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UroGyn Prolog Flashcards

1
Q

gartner duct cyst

A
  • embryonic remnant of mesonephric or wolffian duct
  • posterior or lateral vagina, filled with serous or mucinous fluid
  • adolescence is common
  • many asymptomatic, some cant insert tampon
  • treatment: expectant management vs marsupialization
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2
Q

uretheral diverticula

A
  • can be asympt, but often with post void dribbling, urinary incontinence, dysuria, dysparunia
  • MRI is how you diagnose
  • anterior vaginal wall, 3 cm distal no the anterior wall
  • usually adult women
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3
Q

bartholin gland cyst

A
  • secrete muscus and lubricat the vagina
  • empty into 4 and 8 ocolock ducts of the vaginal vestibule
    distal to hymenal ring
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4
Q

Pronephric duct

A
  • embryologic structure tha regresses

- if doesn’t regress correctly causes abnormal kidney development

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5
Q

Skeene glands

A
  • periurtethral glands
  • “female prostate”
  • if obstructed they are swollen and painful
  • dx via physical exam, anterior wall of vaginal lateral to urethral meauts
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6
Q

stages of anterior/posterior wall prolapse POP-Q system

A

0: none
1: most distal portion is 1cm above the hymen
2: between 1 cm above and 1 cm below hymen
3: more than 1cm below hymen, but 2cm shorter than total vaginal lenght
4. complete eversion

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7
Q

pelvic support muscles

A
  1. levator ani muscle complex (puborectalis, pubococcygeus, iliococcygeus)
  2. endopelvic fascia
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8
Q

ligamentous support of vagina : levels 1-3

A

1: vaginal apex (cardinal ligament-uterosacral ligaments are attached to pubocervical and rectovaginal fascial rings and suspends apex of vagina
2: midvaginal lateral suport where pubocervical fascia is attached laterally to the ARCUS TENDEUS FASCIA PELVIS
3. : support via distal vaginal attachments to perineal membrane ventrally and perineal body dorsally

= USLS, sacrospinous ligament suspension, iliococcygeus fascia suspension

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9
Q

anterior wall prolapse ahve what type of support loss

A

65% have level 1 loss (support at vaginal apex)
- means anterior repair alone often isn’t that helpful long term (w/wo mesh, it needs an apical support surgery add on)

  • sacrospinous and iliococcygeus optoins are extraperitoneal, USLS is intraperitonal (duh)
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10
Q

wound breakdown after OASIS repair

A
  • address active infectin
  • reoperate whenever no further sign of infection
  • stool softeners afterwards
  • do it in an OR
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11
Q

risk for OASIS

A
  • primiparity
  • asian/hisptanic descent-
  • AMA
  • higher infant birth weight
  • forcep assisted delivery (esp with midline epis) 4-5x higher than vacuum, 1-15x higher than SVD
  • vacuum extraction, 1-4x higher for SVD
  • prolonged second stage of labor
  • midline episiotomy
  • persisent OP presentation (could rotate head)
  • squatting positions 2x higher
  • being really skinny (higher weight is protective)
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12
Q

recurrent UTI definition and wu

A
  • 2 in last 6 months OR 3 in last 12 months
  • give suppression meds
  • if dont’ respond to treatment, then image kidney or bladder US or CT urography
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13
Q

when is cystoscopy warrented?

A
  • gross hematuria
  • microscopic hematuria
  • (looking for cancer)
  • (or looking for mesh errosion for pt with frequent UTIs after surgery, looking for forieign body sp surgery for source of infection)
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14
Q

when get renal US?

A
  • concern for renal anomaly, nephrolithiasis, hydronephrosis
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15
Q

treatment of post menopausal UTI

A
  • non- recurrnet then attempt estrogen first

- lower vaginal pH , therefore shifting colonization away from enterobacteriaceae (helps prevent UTIs)

