Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

MRCOG Part 2 > Urinary incontinence and urogynaecology including NICE Urinary Incontinence, Post hysterectomy vault prolapse GT46 > Flashcards

Urinary incontinence and urogynaecology including NICE Urinary Incontinence, Post hysterectomy vault prolapse GT46 Flashcards

(70 cards)

Start Studying
1
Q

What are the 2 most common adverse effects following Botox for Overactive bladder?

A
  1. UTI

2. Voiding difficulties requiring self catheterisation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the first line medications for medical management of OAB

A

oxybutinin (immediate release) - anticholinergic
tolterodine (immediate release) - antimuscarinic
darifenacin (once daily prep) - antimuscarinic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is the % risk of bladder perforation in TVT

A

0.9-25%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the risk of de novo urgency in TVT

A

0.2-15%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what is the risk of bleeding in TVT

A

0.9-2.3%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is the recommended surgical procedure for SUI if conservative management has failed?
What type of material should be used?

A

mid-urethral tape
Bottom- up approach
macroporous type 1 polypropylene mesh

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

of the following 3 options, which ones influence the outcome of surgery for SUI?
BMI
menopause status
Agenig

A

menopause status

ageing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is the cure rate for pelvic floor exercises for management of SUI

A

21-84%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what percentage of women remain symptomatic of incontinence following delivery?

A

12%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what percentage of women experience prolapse in their lifetime

A

40%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the main risk factors for pelvic organ prolapse (POP)

A

caucasian, age, multiparity, obesity, smoking, occupation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what is the lifetime risk of prolapse surgery?

What is the risk of repeat surgery?

A

Life time risk- 11%.

11% Risk of repeat surgery in 11 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

True or false; Buttock pain is a recognised complication of sacrocolpopexy

A

FALSE.

Buttock pain is a complication of sacrospinous fixation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the gold standard procedure for post-hysterectomy vaginal vault prolapse?

A

sacrocolpopexy- fixing the vaginal vault to the sacral promontory using mesh.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

A woman presents in clinic with a vaginal bulge. She had a hysterectomy 10 years ago. In a POP-Q assessment, which value is ommitted?

A

D- posterior fornix

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Which procedure at the time of vaginal hysterectomy is effective at preventing subsequent post-hysterectomy vault prolapse?

A

McCall Culdoplasty (i.e. reattach the uterosacral-cardinal ligament complex to the vagina)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What procedure should be considered during vaginal hysterectomy if the vault descends to the introitus during closure?

A

Sacrospinous fixation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Which procedure for vault prolapse has lower rates of recurrence, dyspareunia and postoperative stress incontinence?

A

Abdominal sacrocolpopexy vs SSF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

When can colpocleisis be considered for vault prolapse?

A

In frail elderly women and/or those who do not wish to retain sexual function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is an effective measure to reduce postoperative SUI in previously continent women at the time of sacrocolpopexy?

A

Colposuspension at the same time.

Not effective for those previously symptomatic with SUI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

To which body should mesh complications be reported to?

A

MHRA (Medicines and healthcare products regulatory agency)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

When may SSF not be appropriate?

A

In women with a short vaginal length, particularly if pre-exising dyspareunia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How many days should a bladder diary be kept for initial assessment of OAB/UI symptoms?

A

3 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

When should urodynamics be performed prior to surgery?

