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Flashcards in Pelvic floor disorders Deck (40):
1

causes of urethral incontinence

urethral sphincter incompetence
detrusor instability
retention with overflow
function

2

types of extraurethral urinary incontinence

congenital
fistula

3

types of urinary incontinence

stress
urge - over reactive bladder
mixed
overflow

4

incidence of USI

1/3 women over 55
1/10 will need surgery for it

5

risk factors for USI

women>men
age
obesity
smoking - chronic cough
kidney disease/DM

6

what is over reactive bladder syndrome

urgency with or without urge urinary incontinence usually with frequency and nocturne in the absence of pathological or metabolic conditions that might explain these symptoms

7

difference between OAB wet and OAB dry

wet is where urge incontinence is present
dry is where incontinence is absent

8

what is urge incontinence

proceeded by an urge to void - triggers such as running water, opening a door

9

what is mixed urinary incontinence

involuntary leak associated with urgency and also with exertion such as sneezing, coughing

10

what is happening to the bladder in OAB and UUI
and the what happens in SUI

bladder experiencing frequent involuntary contractions

bladder muscle experiences stress related contraction and support muscles unable to remain completely shut

11

examination

abdomen - masses, bladder
external genitalia
vaginal - prolapse, malignancy, fistula
rectal - tone, masses

12

what exam can be done for incontinence

standing or supine stress test - cough standing up
post void residual
urine analysis
bladder diary

13

treatment in OAB

lifestyle advice
bladder drill
pelvic floor physio
drugs
botulinum toxin
neuromodulation
reconstructive surgery

14

lifestyle advice in OAB

bladder retraining to increase bladder capacity and decrease frequency
anti muscarinic if frequency a problem
sensible fluid intake
caffeine reduction
weight reduction if BMI >30

15

physical treatments in OAB

pelvic floor muscle exercises - not as useful in urge incontinence

16

anti muscarinic agents when should they be given
what do they do

after lifestyle changes for OAB syndrome

reduce intra vesical pressure
increase compliance
raise volume threshold for micturition
reduce uninhibited

17

types of anti muscarinics

oxybutynin
tolterodine
solifenacin
propiverine

18

anti muscarinic SE

dry mouth
constipation
blurred vision
somnolence

19

B3 agonists example
what does this drug do

mirabegron
relaxes smooth muscle through activation of the b3 adenoreceptor
increases the voiding interval and inhibit spontaneous bladder contractions during filling

20

when is mirabegron given to px

given in overreactive bladder syndrome when antimuscarinic agents are contraindicated, clinically ineffective or have unacceptable side effects

21

what nerve thing can be done for OBS and what does it lead to

percutaneous posterior tibial nerve stimulation - can reduce symptoms in the short and medium term

22

what should be offered to women with OAB or mixed UI

oxybutanin
tolterdodine
peopiverine

23

what is the second line treatment for OAB

tropsium
oxybutynin - extended release
darifenacin

24

what is uroflowmetry
what are the indications for it

measurement of volume of urine in mls expelled from the bladder each second. can measure peak flow, mean flow and voided volume

hesitancy
voiding difficulties
neuropathy
history of urinary retention
post op follow up

25

indications for multi channel urodynamics

uncertain dx
fail to respond to treatment
prior surgery

26

what is cystometry

pressure/volume relationship of the bladder is measures during filling, porvocation and during voiding

27

post ovoidal residue and urine dipstick findings

normal - age dependent 10-80cc
abnormal >100-150cc

28

causes of overflow incontinence
what should be stopped

obstruction of urethra
poor contractile bladder muscle

anticholinergics

29

treatment of stress urinary incontinence

lifestyle - lose weight, stop smoking, stop caffeine
physio - pelvic floor muscle exercise
drugs - duloexetine
surgery

30

treatment for overactive bladder

lifestyle - avoid caffeine
physio - bladde training
drugs - oxyb
surgery

31

types of prolapse

anterior
middle or apical
posterior

32

who does pelvic prolapse occur in
risk of surgery
why is it increasing

almost 50% of parous women
11% lifetime risk
women LE increasing

33

classification of uterovaginal prolapse

1st degree- in vagina
2ng - at interiottus
3rd degree - outside vagina
prociedentia - entirely outside vagina

34

anterior cystocele symptoms

bulging, pressure, mass, difficulty voiding, incomplete emptying, splinter vaginal wall, difficulty inserting tampon, pain with intercourse

35

middle/apical
vaginal vault prolapse symptoms
and retrocede (posterior

bulging, pressure, mass, difficulty voiding, incomplete emptying, splinter vaginal wall, difficulty inserting tampon, pain with intercourse

36

pelvic organ prolapse quantification system

with the px straining 6 sites are evaluated and at rest 3 sites are measured
measure each site in relation to the hymenal ring which is fixed
if its above the hymen -ve
if its below +ve

37

risk factors for vaginal apical prolapse

raging
pelvic surgery
menopause
loss of muscle tone
multiple vaginal births
obesity
chronic constipation, coughing, heavy lifting
uterine fibroids
FH

38

management of uterovaginal prolapse conservative

reassure
avoid heavy lifting
lose weight
stop smoking
vaginal oestrogen IF SYMP ATROPHIC VAGINITIS

39

prolapse treatment options

physio
pessary
surgery - abd, vaginal, lapro, mesh kits

40

indications for pessaries

women unfit for surgery
relief of symptoms while waiting for surgery
further pregnancies planned or preg
as a dx test for prolapse/ensure correction of large cystourethrocele
px request