urogynaecology

Question 1

types of prolapse?

Answer 1

anterior vaginal wall
cystocele- bladder drops into vagina

posterior vaginal wall
enterocele - small intestine bulges into vagina

rectocele - rectum bulges into vagina

uterine prolapse - uterus
vaginal vault prolapse

Question 2

what are the pelvic organs?

Answer 2

vagina
uterus
bladder
urethra
rectum

Question 3

symptoms of prolapse

Answer 3

feeling pelvic pressure- how does it feel to you?
> dragging sensation

bulge in vagina
urinary incontinence
diff emptying bladder
problems having a bowel movement
lower back pain

Question 4

how common? pelvic organ prolapse?

Answer 4

1 in 10 women over 50

Question 5

what is a prociendia?

Answer 5

when whole uterus protrudes out

Question 6

risk factors for POP

Answer 6

pregnancy and childbirth
ageing
being overweight
persistent constipation / cough/ heavy lifting

Question 7

managing prolapse?
conservative? lifetsyle

Answer 7

weight loss
stopping smoking
manage cough / constipation

avoiding running

pelvic floor exercises
>phsyiotherapists -3/6 months

Question 8

prolapse conservative management

Answer 8

lifestyle
pessary : plastic / silicone device which helps support your pelvic organs : ring most common

Question 9

surgical management of prolapse\?
principles?

Answer 9

performed through vagina to restore ligamentous tissue
to apex, anterior, posterior

Question 10

treat a prolapse of the vaginal vault (top of the vagina/front passage) in women who have had a hysterectomy (removal of womb) using a strip of synthetic mesh to lift the top of the vagina and hold it in place

Answer 10

sacrocolpopexy

Question 11

possible surgical options fro prolapse?

Answer 11

vaginal hysterectomy

sacrospinous fixation - sutures

sacrohysteropexy

colpocleisis - last resort

Question 12

what muscle group supports the pelvic organs?

Answer 12

levator ani

Question 13

levator ani muscles?

Answer 13

puborectalis
pubococcgygeus
iliococcygeus

pubic ramus anteriorly
obturator internus fascia to the ischial spine which forms a bowl shaped muscle filling pelvic inelt supporting pelvic organs

Question 14

urinary incontinence conservative management?

Answer 14

fluid balance advice
reduce caffeine
bladder retraining
pelvic floor exercises

Question 15

management of Overactive bladder

Answer 15

bladder diary
bladder training - 6 weeks
anticholinergic drugs -
urodynamic drugs

botulinum toxin

sacral neuromodulation

Question 16

surgical management of incontinence - stress?

Answer 16

synthetic midurethral tape procedure
burch colposuspension