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Y3 Obs and Gynae Anatomy > Anatomy of Urinary Incontinence and Prolapse > Flashcards

Anatomy of Urinary Incontinence and Prolapse Flashcards

1
Q

The pelvic floor seperates _______ (above) from ________ (below)

A

Pelvic cavity

Perineum

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2
Q

What is the role of the pelvic floor?

A

Supports pelvic organs

Role in maintaining urinary and faecal continence

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3
Q

List the three layers that make up the pelvic floor from deep to superficial

A

Pelvic diaphragm
Muscles of perineal pouches
Perineal membrane

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4
Q

What is the deepest layer of the pelvic floor?

A

Pelvic diaphragm

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5
Q

What does the pelvic diaphragm look like?

A

A sling

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6
Q

Which muscle groups make up the pelvic diaphragm?

A

Levator ani

Coccygeus

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7
Q

What is the name for the anterior gap between the medial borders of the pelvic diaphragm? What is it’s role?

A

Urogenital sinus

Passage for urethra and vagina

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8
Q

Name the three parts of the levator ani muscle

A

Puborectalis
Pubococcygeus
Iliococcygeus

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9
Q

What is the role of the levator ani?

A

Tonically contracted most of the time, relaxes to allow urination and defecation

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10
Q

What is the innervation of levator ani?

A

Pudenal nerve

Nerve to levator ani

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11
Q

State the two types of endo-pelvic fascia

A

Loose areolar connective tissue

Fibrous pelvic ligaments

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12
Q

List the main pelvic ligaments providing additional support to pelvic organs

A

Uterosacral ligament
Transverse cervical (cardinal) ligament
Lateral ligament of bladder
Lateral rectus ligaments

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13
Q

Where is the deep perineal pouch?

A

Lies below the fascia covering inferior pelvic diaphragm

Lies above the perineal membrane

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14
Q

What vein lies above the external urethral sphincter in males and females respectively?

A

Dorsal vein of clitoris/ penis

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15
Q

List the contents of the deep perineal pouch in females

A 
Urethra (external urethral sphincter)
Compressor urethrae
Vagina
Dorsal vein of clitoris
Extension of ischioanal fat pads/muscles
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16
Q

What is the function of the compressor urethrae muscle?

A

Wraps anteriorly around the urethra so when it contracts it squeezes the urethra

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17
Q

List the contents of the deep perineal pouch in males

A 
Urethra (external urethral sphincter)
Compressor urethrae
Dorsal vein of penis
Deep transverse perineal muscle
Bulbourethral gland
Extension of ischioanal fat pads/muscles
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18
Q

Where is the bulbourethral gland located in males?

A

Posterior and lateral to the membranous portion of the urethra at the base of the penis in the deep perineal pouch

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19
Q

Where is the perineal membrane located?

A

Superficial to the deep perineal pouch

20
Q

Describe the structure of the perineal membrane

A

Thin sheet of tough, deep fascia

21
Q

Where does the perineal membrane attach laterally? What is the function of this?

A

To the sides of the pubic arch, closing the urogenital triangle

22
Q

Together with the perineal body, what is the function of the perineal membrane?

A

Last passive support of the pelvic organs

23
Q

Where is the superficial perineal pouch?

A

Lies below the perineal membrane

24
Q

List the contents of the superficial perineal pouch in males

A

Crura (‘legs’) and bulb of penis
Erectile tissue (corpus spongiousum, corpus cavernosum)
Muscles (bulbospongiosus, ischiocavernosus)
Proximal spongy penile urethra
Superficial transverse perineal muscle
Branches of internal pudenal vessels
Pudenal nerve

25
Q

List the contents of the superficial perineal pouch in females

A 
Crura and clitoris 
Paired bulbs of vestibule
Erectile tissue (corpus cavernosum)
Muscles (bulbospongiosus, ischiocavernosus) 
Bartholin's glands
Superficial transverse perineal muscle
Branches of internal pudenal vessels
Pudenal nerve
26
Q

Where is Bartholin’s gland location in females?

A

Located slightly posterior and to the left and right of the opening of the vagina in the superficial perineal pouch

27
Q

Describe the layout of the crura and bulb of the genitalia

A

Bulbs are situated on either side of the vaginal opening or the base of the penis, and crura are ‘legs’ adjacent to this

28
Q

What is the function of the bulbospongiosus and ischiocavernous muscles?

A

Contribute to erection by forcing blood towards the erectile tissues

29
Q

What is the importance of the perineal body?

A

Supports the pelvic floor

30
Q

How does the pelvic floor support pelvic organs?

A

Actively contracts during coughing, sneezing and vomiting

31
Q

Which structures in the pelvic floor help maintain urinary continence?

A

External urethral sphincter
Compressor urethrae
Levator ani

32
Q

What is the function of the puborectalis muscle?

A

Bends the anorectum anteriorly, and actively contracts to maintain continence after rectal filling

33
Q

How is the pelvic floor injured during pregnancy and childbirth?

A

Stretching or tearing of muscle fibres causes pudenal nerve damage

34
Q

Damage to the pelvic floor can result in…

A

Incontinence (involuntary loss of urine)

Prolapse (failure of pelvic organ support)

35
Q

Continence depends on what factors within the pelvic floor?

A

Urinary bladder neck support
External urethral sphincter
Smooth muscle in urethral wall

36
Q

Describe a vaginal prolapse

A

Herniation of urehtra, bladder, rectum or rectouterine pouch through supporting fascia

37
Q

How does a vaginal prolapse present?

A

Lump in vaginal wall

38
Q

Define ‘urethrocele’

A

Prolapse of the female urethra into the vagina.

39
Q

Define ‘cytocele’

A

Prolapse of the female bladder into the vagina.

40
Q

Define ‘rectocele’

A

Prolapse of the female rectum into the vagina.

41
Q

Define ‘enterocele’

A

Prolapse of the female bowel into the vagina

42
Q

What is a uterine prolapse?

A

Prolapse of the uterus into the vagina (1st, 2nd or 3rd degree)

43
Q

How does prolapse present?

A

Dragging sensation
Feeling of ‘lump’
Urinary incontinence

44
Q

What is sacrospinous fixation?

A

Sutures placed in sacrospoinous ligament, vaginally, to repair cervical/vault descent in uterine prolapse

45
Q

What structures are at risk of injury in sacrospinous fixation?

A

Pudenal NVB

Sciatic nerve

46
Q

Describe incontinence surgery using the tape procedure

A

Mesh through obturator canal in the obturator foramen, which creates a sling around the urethra

Y3 Obs and Gynae Anatomy (7 decks)

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