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Flashcards in Pelvic Floor Disorders Deck (52):
1

What are the 3 categories of pelvic floor issues?

Urinary Incontinence
Pelvic floor prolapse
Anal incontinence

2

What urethral problems cause urinary incontinence?

Urethral sphincter incompetence
Detrusor instability
Retention with overflow
Functional

3

What Extraurethral problems can cause urinary incontinence?

Congenital
Fistula

4

What are the 4 types of urinary incontinence?

Stress
Urge
Mixed
Overflow

5

What is the incidence of Urinary Stress Incontinence?

1 in 33 women aged 55 and over
1 in 10 will need surgery

6

What are risk factors for urinary incontinence?

Sex - women
Age - older
Obesity
Smoking
Kidney disease
Diabetes
Higher number of children

7

What is OAB?

Overactive Bladder Syndrome

8

What is OAB wet?

Urge incontinence is present

9

What is OAB dry?

Incontinence is absent

10

Describe urge incontinence

Preceded by an urge to void
Can involve triggers such as running water etc.

11

Describe Mixed urinary incontinence?

Involuntary leakage associated with urgency and also with exertion, sneezing or coughing (stress)

12

What physical examinations should be done on a patient with incontinence?

Abdomen - masses, palpable bladder etc.
Pelvis/Perineum - External genitalia, atrophic vaginitis
Vagina - prolapse, malignancy, fistula
Rectal - tone, massesm teach Kegels during exam
Neurological - reflexes, sensory, motor

13

What bladder specific examinations should be done with someone with incontinence?

Stress test
Post void residual
Urine analysis (dipstick)
Bladder diary

14

What lifestyle measures can help with incontinence?

Bladder retraining
Sensible fluid intake
Caffeine reduction
Weight reduction if BMI >30

15

If a women urinates during penetrative sex, is that stress or urge?

Stress

16

If a women urinates during orgasm, is that stress or urge?

Urge

17

What physical treatments can help with incontinence?

Pelvic floor muscle exercises (PFME) - helps mixed and stress

18

What help do antimuscarinic agents do for incontinence?

Reduce intra-vesical pressure
Increase compliance
Raise volume threshold for micturation
Reduce uninhibited contractions

19

Give 3 examples of antimuscarinics

Oxybutynin
Solifenacin
Tolterodine

20

What are side effects of anti-muscarinics?

Dry mouth
Constipation
Blurred vision
Somnolence

21

What are Beta3 agonists?

First class selective B3 adrenoceptor agonist

22

What is the method of action of Beta3 agonists?

Relaxes bladder smooth muscle through activation of the B3 adrenoceptor
Selective agonist for the human B3 adrenoceptor with low intrinsic activity for B1 and B2

23

How much liquid should be taken in each day?

24ml per kg per 24 hours

24

What do B3 adrenoceptors do?

Increase the voiding interval and inhibit spontaneous bladder contractions

25

Give an example of a B3-adrenoceptor agonist?

Mirabegron

26

When would a B3-adrenoceptor agonist be recommended?

When there is contraindications of antimuscarinics or they are ineffective

27

What are the 3 first choice drugs for women with OAB or mixed UI according to NICE?

Oxybutynin
Tolterodine
Propiverine
(All immediate release)

28

What are the 3 second choice drugs for women with OAB or mixed UI according to NICE?

Trospium (immediate)
Oxybutynin (extended)
Darifenacin

29

What are indications for using Uroflowmetry?

Hesitancy
Voiding difficulty
Neuropathy
History of urine retention
Post-operative follow up

30

What are indications for Multichannel Urodynamics?

Uncertain diagnosis
Fail to respond to treatment
Prior surgery

31

What does flow rate enable you to measure?

Peak flow
Mean flow
Voided volume
(min of 200ml needed)

32

What is cystometry?

Method by which the pressure/volume relationship of the bladder is measured during filling, provocation and during voiding

33

What is the normal range for Post Void Residual (PVR) and what is abnormal?

Normal = 10-80cc (age dependant
Abnormal = >100-150cc

34

What are causes of Overflow incontinence?

Obstruction of urethra
Poor contractile bladder muscle
Find out PVR
Stop antimuscarinics

35

What is conservative treatment of stress UI?

Lifestyle changes
Physiotherapy
Drugs - Duloexetine (combined noradrenaline and serotonin reuptake inhibitor) - Increase intraurethral closure pressure
Incontinence pads, vaginal pessaries

36

What are surgical treatments of stress UI?

Low tension vaginal tape
Intraurethral injection
Artificial sphincters
Colposuspension

37

What is PTNS?

Percutaneous Posterior Tibial Nerve Stimulation - 12 week treatment

38

What does the FemSoft do?

Inserted into the urethra
Tip inserts into bladder
Fluid fills a balloon
Creates a seal at the bladder neck and urethra

39

What is the conservative treatment of an Overactive Bladder?

Lifestyle
Physiotherapy
Drugs - Antimuscarinics - block muscarinic receptors and decrease the ability of detrusor muscles to contract

40

What are the surgical treatments of an Overactive Bladder?

Augmentation cytoplasty
Sacral nerve modulation
Tibial nerve stimulation
Bladder overdistension
Botox injections

41

What are the 3 compartments involved in a prolapse?

Anterior
Middle/Apical
Posterior

42

What are the degrees of uterine descent in a Uterovaginal Prolapse?

1st degree - In vagina
2nd degree - At interiotus
3rd degree - Outside vagina
Procidentia - Entirely outside vagina

43

What are symptoms of Cystocele (Anterior)?

Bulging
Pressure
Mass
Difficulty voiding
Incomplete emptying
Splinting vaginal wall
Difficulty inserting tampon
Pain with intercourse

44

What are symptoms of Vaginal vault prolapse / Enterocele (Middle/Apical)?

Bulging
Pressure
Mass
Difficulty voiding
Incomplete emptying
Splinting vaginal wall
Difficulty inserting tampon
Pain with intercourse

45

What are symptoms of a Rectocele? (Posterior)

Bulging
Pressure
Mass
Difficulty defecating
Incomplete defecation
Splinting vaginal wall or perineum
Difficulty inserting tampon

46

What is a Complete Eversion (All compartments)

Uterine procidentia
Complete uterine prolapse

47

What is the Pelvic Organ Prolapse Quantification System (POP-Q)?

Patient straining, 6 specific sites are evaluated, and 3 rest sites measured
Measure each site in relation to the hymen ring (cm) (zero point of reference)
If site is above hymen = negative number
If site is below hymen = positive number

48

What are risk factors for a vaginal apical prolapse?

Aging
Pelvic surgery
Menopause/Hypoestrogenism
Loss of muscle tone
Multiple vaginal births
Obesity
Uterine fibroids
Chronic constipation, coughing or heavy lifting
FHx
Connective tissue disorders e.g. Marfan's syndrome

49

What is the conservative management of Uterovaginal Prolapse?

Reassure
Avoid heavy lifting
Lose weight
Stop smoking
Reduce constipation
Vaginal oestrogens - if symptomatic atrophic vaginitis

50

What are prolapse treatment options?

Expectant management
Physiotherapy
Pessary
Surgery - Abdominal, Vaginal, Laparoscopic, Robotic assisted laparoscopy, mesh kits

51

Who is suitable for prolapse treatment with Pessaries?

If unfit for surgery
Relief symptoms while awaiting surgery
Further pregnancies planned or current pregnancy
As diagnostic test/Ensure correction of large cystourethrocele not cause SUI
Patient request

52

What are repairs of Uterine prolapse/Vault prolapse?

Vaginal hysterectomy
Manchester repair (Cervix amputated, uterosacral ligaments shortened)
Sacrospinous fixation
Abdominal/Laparoscopic sacrocolpopexy, mesh techniques, colpocleisis