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16
Q

POP Q

A
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17
Q

all urogyn pts gets

A

H&P

  • UA, UCx
  • void amount and PVR
  • cough test
  • urethral mobility testing
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18
Q

urge incont

A
  • leaking on way to bathroom, sometimes with sneazing, overnight
  • treatment 1st line beh mod: mod amount/timing of water intake, timed voiding
  • 2nd line: anticholinergics, B-agonists (megbetron),
  • 3rd tline: botulimsm A injections into the detrusor muscle with cystoscopy (complication is UTIs and retention), percutaneous tibial nerve stimulation (placed at ankle and stimulate the peripheral tibial nerve), sacral neuromodulation (plant a trial implant at s3 nerve root, then put in longterm one (or take out not working test lead in OR), complications include explantation due to surgical site infection)
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19
Q

treatment SUI

A
  • PFPT (found to be better than pessary)
  • weight loss
  • ring pessary
  • periurethral bulking
  • (urodynamic testing prior to surgery if they have complicated incontinence or a confouding exam to rule out other forces of urianry problems, cough + test only thing necessary if normal stress incontinence)
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20
Q

mid urtherthal sling MC complication

A

UTI (30%)

  • if you perf the bladder with trochar, you just replace it without stopping the procedure
  • if they have retention, then intermittent cath and it usually resolves quickly
21
Q

overactive bladder syndrome

A

urgency w/ or w/o urge INCONTINENCE

22
Q

anticolingeric SE

A
  • dry mouth, blurry vision, dry eyes, constipation,
  • sustained release are more tolerated than immediate release,
  • contraindicated in narrow angle glucoma
  • examples: oxybutynin
23
Q

mirabegron

A

b-agonst

  • urge incontinence
  • relaxes bladder by mimicing norepinephrine
  • B3 receptor in bladder
  • SE: hypertension, HA, naso-pharyngitis, urinarytract infection, dry mouth (but lower degree than anticholinergics)
  • CI: uncontrolled HTN
24
Q

phenazopyridine

A

makes urine orange and drips into vagina if there is a fistula

25
Q

dont get jets

A

give IV fluid bolus (assuming no cardiac complication)

26
Q

post sling urinary retension

A
  • cut the sling (1-2%) if significant retension (6w post op with high PVR)
27
Q

mesh exposure

A
  • 1st line treatmetn: estrogen cream

- 2nd line: remove exposed area (not entire sling)

28
Q

aggressive prolapse with stage II or greater prolapse undergoing sarcocopoplexy should also get what and why

A

burch procedure (beacuse there is probably underlying urinary stress incontinence that will show it’s self once the prolapse is fixed, and good data supports ppx doing the burch even if you can’t prove they have stress currently (questions stem in fact had retention)

29
Q

painful bladder syndrome

A
  • 6w or more in duration
  • painful bladder feeling in absecne of infection or other causes
  • have associated urinary urgency and frequency wtih subsequent pain
  • some reports a hx of UTIs with negative cultures and refractory to abx
  • assocaited with lots of psych shit
  • often have poor treatment response (no obvious etiology to treat, and a wide variety of treatments haven’t been found reliably to be helfpul, many women get lots os different treatment to no avail).
  • likely multifactorial
  • 1st line treatment: PFPT (dont’ need cystoscopy anymore to dx it, can do it clinically)
30
Q

recurrent UTIs, espcially in older pt

A
  • 1st line: ppx abx
  • – nitrofuranton is awesome (theoretical risk of chronic intersitial lung diease though, therefore can’t give to someone with COPD)
  • – methanamine hippurate plus Vit C (methenamine salts inhibit urinary tract infections by hydrolyzing the urine into formaldehyde, which is bacertiostatic, therefore there is no bacterial resistence possible to the ppx med. It works by increasing the acidity of the urine (and your body, so you get GI upset).
  • vaginal estrogen also helpful (but increasing from 2x daily to 3x daily probably isn’t going to help much)
31
Q

abdominal sarohysteroplexy

A
  • for apical prolapse (which will also fix anterior prolapse often, or you can add on an anterior repair)
32
Q

burch procedure

A
  • fixes stress urinary incontinence
33
Q

MC complication of mesh

A
  • mesh exposure 30% (next most common were UTI 20% , visceral injury 4%, bleeding, fistula 1%)
  • small exposure, then do vaginal estrogen, or antibotics or PFPT&raquo_space; cut out small area of mesh&raquo_space;»»» take out entire sling
34
Q

mesh that is lowest rate of extrusion

A
  • monofiliment (less erosion) and macroporous (>75 microns, least infection)
35
Q

sacrospinous ligament suspension in PACU with butt pain

A
  • take the stitch out because this sounds like nerve pain
36
Q

ectopic ureter comes from what embryonic start

A
  • mesonephric duct
  • (80% of time associated with dupliated urainry system
  • dx after potty trainign with constant urinary leakage
37
Q

autonomic dysreflexia – happens ABOVE what spinal cord level

A
  • must be ABOVE T6
38
Q

when is the miduretheral sling not the best option?