A

Symptoms of OAB leading to suspicion of detrusor overactivity

Symptoms of voiding dysfunction or anterior compartment prolapse

Previous surgery for stress incontinence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What lifestyle interventions should be first line for women with OAB
Reduce caffeine Modify fluid intake If BMI >30 lose weight
26
What is first line treatment for women with SUI or mixed incontinence?
3/12 trial supervised pelvic floor muscle training | 8 contractions TDS
27
What is first line treatment for women with urge incontinence or mixed UI?
6/52 bladder training | Consider combination with OAB drug if not good effect and frequency troublesome
28
When should percutaneous posterior tibial nerve stimulation be considered in OAB?
After MDT review Conservative (including drugs) treatment not worked Woman doesn't want Botox/percutaneous sacral nerve stimulation
29
How long can it take to feel the full benefit of OAB pharmacological treatment?
4 weeks
30
Which drug treatment for OAB should be avoided in older, frail women?
immedite release oxybutynin
31
How often should women be reviewed in primary care once commenced on an OAB drug?
Yearly, or 6 monthly if >75
32
When can desmopressin be used for OAB and when is it contraindicated?
If nocturia troublesome symptom | Care in cystic fibrosis, or >65 if have cardiovascular disease/hypertension
33
Which pharmacological treatment is available for SUI (not first line)
Duloxetine (SSNRI)
34
When should Botox A be offered?
OAB with proven detrusor overactivity not responded to conservative mx (incl drugs)
35
If Botox A is effective when should follow up/repeat treatment be offered?
6 months, or sooner if symptoms return (without MDT)
36
When should percutaneous sacral nerve stimulation be offered for OAB?
After MDT discussion Conservative management failed Unable to perform ISC
37
What are the side effects of augmentation cystoplasty?
``` Bowel disturbance Metabolic acidosis Mucus production Retention in the bladder UTI Small risk of malignancy ```
38
What is second line treatment of SUI after conservative management?
Synthetic midurethral tape Open colposuspension Autologous rectus fascial sling
39
When should follow up be arranged following continence surgery?
6/12 including vaginal examination to check for mesh erosion
40
When should mirabegron be considered for OAB?
If antimuscarinics are contraindicated or clinically ineffective, or with unacceptable side effects (b-3 adrenergic agonist)
41
What is the first line pharmaceutical management of bladder pain syndrome (when conservative measures failed)?
Oral amitryptilline or cimetidine (not licenced)
42
What intravesical options are there for bladder pain syndrome?
``` Lidocaine Hyaluronic acid Botox A Dimethyl Sulfoxide (DMSO) - teratogenic Heparin Chondroitin sulphate ```
43
When can cystoscopic fulguration, laser treatment and transurethral resection of lesions be considered in bladder pain syndrome?
If Hunner lesions identified at cystoscopy | subtype of interstitial cystitis
44
What procedures can be considered if conservative, oral and intravesical therapies have failed in bladder pain syndrome?
Neuromodulation (posterior tibial/sacral) Oral cyclosporin A Cystoscopy +/- hydrodistension Major surgery - last line in refractory BPS
45
Which anticholinergic does not cross the blood brain barrier?
Trospium
46
Which type of prolapse is associated with morbid obesity?
Rectocele (75%) Cystocele (57%) Uterine (40%)
47
What is the risk of de novo prolapse (cystocele) after sacrocolpopexy (mesh) vs sacrospinous fixation (no mesh)
31% vs 14%
48
What is the rate of mesh erosion in vaginal prolapse surgery?
As high as 12%
49
What is the most common cause of urethral diverticulum?
Acquired - repeat infections and obstruction of the periurethral glands
50
What is the normal Qmax at uroflowmetry?
20-36ml/s
51
What happens to urge symptoms following midurethral tape if mixed incontinence?
50% resolution 25% no change 25% worsen
52
What SUI surgery should be performed for neurogenic stress incontinence?
Autologous fascial sling | Mesh should not be used
53
When should a pad test be used?
When there is discrepancy between urodynamics and symptoms (ideal - ambulatory urodynamics) 24 hours more accurate than 1 hour
54
How would voiding difficulty appear on urodynamics?
A steep rise in detrusor pressure during filling
55
What is the estimated prevalence of OAB in the general population?
15-20%
56
How many women are affected by urinary incontinence at some point in their lives?
70%
57
If which patients should desmopressin be used with particular caution
Cystic fibroisis | Avoid >65 with cardiovascular disease or hypertension
58
how does caffeine contribute to OAB?
increase in detrusor pressure and detrusor overactivity seen with caffeine
59
which type of drink is the only one associated with SUI and OAB
carbonated drinks
60
how does smoking affect urinary incontinence?
smoking associated with increased urinary incontinence. Thought to be related to an increase in bladder contractions
61
how does the use of bladder cones compare to PFMT for SUI?
beneficial effects seen with cones, comparable to those seen with PFMT
62
what are the benefits of suprapubic catheter over urethral catheter?
lower rates of symptomatic UTI and catheter bypassing
63
what percentage people FAIL to achieve satisfactory improvement in incontinence with anticholinergics?
25-40%
64
what are the main contraindications for antimuscarinic drugs for OAB?
myasthenia gravis, significant bladder outflow obstruction, severe ulcerative colitis
65
are anticholinergic medications first line or second line medical treatment for OAB?
anticholinergics are first line (Oxybutinin) | antimuscarinics are second line (tolterodine, darifenacin)
66
what is the main contraindication to the use of mirabegron
uncontrolled hypertension
67
what percentage of women will need to perform ISC after botox for OAB?
10-15%
68
single dose Antibiotic phrophylaxis is commonly given prior to botox for OAB. Which type of antibiotics should be avoided and why?
aminoglycosides should be avoided as they can potentiate the effect of botox A
69
what percentage of ppl who have had sacral nerve stimulation end up having to undergo re-operation? what are the main reasons?
33%. | mainly due to pain and infection at implantation site, or lead migration.
70
what percentage of ppl having undergone sacral nerve stimulation needed permanent removal of electrodes?
9%

MRCOG Part 2 (97 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions