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403- O&G > Vulva & Genitourinary > Flashcards

Vulva & Genitourinary Flashcards

1
Q

Stress incontinence

A

Triggered by increased pressure on sphincter/ bladder

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2
Q

Urge incontinence

A

Overwhelming sensation to urinate due to overactivity of the detrusor muscles

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3
Q

Causes of overflow incontinence

A

Medication
- Anticholinergics

Anatomical obstruction

  • Fibroids
  • Pelvic tumours

Neurological

  • MS
  • Spinal cord injury
  • Diabetic neuropathy
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4
Q

Risk factors for incontinence in women

A

Pregnancy related

  • Previous vaginal delivery
  • Gravida

Surgery
- Pelvic floor surgery

Demographic

  • Increased age
  • High BMI
  • Post-menopausal

Neurological

  • MS, spinal cord lesion
  • Cognitive impairment.
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5
Q

Oxford grading system for pelvic floor muscle

A

Used to grade the strength of contraction of pelvic floor muscles during bimanual exam

<2 = weak, very weak or no contraction

3= moderate

4,5= good, strong

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6
Q

What things should be assessed for in incontinence?

A
  • Pelvic organ prolapse
  • Atrophic vaginitis
  • Pelvic masses
  • Urethral diverticulum
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7
Q

Initial investigations in incontinence

A

Bladder diary
- Minimum 3 days

Urine dipstick

  • Rule out infection, kidney damage
  • Mid-stream MCS if positive for nitrites and leucocytes
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8
Q

Urodynamic tests for urinary incontinence

A

Investigation that compares the pressure in rectum compared to bladder

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9
Q

2-week wait indications in incontinence

A

45+ and

  • Unexplained frank haematuria without UTI
  • Frank haematuria after UTI treatment

60+ with Unexplained non-visible haematuria AND

  • Dysuria or
  • Raised WCC on blood test
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10
Q

Lifestyle management for stress incontinence

A
  • Avoid caffeine
  • Sensible fluid intake/ overfilling bladder
  • Weight loss if BMI > 30
  • Smoking cessation
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11
Q

Non-pharmacological treatments for stress incontinence

A

At least 3 months of supervised pelvic floor muscle training

- At least 8 pelvic floor contractions 3x daily

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12
Q

Secondary care treatment of stress urinary incontinence

A

Surgery

  • Tension-free vaginal tape
  • Colposuspension
  • Autologous rectus fascial sling
  • Retropubic mid-urethral mesh sling
  • intramural urethral bulking agents.

Medication (if surgery not suitable or preferred)
- Duloxetine

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13
Q

Initial management of overactive bladder

A

Bladder training

  • Via continence physiotherapist/ continence nurse
  • At least 6 weeks
  • 8 PFM contractions at least 3x day
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14
Q

Second line treatment for urge incontinence + side effects

A

Antimuscurinic medications

  • Oxybutynin immediate release
  • Tolterodine immediate release
  • Darifenancin

Side effects

  • Dry mouth
  • Constipation
  • Drowsiness
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15
Q

3rd line management for urge incontinence (if bladder training and anti-muscarinics fail)

A

Mirabegron

- Beta-3 agonist

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16
Q

Contraindications of mirabegron

A

Uncontrolled hypertension

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17
Q

Medication to manage nocturia

A

Desmopressin

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18
Q

Contraindications of desmopression

A

> 65

Uncontrolled hypertension

CVD

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19
Q

Last line management of urge incontinence

A

Botulinum toxin type A injections

Surgery

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20
Q

Cystometry and Uroflowmetry

A

Urodynamic test that measures the detrusor muscle contraction and pressure

Uroflowmetry measures the flow rate

21
Q

Leak point pressure

A

Urodynamic test that measures pressure required to cause leakage of urine
- Assess stress incontinence

22
Q

Colposuspension

A

Surgery that involves stitches connecting the anterior vaginal wall and the pubic symphysis.

The stitches go around the urethra, and pulls the vaginal wall forwards and adding support to the urethra

23
Q

Vulva carcinomas typically spread lymphatically to _______

A

Inguinal and femoral nodes

24
Q

Most common type of vulva cancer is _______

A

Squamous cell carcinoma

25
Q

Features of vulva carcinoma

A

Firm, asymmetrical lump

Itching/ mild pain

Bleeding- if ulcerated

26
Q

Risk factors for vulva carcinoma

A

HPV infection

Vulva intraepithelial neoplasm (VIN)

Immunosuppression

Lichen planus

27
Q

Bartholin’s cysts

- Presentation

A

Unilateral swelling near vaginal opening

  • Pain when walking
  • Dyspareunia

Typically, in women of child-bearing age

28
Q

Presentation of an infected Bartholin’s cyst

A

Infection

  • Acutely painful
  • Erythema
  • Fever
  • Inguinal lymphadenopathy
29
Q

First line treatment for bartholin’s cyst

A

Marsupialisation

- Inversion of skin after incision and drainage

30
Q

First line treatment for Bartholin’s cyst abscess

A

Expidite marsupialisation

Antibiotics if systemically unwell.

31
Q

Law regarding FGM

A

Illegal and any cases <18 but be reported to the police.

32
Q

Type 1 FGM involves removal of ____

A

Part/ all of the clitoris

33
Q

Type 2 FGM involves removal of ____

A

Part/ all of clitoris and labia minora

34
Q

Type 3 FGM involves ____

A

Infibulation

- Narrowing/ closing of the vaginal orifice

35
Q

Which country has the highest rate of FGM?

A

Somalia

36
Q

Vault prolapse is when…

A

Top of vaginal prolapses into the vaginal

37
Q

Rectocele describes when…

A

Rectum prolapses into vaginal due to weakness in posterior vaginal wall

38
Q

Cystocele describes when…

A

Bladder prolapses into vaginal due to defect in anterior vaginal wall

39
Q

_______ is the grading system for pelvic organ prolapse

A

Pelvic organ prolapse quantification (POP-Q)

- Grades 0-4.

40
Q

First line management of Pelvic organ prolapse (POP-Q grade 1-2)

A

Pelvic floor muscle exercises

  • 16 weeks
  • Led by OT/ physio

Lifestyle
- Weight loss if BMI >30

41
Q

Second line management of Pelvic organ prolapse (POP-Q grade 1-2)

A

Vaginal pessary ring

- Provides support for pelvic organs

42
Q

Complications of vaginal pessary ring

A

Bleeding

Abnormal discharge

Expulsion

43
Q

Vaginal pessary ring must be removed every…

A

6 months

44
Q

_______ is the definitive treatment for pelvic organ prolapse

A

Surgery

45
Q

________ is the uterus preserving surgery indicated for uterine prolapse

A

Vaginal sacrospinus hysteropexy/ Manchester repair.

46
Q

________ is a non-uterus preserving surgery indicated for uterine prolapse

A

Hysterectomy +/- vaginal sacrospinus fixation

47
Q

________ is the surgery indicated for vault prolapse

A

Vaginal sacrospinus fixation w/ suturs

Sacrocolpopexy

48
Q

Medications that exacerbate urge incontinence

A

ACEi

Diuretics

Antidepressants

HRT

Sedatives

403- O&G (21 decks)

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