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Reproduction > Incontinence and Prolapse > Flashcards

Incontinence and Prolapse Flashcards

1
Q

What is the definition of urinary incontinence?

A

The complaint of any involuntary leakage of urine

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2
Q

What are the 3 types of incontinence?

A

Stress
Urgency
Mixed

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3
Q

What is stress incontinence?

A

Involuntary leakage on effort/exertion

Can occur when coughing or sneezing

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4
Q

What is urgency incontinence?

A

Involuntary urine leakage accompanied or immediate preceded by a sudden urgency to urinate

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5
Q

What is a mixed urinary incontinence?

A

When there is involuntary urine leakage associated with both urgency and exertion.

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6
Q

What is wet overactive bladder?

A

This is urgency which occurs along with urgency incontinence
Has increased frequency and nocturia
Can have dry OAB where incontinence does not occur

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7
Q

What specific things should be asked about in the history?

A 
Caffeine intake 
Storage symptoms:
 - frequency
- urgency
 - constant leaking?
Voiding symptoms
 - hesitancy
 - straining 
 - poor flow
Post-micturition symptoms
 - incomplete
 - incontinence
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8
Q

What are the appropriate examinations in UI?

A 
BMI
Abdo exam
Vaginal exam
PR exam
May also require cognitive assessment if history dictates it
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9
Q

Overactive bladder is caused by what?

A

Involuntary contractions of the detrusor muscle

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10
Q

What investigations should be done for UI?

A 
Urinalysis
Post void residual
Urodynamics
Cystoscopy
Imaging (USS)
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11
Q

List some non medical management options for UI?

A 
Weight loss
Fluid restrictions
Caffeine reduction
Bladder training
Pelvic Floor Physiotherapy
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12
Q

List some anti-muscarinic agents

A

Oxybutynin
Tolterodine
Darifenacin

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13
Q

How do antimuscarinics help with OAB?

A

Reduce intravesical pressure
increase compliance
Raise volume threshold before micturition
Reduce uninhibited contractions

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14
Q

List some side effects of antimuscarinic agents?

A

Dry mouth
Constipation
Blurred vision
Somnolence

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15
Q

What class of drug is Mirabegron?

A

B3 agonist

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16
Q

How do B3 agonists work?

A

Relaxes smooth muscle of bladder through activation of the B3 adrenoreceptor
This increases the voiding interval and inhibits spontaneous contractions

17
Q

Other than antimuscarinics, what other managements can be used for overactive bladder (OAB)?

A 
Desmopressin (if nocturia)
Topical oestrogen
Botox
Percutaneous sacral nerve stimulator
Augmentation cystoplasty
18
Q

What is first line management in overactive bladder?

A

Anti-muscarinic

19
Q

What is another medication management in stress incontinence?

A

Duloxetine

Use after conservative measures e.g. PFE do not work

20
Q

What is the mechanism of action in duloxetine?

A

Combined noradrenaline and serotonin reuptake inhibitor - this will increase the intraurethral pressure

21
Q

What is a cystocele?

A

An anterior pelvic prolapse

22
Q

What are the symptoms of a cystocele?

A 
Bulging
Pressure
'Dragging'
Difficulty voiding
Difficulty inserting tampons
Pain on intercourse
23
Q

What is an enterocele?

A

Vaginal vault prolapse

i.e. middle / apical prolapse

24
Q

What is a rectocele?

A

A posterior prolapse

25
Q

What symptoms might present specifically to a rectocele?

A

Difficulty defecating

Incomplete defecation b

26
Q

What is a complete eversion?

A

This is when all compartments of the vagina prolapse outside of the body

27
Q

List some risk factors for vaginal prolapse:

A 
Older age
Parity - especially vaginal delivery
Post menopausal oestrogen deficiency
Obesity
Neurological conditions
Genetic connective tissue disorder
28
Q

What investigations may need to be done for prolapse?

A

USS
MRI
Anorectal manometry
Endoanal USS

29
Q

What are the main management options for prolapse?

A

Conservative
Mechanical - pessaries
Surgery

30
Q

When are pessaries appropriate?

A

Mild to moderate prolapses
If not finished having family
Patient request

31
Q

What are some complications of pessaries?

A

Discharge
Ulcerations leading to fistulas
Fibrous bands

32
Q

How often must pessaries be changed?

A

Every 6 months

33
Q

List the appropriate surgery options for the type of prolapse:

A

Anterior
- Vaginal repair
Posterior
- Vaginal repair
Apical
- Vaginal: Sacrospinous fixation, Colpocliesis
- Abdominal: Sacrohysteropexy, Sacrocolpopexy, Pectopexy

34
Q

What is sacrolcolpopexy?

A

Attach a mesh between the sacrum and the vaginal prolapse material

Reproduction (19 decks)

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