cath

41
Q

Work-up of acute cystitis

A

UA, urine culture, if uncomplicated imaging not necessary

42
Q

UA results of acute cystitis

A

nitrate and leuk positive

WBC and/or RBC in urine

43
Q

Which abx to treat UTI has least resistance to E. coli?

A

nitrofurantoin

44
Q

Reasons for recurrent cystitis in females

A

incomplete tx of previous UTI, kidney stones, obstructive uropahty, genetic predisposition, post-menopausal, fistula

45
Q

Acute cystitis treatment

A

3-5 days of abx: Nitrofurantoin, TMP-SMX (Bactrim), or Fluoroquinolone (Cipro)

46
Q

Work-up of recurrent cystitis

A

typical UA and culture PLUS upper tract imagine

U/S, IV pyelogram, cystoscopy, CT scan

47
Q

What are signs of vesicovaginal fistula?

A

leaking urine/incontinence
hematuria
painless

48
Q

What are signs of vesicovaginal fistula?

A

leaking urine
hematuria

??????

49
Q

Management of recurrent cystitis

A

Longer antibiotic course required: 7-14 days of fluroquinolone

Surgical removal of reinfection source (such as urinary calculi or fistula)

Prophylactic abx: take low dose continuously, patient initiated therapy at sign of sx’s, take single dose post-coital

50
Q

Alternatives to antibiotic therapy for prevention of recurrent cystitis

A

Intravaginal estriol in postmenopausal women
Lactobacillus vaginal suppositories
Cranberry juice
Post coital hygiene

51
Q

Overflow incontinence treatment in men

A

alpha-adrenergic blocker to reduce prostate size in men

52
Q

Common cause of UTI in pregnancy

A

hydronephrosis with resultant urinary stasis due to compression of urinary tract by uterus

53
Q

Overflow incontinence treatment

A

alpha-adrenergic blocker to reduce prostate size in men

Women's Health - GYN (12 decks)

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