Urogynaecology

Question 1

What are the different types of chronic incontinence?

Answer 1

1. Stress incontinence
2. Urge incontinence
3. Mixed
4. Overflow incontinence
5. Fistula
6. Functional incontinence

Question 2

What is the most common type of chronic incontinence?

Answer 2

Stress incontinence

Question 3

What is the mnemonic for transient causes of incontinence?

Answer 3

DIAPPERS

Question 4

What are the transient causes of incontinence?

Answer 4

Delirium
Infection
Atrophic changes
Pharmacological
Psychological
Excessive urine output
Restricted mobility
Stool impaction

Question 5

What is stress incontinence?

Answer 5

Involuntary leakage of urine upon exertion - i.e. an increase in intra-abdominal pressure

Question 6

What is the cause of stress incontinence?

Answer 6

Urethral sphincter weakness

Question 7

What are the risk factors for stress incontinence?

Answer 7

1. Increasing age
2. Increased parity
3. Vaginal delivery - particularly deliveries that were instrumented, prolonged, or delivered a macrocosmic infant
4. Obesity

Question 8

How should suspected stress incontinence be investigated?

Answer 8

1. Urine dip/culture
2. Blood glucose
3. Micturition diary
4. Urodynamic evaluation with cystometry

Question 9

What are the conservative methods of management, suitable for stress incontinence?

Answer 9

1. Lifestyle modification - WL, smoking cessation, modify fluid intake, modify caffeine intake
2. PRMT - e.g. vaginal cones
3. Biofeedback
4. Treat/prevent constipation
5. HRT
6. Pads

Question 10

What is the medical management of stress incontinence?

Answer 10

Duloxetine - selective serotonin re-uptake inhibitor

Question 11

What are the adverse effects of the medical management of stress incontinence?

Answer 11

Nausea (most commonly); dyspepsia; dry mouth; dizziness; drowsiness; insomnia

Question 12

What examination should be performed when a woman is suspected to have stress incontinence?

Answer 12

1. Patient cough
2. Bimanual - to assess pelvic floor muscles by asking to squeeze
3. Speculum (?prolapse)
4. Abdominal examination

Question 13

Of all the available treatments for stress incontinence, which is considered first-line?

Answer 13

Pelvic floor muscle training

Question 14

Which is preferable - medical or surgical management of incontinence?

Answer 14

Surgical, due to the adverse effects of medical. Medical management should only be offered to women unsuitable for, or unwilling to undergo surgery

Question 15

What are the surgical management options for stress incontinence?

Answer 15

1) Mid-urethral sling procedures
2) Injectable periurethral bulking agent
3) Artificial urinary sphincter

Question 16

What is the first-line surgical management for stress incontinence?

Answer 16

Mid-urethral sling procedures

Question 17

What are the two types of mid-urethral sling procedures?

Answer 17

1) Tension-free vaginal tape

2) Transoburator tape

Question 18

What are the complications of mid-urethral sling procedures?

Answer 18

1) Bladder perforation
2) Postoperative voiding difficulty
3) Bleeding
4) Infection
5) Suture or mesh erosion

Question 19

What are the differences between Tension-free vaginal tape (TVT) and transoburator tape?

Answer 19

Mesh is used to elevate the mid-urethra in both procedures, but transoburator tape is fitted in a different way such that there is less risk of bladder damage

Question 20

What is urge incontinence?

Answer 20

Spontaneous OR provoked detrusor contraction results in bladder pressure>urethral pressure = incontinence

Question 21

What are the conservative forms of management suitable for urge incontinence?

Answer 21

1. Lifestyle modification
2. PFMT
3. Biofeedback
4. Use of pads

Question 22

How may an overactive bladder (due to detrusor contraction) be medically managed?

Answer 22

1. Anticholinergics

2. Intravescial botox

Question 23

How may an overactive bladder (due to detrusor contraction) by surgically managed?

Answer 23

1. Augmentation enterocystoplasty
2. Autoaugmentation
3. Urinary diversion

Question 24

What are the contraindications to anticholinergics?

Answer 24

1. MG
2. BOO
3. Bowel disorders
4. Uncontrolled narrow angle glaucoma

Question 25

What are the S/Es of anticholinergics?

Answer 25

1. Dry mouth 2. Constipation 3. Blurred vision 4. Urinary retention

Question 26

What are the contraindications to intravesical botox?

Answer 26

1. MG 2. Eaton-Lambert syndrome 3. Breastfeeding 4. Pregnancy 5. Bleeding disorders

Question 27

What are the S/Es of intravesical botox?

Answer 27

1. Urinary retention 2. Haematuria 3. UTI 4. Bladder pain 5. Dysphagia 6. Diplopia

Question 28

What are the risk factors for overactive bladder?

Answer 28

Idiopathic MS Surgical treatment for stress incontinence

Question 29

What are the different types of anterior vaginal wall prolapse?

Answer 29

1. Cystocele 2. Urethrocele 3. Cystourethrocele

Question 30

What are the different types of posterior vaginal wall prolapse?

Answer 30

1. Rectotocele | 2. Enterocele

Question 31

What is a uterus prolapse?

Answer 31

Descent of entire uterus

Question 32

What is a vaginal vault/apical prolapse?

Answer 32

Apex of the vagina, where the uterus used to be, can prolapse post-hysterectomy

Question 33

What is a cystocele?

Answer 33

Upper anterior vaginal wall, causing descent of the bladder only

Question 34

What is a urethrocele?

Answer 34

Lower anterior vaginal wall, causing descent of the urethra only

Question 35

What is a cystourethrocele?

Answer 35

Descent of both the bladder and the urethra

Question 36

What is a rectotocele?

Answer 36

Lower posterior vaginal wall, affecting the anterior wall of the rectum

Question 37

What is a enterocele?

Answer 37

Upper posterior vaginal wall, creating a pouch containing loops of bowel

Question 38

What are the risk factors for prolapse?

Answer 38

1. Vaginal delivery 2. Ageing - atrophy of connective tissues 3. Obesity 4. Raised intra-abdominal pressure - e.g. chronic cough from smoking 5. Iatrogenic - poorly supported vaginal vault post-hysterectomy 6. Congenital

Question 39

What is a 1st degree prolapse?

Answer 39

Cervix down into the vagina, but above the introitus

Question 40

What is a 2nd degree prolapse?

Answer 40

Cervix to introitus (opening that leads to the vaginal canal)

Question 41

What is a 3rd degree prolapse?

Answer 41

Cervix outside introitus

Question 42

How may prolapse be medically managed?

Answer 42

1. HRT - when oestrogen withdrawal is responsible for the loss of tone 2. Ring pessary

Question 43

What are the S/Es of ring pessaries?

Answer 43

1. Pain 2. Urinary retention 3. Infection 4. Displacement