Urology Flashcards
(53 cards)
________ and __________ hold the uterus and upper vagina in their proper place over the levator plate.
Cardinal and uterosacral ligaments
Signs/sx’s of pelvic organ prolapse
urgency, freq, urge incontinence, recurrent UTIs
obstructive voiding sx’s due to urethral kinking
need unusual positions to void
Sx’s of rectocele
constipation and difficult defecation with distal stool trapping
patient reports manually assisting evacuation with finger in vagina
Most common type of pelvic organ prolapse
cystocele (anterior compartment prolapse) where bladder protrudes into vagina
How to workup cystocele with recurrent UTIs?
PVR eval (post-void residual)
If patient has positive PVR, what should be checked next?
check upper urinary tract/ kidneys for hydronephrosis
Enterocele or middle compartment prolapse
intestines prolapse into vagina
post hysterectomy
When should uterine prolapse be referred to urology?
dyspareunia
extension past introitus
difficulty defecating or urinating
Non-surgical therapy for prolapse
treat associative factors: chronic cough, obesity, constipation
Pessary - device placed into vagina to support uterus or bladder and rectum
Can imperforate hymen obstruct urine flow? What does it obstruct?
No urine flow blockage, but does prevent vaginal secretions
hydrometrocolpos
expanded fluid filled vaginal cavity, usually from imperforate hymen
PE of labial fusion
labia minora fused together in newborn
Labial fusions can spontaneously resolve, but when should it be treated? With what?
urine pooling in vagina with voiding, freq UTIs, parent request
tx: topical estrogen cream, consider surgical or manual separation
Orgasmic disorder in women
APA guidelines necessitates that an acceptable and preferred form of sexual stimulation has occurred and orgasm has not resulted
** absence of climax from coitus should not be diagnosed as sexual dysfunction unless it represents a distressing change from a woman’s prior state of affairs
vaginismus
Recurrent or persistent involuntary spasm of musculature of outer third of vagina that interferes with sexual intercourse
Medications that may cause female arousal/orgasm disorders
SSRI
Oral contraceptives
Pharm therapy for female sexual dysfunction
topical estrogen - estriol (E3) has highest affinity for vagina
PDE-5I like Viagra
Muscles of pelvic floor
levator ani muscles: puborectalis, pubococcygeus, iliococcygeus
coccygeus
If patient has high PVR, what should be checked next?
check upper urinary tract/ kidneys for hydronephrosis
CT urogram or U/S
When can transient incontinence occur?
after childbirth
during an acute UTI
When to refer to urology for incontinence?
Total incontinence Incontinence associated with pain Hematuria Recurrent infection Pelvic irradiation Radical pelvic surgery Suspected fistula Significant post void residual (>200cc)
Involuntary urine leakage on effort or exertion (sneezing, coughing) =
stress urinary incontinence
Majority of stress incontinence occurs in what women?
after middle-age
repeated vaginal deliveries and obstructed labor
Pathophysiology of incontinence
weakness/disruption of pelvic floor muscle and ligaments
hypermobility of sphincteric unit - loses closing efficiency
