Urogynaecology Flashcards
(23 cards)
List 4 clinical features of uterine prolapse
- Groin/back pain (stretching of uterosacral ligaments)
- Feeling of heaviness/pressure in the pelvis - worse with standing and lifting; worse at the end of the day; relieved by lying down
- ulceration/bleeding (particularly if hypooestrogenic)
- +/- urinary incontinence
What is uterine prolapse?
Protrusion of cervix and uterus into vagina
What is vault prolapse?
Protrusion of apex of vaginal vault into vagina, post-hysterectomy
What is a cystocoele?
Protrusion of bladder into the anterior vaginal wall
List 5 clinical features of a cystocoele
Frequency Urgency Nocturia Stress incontinence Incomplete bladder emptying +/- associated increased incidence of UTIs
What is a rectocoele?
Protrusion of rectum into posterior vaginal wall
List 2 clinical features of a rectocoele
Straining/digitation to evacuate stool
Constipation
What is the Baden Walker grading for prolapse?
Grade 1 - prolapse within vagina
Grade 2 - prolapse to the introitus
Grade 3 - Prolase beyond the introitus
Grade 4 - complete procidentia - failure of genital supports and complete protrusion of uterus through the vagina
What is the Pop-Q?
Measure prolapse in relation to the most dependent part of the vagina (proximal to a point 3cm into the vagina) in relation to introitus
Stage 1 - less than -1
Stage 2 - -1 to +1
Stage 3 - more than +1 but less than TVL -2
Sage 4 - more than TVL -2
How is pelvic organ prolase treated?
Conservative - physiotherapy/pelvic floor exercises, vaginal pessary
Surgery - dependent on type of prolapse
List 3 surgical treatments for (pelvic organ) prolapse
- Vaginal repair with or without mesh or biological graft reinforcement
- Vaginal or uterine ‘hitch up’ to spine (sacral colpopexy or hysteropexy) or pelvis (sacrospinous fixation)
- Vaginal hysterectomy or uterine conservation
What is a colporrhapy?
Essentially vaginal wall repair; used to treat cystocoeles (anterior colporrhapy) and rectocoeles (posterior colporrhapy)
What is stress incontinence?
Involuntary loss of urine with increased intra-abdominal pressure (coughing, laughing, sneezing, walking, running)
What can stress incontinence be due to? (2)
- Lack of support to upper urethra and bladder outlet (urethral hypermobility)
- “Intrinsic sphincter deficiency” - more common in older, previous radiation, multiple previous continence surgeris
List 6 risk factors for stress incontinence in women.
- Pelvic prolapse
- Pelvic surgery
- Vaginal delivery
- Hypooestrogenic state (post-menopause)
- Age
- Neurological/pulmonary disease
What is urge incontinence?
Urine loss associated with an abrupt sudden urge to void
What is the aetiology behind urge incontinence?
- Idiopathic (90%)
2. Detrusor muscle overactivity
How is urinary incontinence evaluated? (4)
Most patients can be diagnosed with clinical history alone
- History and examination
- Dipstick and/or MSU
- Bladder diary
- Urodynamics - gold standard
What is the gold standard diagnostic test for urinary incontinence?
Urodynamics
List 2 conservative measures of management for stress incontinence
pelvic floor exercise and bladder training
support devices - intravaginal support, external urethral occlusive and intraurethral plugs
List 4 surgical treatment for stress incontinence
- Mid-urethral tapes TVT/TOT (“tension free”)
- Bladder neck suspension procedures - Burch colposuspension
- Urethral injections
- Reconstructive surgery - pubovaginal sling, artificial urethral sphincter
List 3 non-operative treatments for urge incontinence
Behaviour modification - reduce caffeine/liquid, smoking cessation, regular voiding schedule
Pelvic floor exercises and bladder training
Medications: anticholinergics e.g. oxybutinin (oral or transdermal patch), tolterodine or solifenacin
List 3 surgical treatments for urge incontinence
Botox injections into bladder Sacral nerve stimulation Bladder reconstruction (last resort!)
