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Women's Health > Urology > Flashcards

Urology Flashcards

1
Q

What supports the pelvic?

A

LEVATOR ANI MUSCLES
• Pubococcygeus
• Puborectalis
• Iliococcygeus

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2
Q

What are sx of pelvic organ prolapse?

A
  • Asymptomatic
  • Vaginal bulging
  • +/- Suprapubic pressure/pain
  • Urgency
  • Frequency
  • Urge incontinence
  • Recurrent UTI
  • Unusual position to void – pelvic titling/squatting/standing
  • Constipation – manual splinting
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3
Q

How do you tx anterior/cystocele? Mild, recurrent UTI, high stage cystocele?

A 
Mild
•	Observe/ no tx
Recurrent UTI
•	PVR eval
High stage Cystocele
•	Upper-tract image*
•	Check for hydroureteronephrosis w/ severe vaginal prolapse
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4
Q

What can cx enterocele?

A

• Post hysterectomy

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5
Q

How do you tx enterocele?

A

Refer

• If dysparunia or extension past introitus

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6
Q

How do you tx rectocele?

A

Nonsurgical Therapy
• Pessary
• Tx chronic cough, obesity, constipation
Refer
• If dyspareunia or difficulty defecating

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7
Q

What are two introitus issues in newborns?

A

imperforate hymen

labial fusion

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8
Q

What is imperforate hymen?

A
  • Prevents the output of normal vaginal secretion producing a hydrometrocolpos
  • Obstructs menses from excreting the body
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9
Q

How do you tx labial fusion?

A
  • Observe unless urine pools and can be associated w/ UTI

* Topical estrogen can be used

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10
Q

How do you tx labial fusion?

A
  • Observe unless urine pools and can be associated w/ UTI

* Topical estrogen can be used

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11
Q

What are the different types of incontinence?

A

stress
urge
mixed
overflow

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12
Q

What is stress incontinence?

A

• Involuntary urine leakage on effort/exertion/sneezing/coughing

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13
Q

What can cx stress incontinence?

A
  • Repeated vaginal deliveries and obstructed labor → weakness/disruption of the pelvic floor muscle and ligaments → poor support at bladder neck and sphincter
  • Meds → anticholingeric, opiates
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14
Q

How to tx stress incontinence?

A

Mild-Mod
• Lifestyle changes – wt loss, ↓caffeine, pelvic floor muscle training, response to alpha adrenergic agonist
• Refer if nothing works

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15
Q

What is urge incontinence?

A

• Involuntary loss of urine (frequency)+ urgency

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16
Q

What is RF for urge incontinence?

A

• Many births

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17
Q

What cx urge incontinence?

A

• Overactive Bladder (OAB) → loss of urine while attempting to inhibit mictrution

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18
Q

What are cx of OAB?

A
  • Neuropathic injuries – brain/spinal cord
  • Radiation
  • Inflammation (interstital cystitis, UTI)
  • Caffeine intake
  • BOO → bladder damage
  • DM
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19
Q

What are sx for urge incontinence?

A
  • Sudden urge w/ uncontrolled loss of urine – NOT associated w/ physical activity
  • +/- Cough induced
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20
Q

What are drugs to tx urge incontinence?

A

• Meds
o First line – anticholinergic agent (Oxybutynin, Tolterodine, Fesoterodine, Trospium)
o B3 agnoist
o Botox for the bladder

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21
Q

What is mixed urinary incontinence?

A

• Stress + OAB +/- urge incontinence

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22
Q

How to tx mixed urinary incontinence?

A
  • Tx the one that is the MOST bothersome: stress vs urge incontinence
  • If BOTH → tx urge incontinence (anticholinergic)
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23
Q

What is overflow incontinence?

A

• Involuntary loss of urine + bladder over-distension

24
Q

What are the types of overflow incontinence?

