Urinary incontinence and Prolapse Flashcards Preview

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Flashcards in Urinary incontinence and Prolapse Deck (38):
1

What muscle is responsible for an overactive bladder?

Detrusor

2

What drug treatment is used in stress incontinence?

Duloexetine (combined noradrenaline and serotonin reuptake inhibitor)

3

What drug treatment is used in treating an overactive bladder?

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

4

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

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

5

What surgical treatments are available for stress incontinence?

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

6

What is the most common cause of overactive bladder?

Detrusor overactivity

7

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

Levator Ani
Cocygeua

8

Which lies more medially; coccygeus or levator ani?

Levator Ani

9

What are the attachments of the levator ani muscle?

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

10

What are the three parts of levator ani?

Puborectalis
Pupococcygeus
Iliococcygeus

11

What two nerves innervate the levator ani muscle?

Pudendal nerve
Nerve to leavator ani

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?

Deep perineal Pouch

13

What kind of epithelium lines the bladder?

Transitional epitheliym

14

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

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

15

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

200ml

16

What does cystometry measure?

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

17

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

Bladder outlet obstruction

18

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

Overactive bladder

19

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

Low tension vaginal tape
Intraurethral injections
Artificial sphinters
Colposuspension

20

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

Botox injections

21

What is meant by a 1st degree uterine prolapse?

Uterus has descended into vagina

22

What is meant by a 2nd degree uterine prolapse?

Prolapse into the interiotus

23

What is meant by a 3rd degree uterine prolapse?

Uterus is visible outside the vagina

24

What is meant by a 4th degree uterine prolapse?

The uterus is entirely outside the vagina

25

What is a rectocele?

Prolapse of the rectum into the vagins

26

What is an enterocele?

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

27

What is a cytocele?

Prolapse of the bladder into the vagina

28

How might a rectocele present?

Constipation
Painful passing of faeces

29

How might a cysourethrocele present?

Stress incontinence
Recurrent UTI
Urinary retention

30

What is the treatment of atrophic vaginitis?

Vaginal oestrogens

31

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

Pessary such as a ring

32

What is a vault prolapse?

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

33

What is the most common symtpoms of a uterine prolapse?

Feeling of a lump "coming down"
Dragging disccomfort
Backache

34

How is a uterine prolapse diagnosed?

Vaginal examination

35

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

Pessary

36

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

Posterior wall prolapse

37

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

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

38

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

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