Urogynae Flashcards
(25 cards)
What is overactive bladder syndrome?
Increased frequency and nocturia without incontinence
What can continuous incontinence indicate?
Very severe incontinence or a fistula
Describe pelvic floor muscle training?
Supervised training involving at least 8 contractions, 3 times a day for a minimum of 3 months
When should follow up for all urogynae surgeries be completed?
Within 6 months
What is the review period for duloxetine?
2-4 weeks
What are the surgical methods for colposuspension?
- Open (bikini line incision, up to 4 days in hospital)
- Laparoscopic (1-2 days in hospital)
What is the after care for colposuspension?
- Don’t drive until can comfortably make an emergency stop (usually 3-4 weeks)
- Refrain from sexual activitiy for 4-6 weeks
- Return to light job after 6 weeks
- Return to heavier or busy job after 12 weeks
How is autologous rectal fascial sling performed?
Abdominal and vaginal incision + catheter
What is the aftercare for rectus fascial sling?
Same as colposuspension
How long is bladder retraining done in urge incontinence?
6 weeks, gradually increasing intervals between voiding
What are the first line bladder stabilising drugs for urge incontinence?
- Oxybutynin (immediate release)
- Tolterodine (immediate release)
- Darifenacin (once daily preparation)
Who should immediate release oxybutynin be avoided in?
Frail older women
What is the medical management of urge incontinence in frail elderly women?
Mirabegron (beta-3-agonist)
What are the 4th line surgical options for urge incontinenece?
- Botox injection
- Percutaneous tibial nerve stimulation (PTNS) or sacral nerve stimulation (SNS)
How long is the course of pelvic floor exercises for vaginal prolapse?
16 weeks
What is colpocleisis?
Surgery sewing together the vaginal walls to better support a vault prolapse
When would colpocleisis be considered?
If the woman does not want to have penetrative sex or they’re at high surgical risk
How often is a vaginal ring pessary changed?
Every 6 months
What are the side effects of vaginal ring pessary?
Unpleasant discharge, irritation, UTI, interference with sex (if it’s a shelf pessary)
What are the surgical options for uterine prolapse?
- Hysterectomy (+- vaginal sacrospinous fixation)
- Sacro-hysteropexy
- Vaginal sacrospinous hysteropexy
- Manchester repair
What is the difference between a sacro-hysteropexy and a vaginal sacrospinous hysteropexy?
Sacro-hysteropexy:
- Uterus is fixed to the sacrum via a mesh or tape
Vaginal sacrospinous hysteropexy:
- Cervix/ uterus is fixed to the sacrospinous ligament using a mesh
What is a manchester repair?
Shortening and stitching the cervix to surrounding structures to better support the uterus, not suitable if the woman wishes to have children in the future
What are the surgical options for vaginal vault prolapse?
- Vaginal sacrospinous fixation
- Sacrocolpopexy
- Colpocleisis
What is the difference between vaginal sacrospinous fixation and sacrocolpopexy?
Vaginal sacrospinous fixation:
- Stitching the top of the vagina to the sacrospinous ligaments
Sacrocolpopexy:
- Using a mesh to attach the top of the vagina to the sacrum
