O&G Written - Urogynae

Question 1

Indications for urodynamic testing

Answer 1

Urge predominant mixed incontinence
Unclear type
Sx of voiding dysfunction
Anterior or apical prolapse
Hx previous surgery for stress incontinence

NOT if predominant stress mixed type

Question 2

Urge incontinence management

Answer 2

Bladder retraining 6 weeks

Medical: antimuscarinic

• Oxybutynin, tolterodine
• Mirabegron in frail older women

Botox injection - if willing/able to self-catheterise

Percutaneous sacral nerve stimulation OR posterior tibial nerve stimulation

Surgery:

• augmentation cystoplasty if willing/able to self-catheterise
• diversion

Question 3

Stress incontinence management

Answer 3

Pelvic floor exercises - 3 months

Duloxetine

Surgery: colposuspension?

Question 4

RF for stress incontinence

Answer 4

menopause
Multiparity
Birth trauma - instrumental, long labour, macrosomia
Obesity
Urologic/retropubic surgery
Chronic cough

Question 5

RF for urge incontinence

Answer 5

Elderly
Diabetes
Neuro disease
Childbirth

Question 6

Rf/causes of overflow incontinence

Answer 6

Ineffective detrusor

• autonomic innervation disorders: DM, spinal cord injury
• anticholinergic medications

Urinary flow blockage

• BPH, prostate ca. (men)
• urethral stricture
• severe constipation
• cystocele
• uterine prolapse

Question 7

urodynamic results in overflow incontinence

Answer 7

Reduced flow rate

High voiding detrusor pressure

Question 8

Pelvic organ prolapse Tx

Answer 8

Lifestyle: weight loss, avoid heavy lifting, stop smoking

Oestrogen pessary or cream

Intravaginal pessary - plastic or silicone

Surgery: pelvic floor repair, sacrocolpoplexy / sacrospinous fixation / colposuspension +/- vaginal hysterectomy