Urogynaecology Flashcards
(25 cards)
What is a cystocele?
Bladder prolapses backwards into vagina caused by a defect in the anterior vaginal wall.
What is a rectocele?
A defect in the posterior vaginal wall, allowing the rectum to prolapse forwards into the vagina.
How does a rectocele present?
Constipation and difficulty with defecation, faecal loading in the part of the rectum that has prolapsed into the vagina, urinary retention, tenesmus or sensation of pressure in the rectum
What is enterocele and how does it present?
An enterocele is the prolapse of the small bowel into the vagina. It would typically present with a posterior vaginal wall bulge and lower back pain
What are the different prolapses that can occur if there’s a defect in:
- Anterior vaginal wall
- Posterior vaginal wall
- Apical vaginal wall
- cystocele, urethrocele, urethrocystocele
- rectocele, eneterocele
- vaginal vault (roof of vagina common after hysterectomy), uterine prolapse
What are the risk factors for developing pelvic organ prolapse?
Multiple vaginal deliveries
Instrumental, prolonged or traumatic delivery
Advanced age and postmenopause status
Obesity
Chronic respiratory disease causing coughing
Chronic constipation causing straining
Sx of Pelvic organ prolapse?
Heavy feeling, dragging
Urinary symptoms, such as incontinence, urgency, frequency, weak stream and retention
Bowel symptoms, such as constipation, incontinence and urgency
Sexual dysfunction, such as pain, altered sensation and reduced enjoyment
Describe examination for pelvic organ prolapse
- px should empty bladder
- Sim’s speculum (u-shaped, single bladed speculum) used to examine prolapse
- Ask px to cough to assess full prolapse
Describe conservative tx for pelvic organ prolapse.
Physiotherapy (pelvic floor exercises for 6 months)
Weight loss
Lifestyle changes for stress incontinence, such as reduced caffeine intake and incontinence pads
Vaginal oestrogen cream
Describe medical/surgical tx for pelvic organ prolapse
Vaginal pessary - provide extra support to pelvic organs
What is the complication of using pessaries and what can be used to relieve this?
They can cause vaginal irritation and erosion over time. Oestrogen cream helps protect the vaginal walls from irritation.
What is urinary tract calculi?
aka renal stones. Solid concentrations formed in urinary tract from substance present in urine.
What are the different types of kidney calculi?
What are they made from?
- Calcium oxalate (MC)
- Calcium phosphate
Other less common ones:
* Cystine
* Uric acid
* Struvite
Sx of urinary tract calculi
Renal colic pain (colicky unilateral loin to groin pain)
Restlessness (always moving due to pain)
N+V
Haematuria
Decreased urinary output
Sepsis sx
Ix of urinary tract calculi
Urine dipstick (haematuria)
FBC and U&E (hypercalcaemia)
Abdo x-ray
GS Non-contrast CT KUB
Tx of urinary tract calculi
Analgesia (NSAIDs)
Watchful waiting
Tamsulosin (aid renal stone movement)
Surgical options:
ESWL (shock waves)
Ureteroscopy + laser lithotripsy
PCNL (for large stones)
Open surgery (last resort - complex surgery)
- Extracorporeal shockwave lithotripsy (ESWL) is a non-invasive procedure that uses shock waves to break up kidney and ureter stones
- Percutaneous nephrolithotomy (PCNL) is a minimally invasive procedure to remove kidney stones that are too large to pass on their own
Define the following:
- Uterine prolapse
- Vault prolapse
- Cystourethrocele
- Uterus itself descends into the vagina.
- The top of the vagina (the vault) descends into the vagina in women that have had a hysterectomy, and no longer have a uterus.
- Prolapse of both both bladder and urethra into vagina
What is overactive bladder?
A chronic condition that results from hyperactivity of the detrusor muscle, a layer of the urinary bladder wall.
Sx of overactive bladder
Urinary urgency Sx:
* Urge incontinence: involuntary leakage accompanied by or immediately preceded by urgency
* Frequency: urinating more often than what is considered normal
* Nocturia
Ix for overactive bladder
Urinalysis - rule out infection
Bladder diary
Urodynamics - evaluate bladder muscle function
Mx for overactive bladder (OAB)
- Lifestyle modifications - reducing oral fluid intake, and avoiding caffeine and alcohol
- Anticholinergic drugs: Like oxybutynin and solifenacin
- Vaginal oestrogens: Used if urogenital atrophy present
- Botox
Anticholergic drugs - block acetylcholine which is responsible for stimulating the bladder to contract leading to urgent and frequent need to urinate. Therefore, blocking it helps manage sx of OAB.
What is a genital tract fistula?
Abnormal opening between genital tract and another organ or surface of the body.
RF for genital tract fistula
Prolonged or obstructed labor during childbirth
Obstetric trauma, such as perineal tears or episiotomy
Pelvic surgery, including hysterectomy or pelvic organ prolapse repair
Sx of genital tract fistula
Urinary and faecal incontinence (passage of faeces through vagina)
Vaginal discharge (foul-smelling)
Recurrent UTI’s
