Gynae - urogynae

Question 1

What is pelvic organ prolapse?

Answer 1

the descent of pelvic organs into the vagina due to weakness and lengthening of the supporting ligaments and muscles.

Question 2

What are the types of prolapse?

Answer 2

• Uterine prolapse
• Vault prolapse (post-hysterectomy)
• Rectocele (posterior wall defect)
• Cystocele (anterior wall defect)
• Urethrocele
• Cystourethrocele

Question 3

What are risk factors for prolapse?

Answer 3

• Multiple vaginal deliveries
• Traumatic/instrumental labour
• Aging and postmenopausal state
• Obesity
• Chronic cough or constipation

Question 4

Common symptoms of prolapse?

Answer 4

• “Something coming down” sensation
• Pelvic heaviness or dragging
• Urinary and bowel issues
• Sexual dysfunction
• Visible or palpable lump

Question 5

How is prolapse graded?

Answer 5

Using POP-Q system:

• Grade 0: No prolapse
• Grade 1: >1cm above introitus
• Grade 2: Within 1cm of introitus
• Grade 3: >1cm below introitus
• Grade 4: Full descent with vaginal eversion

Question 6

prolapse Mx

Answer 6

conservative:

• pelvic floor exercises
• weight loss
• vaginal oestrogen

vaginal pessary - device inserted into vagina to support pelvic organs

surgery:

• hysterectomy
  uterosacral ligament suspenstion

Question 7

What are the main types of urinary incontinence?

Answer 7

• stress incontinence → involuntary leakage of urine during increased intra-abdominal pressure
• urge incontinence (OAB syndrome) → urgency, usually with frequency and nocturia in the absence of UTI

Question 8

Investigations for urinary incontinence?

Answer 8

• exclude infection
• frequency/volume charts
  
  • stress - normal frequency and bladder capacity
  • urge - increased frequency
• urodynamic studies - performed in stress urinary incontinence when considering surgery, to confirm the diagnosis and rule out concomitant detrusor over-activity

Question 9

stress incontinence Mx

Answer 9

• Conservative: Weight loss, pelvic floor training
• Surgical: Colposuspension, tension free vaginal tape
• Medical: Duloxetine

Question 10

urge incontinence Mx

Answer 10

• Lifestyle: Bladder retraining, caffeine reduction
• Medical: Anticholinergics (oxybutynin), oestrogens, botox
• Surgical: Augmentation cystoplasty (for severe cases)