Pelvic floor disorders

Question 1

causes of urethral incontinence

Answer 1

urethral sphincter incompetence
detrusor instability
retention with overflow
function

Question 2

types of extraurethral urinary incontinence

Answer 2

congenital

fistula

Question 3

types of urinary incontinence

Answer 3

stress
urge - over reactive bladder
mixed
overflow

Question 4

incidence of USI

Answer 4

1/3 women over 55

1/10 will need surgery for it

Question 5

risk factors for USI

Answer 5

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

Question 6

what is over reactive bladder syndrome

Answer 6

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

Question 7

difference between OAB wet and OAB dry

Answer 7

wet is where urge incontinence is present

dry is where incontinence is absent

Question 8

what is urge incontinence

Answer 8

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

Question 9

what is mixed urinary incontinence

Answer 9

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

Question 10

what is happening to the bladder in OAB and UUI

and the what happens in SUI

Answer 10

bladder experiencing frequent involuntary contractions

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

Question 11

examination

Answer 11

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

Question 12

what exam can be done for incontinence

Answer 12

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

Question 13

treatment in OAB

Answer 13

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

Question 14

lifestyle advice in OAB

Answer 14

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

Question 15

physical treatments in OAB

Answer 15

pelvic floor muscle exercises - not as useful in urge incontinence

Question 16

anti muscarinic agents when should they be given

what do they do

Answer 16

after lifestyle changes for OAB syndrome

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

Question 17

types of anti muscarinics

Answer 17

oxybutynin
tolterodine
solifenacin
propiverine

Question 18

anti muscarinic SE

Answer 18

dry mouth
constipation
blurred vision
somnolence

Question 19

B3 agonists example

what does this drug do

Answer 19

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

Question 20

when is mirabegron given to px

Answer 20

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

Question 21

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

Answer 21

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

Question 22

what should be offered to women with OAB or mixed UI

Answer 22

oxybutanin
tolterdodine
peopiverine

Question 23

what is the second line treatment for OAB

Answer 23

tropsium
oxybutynin - extended release
darifenacin

Question 24

what is uroflowmetry

what are the indications for it

Answer 24

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

Question 25

indications for multi channel urodynamics

Answer 25

uncertain dx fail to respond to treatment prior surgery

Question 26

what is cystometry

Answer 26

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

Question 27

post ovoidal residue and urine dipstick findings

Answer 27

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

Question 28

causes of overflow incontinence | what should be stopped

Answer 28

obstruction of urethra poor contractile bladder muscle anticholinergics

Question 29

treatment of stress urinary incontinence

Answer 29

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

Question 30

treatment for overactive bladder

Answer 30

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

Question 31

types of prolapse

Answer 31

anterior middle or apical posterior

Question 32

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

Answer 32

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

Question 33

classification of uterovaginal prolapse

Answer 33

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

Question 34

anterior cystocele symptoms

Answer 34

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

Question 35

middle/apical vaginal vault prolapse symptoms and retrocede (posterior

Answer 35

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

Question 36

pelvic organ prolapse quantification system

Answer 36

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

Question 37

risk factors for vaginal apical prolapse

Answer 37

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

Question 38

management of uterovaginal prolapse conservative

Answer 38

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

Question 39

prolapse treatment options

Answer 39

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

Question 40

indications for pessaries

Answer 40

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