Urogynaecology Flashcards
(29 cards)
Give 5 predisposing factors for genitourinary prolapse
> 40 years old
Parous- multiple, long labour, large babies
Chronic increase in intra-abdominal pressure- constipation, cough
Obesity
Menopause
Pelvic surgery- hysterectomy
Connective tissue disorder- Ehlers Danlos, Marfans
What is a urethrocele?
Prolapse of lower anterior vaginal wall involving the urethra only
What is a cystocele/anterior prolapse?
Prolapse of the upper anterior vaginal wall involving the bladder
What is an apical prolapse?
Prolapse of the uterus, cervix and upper vagina
What is a uterine prolapse?
Uterus prolapses into vagina
What is a vaginal vault prolapse?
Top of vagina sags down after a hypsterectomy
What is an enterocele?
Small bowel prolapses into vagina
What is a rectocele?
Rectum prolapses into vagina
Suggest 4 clinical features of genitourinary prolapse
Sensation of a lump moving downwards in the pelvis
Dragging discomfort, worse if sat down all day
Can sometimes see a lump or bulge
Urinary symptoms- frequency, stress incontinence, cystitis
Numbness during sex
How is a genitourinary prolapse diagnosed?
Speculum examination
Describe the Baden- Walker Classification of genitourinary prolapse
0: no descent when straining
1: leading surface of prolapse does not descend to 1 cm above hymenal ring
2: leading surface of prolapse extends from 1cm above to 1 cm below hymenal ring
3: leading surface of prolapse does not extends > 1 cm below hymenal ring
4: vagina completely everted
How is genitourinary prolapse managed conservatively?
Pelvic floor exercises Lose weight Stop smoking Avoid high impact exercise Manage constipation
How is genitourinary prolapse managed medically?
Oestrogen vaginal cream
Vaginal pessary- rubber or silicon device placed into the vagina to support the vaginal walls and pelvic organs
What are the positives and negatives of medically treating genitourinary prolapse with a vaginal pessary?
+ = avoids surgery, can have sex
- = needs to be removed and cleaned regularly, not useful in posterior prolapse, side effects (UTI, stress incontinence, BV, irritation, bleeding)
How is genitourinary prolapse managed surgically?
Uterine prolapse= vaginal hysterectomy
Vaginal vault prolapse= sacrocolpopexy, sacrospinous fixation
Vaginal wall prolapse= anterior/posterior repairs
What is stress incontinence?
Involuntary leaking of urine on effort, exertion, sneezing or coughing
Give 4 predisposing factors for stress incontinence
Pregnancy Vaginal delivery Obesity Hysterectomy Prolonged labour Forceps delivery Post-menopausal
What is the pathophysiology of stress incontinence?
Increased intra-abdominal pressure causes the bladder to compress. Usually the bladder neck will also compress to compensate. If the bladder neck has slipped, its pressure will not change and incontinence occurs
How is stress incontinence investigated?
Urine dip to exclude UTI
Cystometry to exclude overactive bladder
How is stress incontinence managed conservatively?
Weight loss Reduce fluid intake Stop smoking Pelvic floor exercises- 1st line treatment, 8 contractions, 3 times a day for 3 months Vaginal cones/sponges
How is stress incontinence managed medically?
Duloxetine- SNRI which also increases urethral sphincter activity. Not routinely used due to side effect profile- nausea, dyspepsia, dry mouth
How is stress incontinence managed surgically?
Tension free vaginal tape- tape placed in a U shape around mid urethra
Colposuspension- neck of bladder lifted up
Urethral bulking agents- increase size of urethral walls
What is urge incontinence?
Do not feel the urge to go to the toilet until very late so bladder overflows and leaks
What is the pathophysiology of urge incontinence?
Involuntary detrusor contractions during the filling phase causes detrusor overactivity. If the contraction is strong enough the bladder pressure is greater than the urethral pressure and urine leaks out.