A
  • when during a concominant urethral diverticula repair surgery, beacuse it increases the risks the diverticula will come back
  • instead want autologious sling
  • or you can do two separate procedures and wait until urethtral diverticula is healed from first surgery (cause mid urethral is better.
39
Q

rectovaginal fistula recommendations

A
  • immediate closure now recommended if >5mm defect
  • when no infection is present, do a simpled layered approach
  • <5mm defect can often close on own, so you can expected wait
  • temporarly diversion is limited to peopel who fail first time repair
40
Q

anal leakage recs

A
  • risk factors: age > loose stool
  • medical management of loose stool > surgical repair (beacuse surgical repairs suck)
  • loperimide is often sufficient
41
Q

nerve injurty in gyn surgery

A
  • usually stretch/tempary vascuar compression in myelin
  • usually resolves on own days to months
  • but early PT is recommended
  • femoral from self retaining abdominal retractors
  • obturaror (adduction) for paravaginal sutures
  • sicatic causes leg/patellar pain S2-4 (not lumbar)
42
Q

nocturia recs

A
  • voiding diary
  • bedsdie commod (need to prevent falls which are life threatening in older women)
  • usually multifactorial, so not just urge incontinence (pee on way to toliet in middle of night)
  • no meds if really only occurs at night
43
Q

colpocliesis outcomes

A
  • really great, 90-100% success without recurreance
  • the chance of a rectoral prolapse aftwresad is very unlikey, so if have rectal fullness, incontenence, and incomplete bowel evacuatino, then likely they have anew problem of rectal PROLAPSE.
  • thsi question is testing your knowlde of how good the colpocliesis is
  • also higher incidence in women with colpocliesis than normal women
  • no all cases come through the vagina completely, so they sit at the introitus and confuse patiens on why thye feel rectally full and have incontinenece
  • evaluate always with straining on comod, cannot replicat on back. if can’t replicate, then do defecography
  • fix with mesh (ideally intraabdominally, but can do perineally for pt that are bad extended surgery candidates)
44
Q

spinal cord injury and bladder use

A
  • often have 6-12w of bladder shock, regardles of future outcomes. Indwelling catheter and then straight cath when able.
  • however as spinal cord injury progresses/develops, can cuase other problems which cause leakign between catheterizations
    (bladder distention restrcition and detursor overactivty)
  • longterm bladder control is best maintained fro most with straight cath and anticholinergics to reduce blader activity
  • if this starts to not work, this can lead to kidney problems.
  • therefore, need to surgically intervene.
  • ileoystoplasty (make new bladder flat with intestineal tissue and then just straight cath, coudl make new abdominal urine exit but often problematic, so if can straight cath, try to keep urethral opening)
45
Q

intermittent cath and….

A

usually anticholinergics

46
Q

sling placement with trochars through bladder

A
  • replace teh sling
  • the bleeding will stop on own usually
  • no repair needed i dont’ see in the answer
  • if bleeding doesn’t stop, then you can coaguate with monopolar energy source via cystoscopy
47
Q

posterior wall defect w/wo apical descent

A
  • w/o needs posterior repair
  • w/ needs sacral colpoperineopexy

:)

  • no mesh for posterior repair along
48
Q

vertebral osteomylitis from sacrocolpopexy

A
  • direct seeding from vagina on mesh to sacrum where attached
  • s. aureus is most common
49
Q

USLS nerve entrapement

A
  • sacral nerve roots
  • pain and numbness to buttock that raidates down back of thigh to popliteal fossa (makes sense)
  • plaecd in USL at level of ischial spine
  • entrapement suspected, then need to take out sutures immeidately
  • S2-4 is where this is located

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