Urinary incontinence and prolapse Flashcards

Question

lifestyle factors

Answer 1

caffeine alcohol medications BMI

Answer 2

stop anticholinergic and bladder-related medications around 5 days before tests thin catheter into bladder and then into rectum cystometry uroflometry leak point pressure post-void residual bladder volume tests video urodynamic testing

Answer 3

Cystometry measures the detrusor muscle contraction and pressure

Answer 4

Uroflowmetry measures the flow rate

Answer 5

Leak point pressure is the point at which the bladder pressure results in leakage of urine. The patient is asked to cough, move or jump when the bladder is filled to various capacities. This assesses for stress incontinence.

Answer 6

Post-void residual bladder volume tests for incomplete emptying of the bladder

Answer 7

Video urodynamic testing involves filling the bladder with contrast and taking xray images as the bladder is emptied. Theses are only performed where necessary and not a routine part of urodynamic testing.

Answer 8

Sensible fluid intake: 1,500-2,500ml/day Tea, coffee, alcohol are all diuretic Mobility aids or downstairs toilets Pads, bedpans, commodes etc.

Answer 9

Avoiding caffeine, diuretics and overfilling of the bladder Avoid excessive or restricted fluid intake Weight loss (if appropriate) Supervised pelvic floor exercises for at least three months before considering surgery Surgery Duloxetine is an SNRI antidepressant used second line where surgery is less preferred `

Answer 10

``` burch colposuspension laproscopic colposuspension tension free vaginal tape transobturator rapes intramural urethrl bulking periurethral injections ```

Answer 11

this is now rarely performed due to the introduction of vaginal tapes. It involves inserting sutures between the paravaginal fascia and Cooper’s ligament.

Answer 12

Tension free vaginal tape (TVT) – the most commonly performed operation with a high objective cure rate. It involves a tape being placed under the mid urethra via a small vaginal incision. There has been recent controversy over this procedure with many women reporting complications of erosions into the vagina, urethra and bladder resulting in chronic pelvic pain.

Answer 13

``` lifestyle Bladder retraining (gradually increasing the time between voiding) for at least six weeks is first-line ``` Anticholinergic medication, for example, oxybutynin, tolterodine and solifenacin Mirabegron is an alternative to anticholinergic medications Invasive procedures where medical treatment fails

Answer 14

oxybutynin, solifenacin, tolterodine intravaginal oestrogen boutilism toxin A neuromodulation and sacral nerve stimulation

Answer 15

detrusor myomectomy and augmentation cystoplasty urinary diversion

Answer 16

``` dry mouth urinary retention constipation postural hypotension cognitive decline, memory problems, worsening of dementia ```

Answer 17

contraindicated in uncontrolled HTN b3 agonist less of anticholinergic burden

Answer 18

Pelvic organ prolapse refers to the descent of pelvic organs into the vagina. Prolapse is the result of weakness and lengthening of the ligaments and muscles surrounding the uterus, rectum and bladder.

Answer 19

Vault prolapse occurs in women that have had a hysterectomy, and no longer have a uterus. The top of the vagina (the vault) descends into the vagina. Vault prolapse occurs in women that have had a hysterectomy, and no longer have a uterus. The top of the vagina (the vault) descends into the vagina.

Answer 20

defect in posterior vaginal wall rectum prolpses forwards into the vagina associated with constipation and urinary retention

Answer 21

defect in anterior vaginal wall | bladder prolapses backwards into vagina

Answer 22

Multiple vaginal deliveries Instrumental, prolonged or traumatic delivery Advanced age and postmenopause status Obesity Chronic respiratory disease causing coughing Chronic constipation causing straining Connective tissue disease Smoking

Answer 23

A feeling of “something coming down” in the vagina A dragging or heavy sensation in the pelvis Urinary symptoms, such as incontinence, urgency, frequency, weak stream and retention Bowel symptoms, such as constipation, incontinence and urgency Sexual dysfunction, such as pain, altered sensation and reduced enjoyment

Answer 24

empty bladder and bowel Sim's speculum cough or bear down

Answer 25

Grade 0: Normal Grade 1: The lowest part is more than 1cm above the introitus Grade 2: The lowest part is within 1cm of the introitus (above or below) Grade 3: The lowest part is more than 1cm below the introitus, but not fully descended Grade 4: Full descent with eversion of the vagina

Answer 26

A prolapse extending beyond the introitus can be referred to as uterine procidentia

Answer 27

conservative vaginal pessary surgical

Answer 28

Physiotherapy (pelvic floor exercises) Weight loss Lifestyle changes for associated stress incontinence, such as reduced caffeine intake and incontinence pads Treatment of related symptoms, such as treating stress incontinence with anticholinergic mediations Vaginal oestrogen cream

Answer 29

Ring pessaries are a ring shape, and sit around the cervix holding the uterus up Shelf and Gellhorn pessaries consist of a flat disc with a stem, that sits below the uterus with the stem pointing downwards Cube pessaries are a cube shape Donut pessaries consist of a thick ring, similar to a doughnut Hodge pessaries are almost rectangular. One side is hooked around the posterior aspect of the cervix and the other extends into the vagina. give oestrogen cream to prevent irritation from pessary

Answer 30

Pain, bleeding, infection, DVT and risk of anaesthetic Damage to the bladder or bowel Recurrence of the prolapse Altered experience of sex

Answer 31

Chronic pain Altered sensation Dyspareunia (painful sex) for the women or her partner Abnormal bleeding Urinary or bowel problems

Answer 32

Recurrent prolapse Haemorrhage and vault haematoma Vault infection DVT New incontinence Ureteric or bladder injury

Urinary incontinence and prolapse Flashcards

(56 cards)