Urogynae

Question 1

What are the storage symptoms’

Answer 1

FUNN

Frequency
Urgency
Nocturia
Nocturnal enuresis

Question 2

What are storage symptoms indicative of?

Answer 2

Urge incontinence

Question 3

What are the voiding symptoms?

Answer 3

Hesitancy
Intermittent stream
Poor stream / dribbling / spitting and spraying
Slow stream

Question 4

What are the two key tissues controlling micturition?

Answer 4

Detrusor muscle

Urethral sphincter

Question 5

What nerve fibres innervate the detrusor?

Answer 5

Muscarinic cholinergic muscles of PNS

Question 6

What nerve fibres innervate the urethral sphincter?

Answer 6

Noradrenergic fibres of SNS

Question 7

What is stress incontinence?

Answer 7

Involuntary leakage of urine due to increased pressure (effort, exertion, sneezing, coughing)

Question 8

What is stress incontinence due to?

Answer 8

An incompetent urethral sphincter, due to weakness and hypermovility

Question 9

what is the key RF for stress incontinence?

Answer 9

CHILDBIRTH

Question 10

Why is childbirth a major RF?

Answer 10

Causes overstretching of pelvic floor muscles , damage to pudendal nerves, loss of pelvic floor support

Question 11

What are conditions that increase childbirth causing stress incontinence?

Answer 11

Multiparity 
Forceps delivery 
Perineal trauma 
Long labour 
Epidural 
high birth weight 
increased age
postmenopause 
obesity

Question 12

What is urge incontinence?

Answer 12

sudden spontaneous urge to urinate

Question 13

What is urge incontinece caused by?

Answer 13

Detrusor overactivity

So involuntary detrusor contractions during the filling stage of micturition

Question 14

What are modifiable RF for detrusor overactivity?

Answer 14

Obesity
Smoking
Continence surgery

Question 15

What Ix should be done in someone reporting incontinece?

Answer 15

MSU 
Bladder diary (3 days) 
Pad test 
Urodynamic testing 
USS Kidney / Pelvis (if pelvic pain, mass, haematuria act)
Cystoscopy is Red flag sx

Question 16

How do you treat urge incontinece?

Answer 16

Bladder training
Anticholinergic drugs
Botulinum toxin

Question 17

How do you treat stress incontinence’

Answer 17

Pelvic floor muscle training
Anticholinergics
Surgery (Midurethral tape procedure/Burch colposuspension)

Question 18

What is important conservatives mx for incontinence=?

Answer 18

Fluid balance (don’t over drink)
Avoid caffeine / alcohol / artifically sugar drinks
Bladder retraining
Pelvic floor exercise

Question 19

What are examples of anticholinergics?

Answer 19

Oxybutinin

Question 20

What is given as second line med to anticholinergics?

Answer 20

Mirabegron (beta - 3 adrenergic agonist, enhances detrusor relaxation)

Question 21

What is mirabegron given for?

Answer 21

Urge incontiunence

Question 22

What surgeries are done for stress incontinence?

Answer 22

Midurethral tape

Burch colposuspension

Question 23

How is urge incontinence surgically treated?

Answer 23

Botukinum injecgion

Question 24

What is a prolapse?

Answer 24

Displacement of an organ or part of an organ from its normal position

Question 25

What are sx of vaginal prolapse

Answer 25

``` Sensation of vaginal bulge, heaviness, protrusion Dragging discomfort Lowe abdo / bacs pain Difficulty voiding urine Sensation of incomplete emptying Digitation for complete emptying Urinary / faecal incontinence Pain/discomfort / failure to achieve penetration during sex ```

Question 26

How many levels of vaginal descent are there?

Answer 26

3

Question 27

What is level 1 of vaginal prolapse?

Answer 27

descent of uterus into vagina DOES NOT REACH HYMEN

Question 28

Level 2 of vaginal prolapse?

Answer 28

Prolapse of vaginal wall into vaginal lumen (anterior / posterior vaginal prolapse) REACHES HYMEN

Question 29

Level 3 of vaginal prolapse?

Answer 29

Lower posterior vaginal wall prolapse THROUGH HYmen

Question 30

What are the types of vaginal prolapse in the anterior vagina?

Answer 30

Cystocoele - upper half of vagina, from bladder Urethrocoele - Lower half of vagina

Question 31

What are the types of vaginal prolapse in the posterior vagina?

Answer 31

Enterocoele - upper third of vagina | Rectocoele - lower 2/3 of vagina

Question 32

What is conservative treatment for prolapse?

Answer 32

pelvic floor exercises | Vaginal pessaries

Question 33

How often do you replace vaginal pessaries?

Answer 33

6 months