Urinary incontinence and Prolapse

Question 1

What muscle is responsible for an overactive bladder?

Answer 1

Detrusor

Question 2

What drug treatment is used in stress incontinence?

Answer 2

Duloexetine (combined noradrenaline and serotonin reuptake inhibitor)

Question 3

What drug treatment is used in treating an overactive bladder?

Answer 3

• Antimuscarinic (oxybutynin) as these block detrusore muscarinic receptors and decrease the ability of the detrusor muscles to contract.
• B3 receptor antagonist

Question 4

Which patients with OAB should be offered oestreogen and how should this be given?

Answer 4

Should only be given intravaginally to postmenopausal women with vaginal atrophy.

Question 5

What surgical treatments are available for stress incontinence?

Answer 5

• Synthetic mid urethral tape
• Open colposuspension
• Autologous rectus fascial sling

Question 6

What is the most common cause of overactive bladder?

Answer 6

Detrusor overactivity

Question 7

What are the two muscle groups that make up the pelvic diaphragm?

Answer 7

Levator Ani

Cocygeua

Question 8

Which lies more medially; coccygeus or levator ani?

Answer 8

Levator Ani

Question 9

What are the attachments of the levator ani muscle?

Answer 9

Pubic bones
Ischial spines
Tendinous arch of levator ani 
In the midline...
Perineal body
Coccyx
Walls of organs in the midline

Question 10

What are the three parts of levator ani?

Answer 10

Puborectalis
Pupococcygeus
Iliococcygeus

Question 11

What two nerves innervate the levator ani muscle?

Answer 11

Pudendal nerve

Nerve to leavator ani

Question 12

What structure lies above the perineal membrane and contains the bulbourethral glands in the male and the neurovascular bundle for the penis and clitoris?

Answer 12

Deep perineal Pouch

Question 13

What kind of epithelium lines the bladder?

Answer 13

Transitional epitheliym

Question 14

List the investigations that can be used when assessing urinary incontinence?

Answer 14

Urinalysis (look for nitrites for UTI, glucose for diabetes)
Blood for renal function (U & E’s) if impairment suspected
Bladder chart
Pad test (quantifies urine leakage
Urodynamics

Question 15

What is the minimum void of urine required to determine flow rain is uroflometry?

Answer 15

200ml

Question 16

What does cystometry measure?

Answer 16

The pressure/volume relationship of the bladder is measured during filling, provocation and voiding

Question 17

On cystometry you see high detrusor pressure but a low flow rate on voiding. What is the most likely diagnosis?

Answer 17

Bladder outlet obstruction

Question 18

On cystometry you see involuntary detrusor contractions and the patient complains of urgency

Answer 18

Overactive bladder

Question 19

What surgical techniques are used in the treatment of stress urinary incontinence?

Answer 19

Low tension vaginal tape
Intraurethral injections
Artificial sphinters
Colposuspension

Question 20

What is the mainstay of surgical interventions used in the treatment of an overactive bladder?

Answer 20

Botox injections

Question 21

What is meant by a 1st degree uterine prolapse?

Answer 21

Uterus has descended into vagina

Question 22

What is meant by a 2nd degree uterine prolapse?

Answer 22

Prolapse into the interiotus

Question 23

What is meant by a 3rd degree uterine prolapse?

Answer 23

Uterus is visible outside the vagina

Question 24

What is meant by a 4th degree uterine prolapse?

Answer 24

The uterus is entirely outside the vagina

Question 25

What is a rectocele?

Answer 25

Prolapse of the rectum into the vagins

Question 26

What is an enterocele?

Answer 26

Prolapse of the pouch of douglas containing small bowel into the vagina

Question 27

What is a cytocele?

Answer 27

Prolapse of the bladder into the vagina

Question 28

How might a rectocele present?

Answer 28

Constipation | Painful passing of faeces

Question 29

How might a cysourethrocele present?

Answer 29

Stress incontinence Recurrent UTI Urinary retention

Question 30

What is the treatment of atrophic vaginitis?

Answer 30

Vaginal oestrogens

Question 31

What would you give to a women who had a 2nd degree prolapse but who was strongly against surgery?

Answer 31

Pessary such as a ring

Question 32

What is a vault prolapse?

Answer 32

After a hysterectomy has been performed the top (vault) of the vagina may bulge down

Question 33

What is the most common symtpoms of a uterine prolapse?

Answer 33

Feeling of a lump "coming down" Dragging disccomfort Backache

Question 34

How is a uterine prolapse diagnosed?

Answer 34

Vaginal examination

Question 35

What is the treatment of uterine prolapse in women who want to have children?

Answer 35

Pessary

Question 36

What kind of prolapse is usually not treated with a pessary?

Answer 36

Posterior wall prolapse

Question 37

Discuss the surgical options used in the treatment of a cystocele or a rectocele?

Answer 37

Pelvic flow repair. The walls of the vagina are tightened using mesh sewn into the vaginal walls. This is performed vaginally.

Question 38

Discuss the surgical options used in the treatment of a uterine prolapse?

Answer 38

Sarcocolpopexy Sacrospinous fixation. Mainly done by keyhole surgery the uterus if lifted and attached to the sacrum or sacrospinous ligament. Vaginal hysterectomy