A

atonic bladder

outflow obstruction

25
Q 
o	BPH
o	Bladder neck contracture/uretheral stricture
o	Cystocele
o	Pelvic organ prolapse
o	Hx of incontinence surgery 
Type of overflow incontinence?
A

outflow bladder

26
Q 
o	Meds
o	Spinal/peripheral nerve injuries
o	Long-standing overdistension
o	DM
Type of overflow incontinence?
A

atonic bladder

27
Q

How to dx overflow incontinence?

A

PVR (post void residual)

28
Q

What residual vol indicates overflow bladder?

A

> 200ml

29
Q

How to tx overflow inctoninence?

A

tx the underlying cx

30
Q

What are the host defenses in LUTI?

A
  • Urine has specific characteristics that inhibit bacterial growth and colonization → TAMM-HORSFALL GLYCOPROTEIN (factor that inhibit bacterial adherence – GOOD!)
  • ↑↑ Lactobacillus is GOOD – but meds can destroy them
31
Q

What are host RF?

A

• ↓ Estrogen/abx can cause alterations to the periurethral environment → damage to periurethral flora

32
Q

16-35yo RF - LUTI?

A

sexual intercourse

diaphragm use

33
Q

36-65yo RF - LUTI?

A

gyn surgery

bladder prolapse

34
Q

65yo+ - LUTI?

A
  • Incontinence

* Chronic use of urinary catheters – nursing homes

35
Q

Bug for acute cystitis?

A

e coli

36
Q

Sx for acute cystitis?

A
  • Dysuria
  • Frequency
  • Urgencys
  • Low back/suprapubic pain
  • Hemturia
  • +/- Cloudy/foul smelling
  • +/- Fever
37
Q

What test to run for acute cystitis?

A

UA
(+) nitrate and leukocyte
>3-5WBC + RBC

38
Q

What is dx for acute cystitis?

A

culture

39
Q

What test to run for recurrent cystitis?

A

UA
US
CT - if suspecting fistula

40
Q

How to tx cystitis?

A

nitro/TMP-SMX/Fluroquinolone x3-5days

41
Q

What to keep in mind re: the drugs for acute cystitis?

A

nitro is more sensitive to e. coli than TMP SMX and fluroquinolone

42
Q

What abx is useless against e.coli?

A

pcn

43
Q

How to tx recurrent acute cystitis?

A

longer tx: 7-14days

source is found? remove (urinary calculi)

44
Q

What are prophylactic plans for cystitis - drugs?

A

long term LD nitrofuratnoin
pt initiated therapy: keeping abx at home and culture in the meanwhile - nitro x3-5days
related to sex: hygiene and nitro x1dose

45
Q

What are nonpharm tx for prophylactic cystitis?

A

hygiene
cranberry
lactobacillus vaginal suppositories

46
Q

What can cause bacterial persistence in acute cystitis?

A

incomplete tx
obstructive uropathy
nephrolithiasis

47
Q

What to ask if pt has recurrent infxn of cystitis?

A

pneumotruia and hx of radiation –> suspect fistula

48
Q

What to ask if pt has recurrent infxn of cystitis?

A

pneumotruia and hx of radiation –> suspect fistula

49
Q

Biggest RF for bladder cancer?

A
  • Smoking

* Occupation exposure

50
Q

Sx for bladder cancer?

A
  • HEMATURIA
  • Frequency
  • Urgency
  • Dysuria
  • Palpable mass
51
Q

What test to use for suspected bladder cancer BEFORE referral? Why?

A

• CT/urgoram → used to R/O

52
Q

What test to use for suspected bladder cancer BEFORE referral? Why?

A

• CT/urgoram → used to R/O

53
Q

Tx options for bladder cancer?

A
  • Intravesical Therapy
  • Transurethral Resection of Bladder Tumor (TURBT)
  • Removal of bladder
  • Chemotherapy
  • Radiation – MINOR ROLE
54
Q

Tx options for bladder cancer?

A
  • Intravesical Therapy
  • Transurethral Resection of Bladder Tumor (TURBT)
  • Removal of bladder
  • Chemotherapy
  • Radiation – MINOR ROLE
55
Q

If bladder is removed - how to get urine out?

A

Ileal conduit

orthotopic neobladder

Women's Health (10 decks)

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