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Obstetrics and Gynaecology > Urogynaecology > Flashcards

Urogynaecology Flashcards

1
Q

Define stress incontinence

A

Rise in intra-abdominal pressure without detrusor muscle contraction causing urine leakage e.g. laughing

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2
Q

Define urgency incontinence

A

Leakage of urine due to involuntary contraction of detrusor

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3
Q

Give 4 causes of an overactive bladder/urgency incontinence

A

Parkinson’s
MS
Acute UTI
Alcohol

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4
Q

Give 4 risks of stress incontinence

A

Anatomical abnormality
Drugs
Menopause
Cognitive impairment

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5
Q

What is urodynamic stress incontinence?

A

Stress incontinence which has been proven by urodynamic testing

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6
Q

Give 4 symptoms of incontinence

A

Frequency
Urgency
Nocturia
Voiding problems

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7
Q

Give 4 risks of incontinence

A

Reduced mobility
Renal pathology
Cardiac pathology
Pelvic surgery

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8
Q

Which 2 examinations may be done in the investigation of incontinence?

A

Abdominal and bimanual

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9
Q

Which investigation MUST be carried out in all women presenting with incontinence symptoms

A

Urine dip and culture

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10
Q

Give 2 investigative tests used in incontinence

A

Cystoscopy

Renal tract imaging

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11
Q

Give 3 conservative management options for incontinence

A

Continence advice
Physiotherapy
Bladder retraining

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12
Q

What is 1st line medical treatment for overactive bladder/urgency incontinence?

A

Anticholinergic (e.g. Oxybutynin)

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13
Q

What is 1st line medical treatment for stress incontinence?

A

Duloxetine (serotonin and noradrenaline reuptake inhibitor)

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14
Q

Give 1 surgical option for overactive bladder

A

Botox injection of detrusor

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15
Q

Give 1 surgical option for stress incontinence

A

Mid-urethral sling

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16
Q

Define uterovaginal prolapse

A

Protrusion of uterus and/or vagina beyond normal anatomical confines

17
Q

Give 3 structures in the pelvic floor which support the uterus

A
  • Vaginal walls
  • Transverse cervical ligaments
  • Round and broad ligaments
18
Q

What are the 3 main components of the pelvic floor?

A
  • levator ani muscles
  • coccygeus muscle
  • fascial coverings of muscles
19
Q

Which 2 ligaments support the cervix and upper 1/3 of vagina?

A

Transverse cervical ligament

Uterosacral ligament

20
Q

Give 3 risks of prolapse

A
  • Age
  • Vaginal deliveries
  • Raised intra-abdominal pressure
21
Q

Give 6 ways in which a prolapse may present

A
  • Bulging from vagina
  • Bleeding
  • Dyspareunia
  • Constipation
  • Urinary incontinence
  • Pressure sensation in vagina
22
Q

Give 3 things that should be done during speculum examination of a prolapse

A
  • Check walls for descent or atrophy
  • Check for ulceration
  • Ask pt. to cough
23
Q

What does the pelvic organ prolapse quantification assess?

A

Based on position of most distal part of prolapse during straining

24
Q

Briefly define the stages of prolapse (0-4)

A 
0 = no prolapse 
1 = more than 1cm above hymenal ring 
2 = prolapse from 1cm above to 1cm below hymenal ring 
3 = 1cm or more below hymenal ring 
4 = vagina completely everted
25
Q

Outline the degrees of uterine prolapse from 1st to 3rd

A

1st degree: cervix descends within vagina but doesn’t pass outside

2nd degree: cervix protrudes beyond opening

3rd degree: total prolapse of uterus outside vagina

26
Q

Give 4 conservative management options for prolapse

A
  • Weight loss
  • Smoking cessation
  • Physiotherapy
  • Pessaries
27
Q

Where anatomically are ring pessaries placed?

A

Between posterior symphysis pubis and posterior fornix of vagina

28
Q

Give 3 complications of a pessary

A
  • Infection
  • Interfere with sex
  • Ulceration
29
Q

What is a Manchester repair?

A

Removes part of cervix and pushes uterus into place by shortening holding ligaments

30
Q

In vaginal vault prolapse, which ligament can be used to suture the vaginal vault to to hold it in place?

A

Sacrospinous ligament

31
Q

What procedure closes the opening of the vagina completely?

A

Colpocleisis

32
Q

Give 3 methods used to prevent prolapse

A
  • Weight loss
  • Treatment of chronic constipation
  • Smoking cessation

Obstetrics and Gynaecology (10 decks)

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