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38 Cards in this Set
- Front
- Back
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What are hte main muscles, ligaments, and fascia that support the pelvic organs?
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-Levator muscles
-Uterosacral/Cardinal ligaments -Endopelvic fascia/UG diaphrm |
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What are 5 ways that the supports of the pelvic organs can lose their ability to function?
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-Birth trauma
-Chronic elevatioons in intra abdominal pressure -Intrinsic weaknesses -Atrophic changes from aging -Loss of estrogen |
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What is procidentia?
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When the uterus extends beyond the vulva
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What is a common complaint of patients with a cystocele or urethrocele?
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Urinary incontinence
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What has to happen in any person for urine to flow?
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Pressure in the bladder has to exceed that in the urethra.
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How does urine flow physiologically?
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Muscles around the urethra involuntarily relax, around the bladder contract.
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How does urine flow when pelvic support fails?
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The urethra slips out so now when sphincters try to close it off, they don't.
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What is this called when bladder pressure > urethral pressure during instances of increased intrabdom pressure?
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Stress incontinence
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What is it called when there is loss of normal innervation and bladder control leading to involuntary bladder ctx's?
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Urge incontinence
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What is it called when there is loss of normal innervation and bladder control leading to bladder atony?
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Overflow incontinence
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When are symptoms noted in Stress incontinence, how much urine typically leaks, and for how long of duration?
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-When intrabdom pressure increases (cough/laugh)
-Little spurts -Short brief spurt |
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When are symptoms noted in Urge incontinence, how much urine typically leaks, and for how long of duration?
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-Often at night (nocturia)
-Large amts - complete empty -Mod duration, several seconds |
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What type of symptoms noted in Overflow incontinence, how much urine typically leaks, and for how long of duration?
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-Fullness, pressure frequency
-Small dribbling -Often its continuous |
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What is the best way to demonstrate pelvic relaxation on physical exam?
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Have the patient bear down
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What is the scale used to rate pelvic organ prolapse?
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1-3 degrees
1st: limited to upper 2/3 of the vagina 2nd: approaches introitus 3rd: present outside vulva |
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How is a urethrocele commonly quantified?
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With the Q-tip test
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What is the Q-tip test?
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Place Qtip in urethra; if it rotates up 30' when patient bears down, its pos for urethral prolapse.
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What is urodynamics?
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A group of procedures that evaluate bladder structure and function
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What is the best way to demonstrate pelvic relaxation on physical exam?
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Have the patient bear down
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What is the scale used to rate pelvic organ prolapse?
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1-3 degrees
1st: limited to upper 2/3 of the vagina 2nd: approaches introitus 3rd: present outside vulva |
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How is a urethrocele commonly quantified?
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With the Q-tip test
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What is the Q-tip test?
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Place Qtip in urethra; if it rotates up 30' when patient bears down, its pos for urethral prolapse.
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What is urodynamics?
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A group of procedures that evaluate bladder structure and function
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So what is the hallmark characteristic of overflow incontinenced?
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Failure to empty the bladder completely
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What is a normal PVR (post void residual)?
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50-60 cc
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What would a pvr of 400cc indicate?
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Overflow incontinence due to detrussor atony
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What are 2 general categories of conditions in which such bladder atony and overflow incontinence can be seen?
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-Neurologic
-Obstructive |
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What are 3 neurlogic conditions to remember with it?
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-Diabetes mellitus
-Multiple sclerosis -Neuro disorders |
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What are 2 obstructive causes of overflow incontinence?
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-Post surgical
-Severe prolapse |
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Does the bladder normally contract during filling?
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No
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What is it called when the bladder shows uninhibited contraction with filling?
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Detrusor instability incontinence
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What is the majority of GSI, genuine stress incontinence, due to?
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URethral hypermobility - straining Qtip angle >30 deg from horizon
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What is SOME GSI due to?
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Intrinsic sphincteric deficiency (ISD) of the urethra
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What 2 treatments have the best success rates for patients with GSI due to hypermobility alone?
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-Retropubic urethropexy
-Sling |
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Why does the Sling have a higher complication rate than retropubic urethropexy?
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Because of higher potential for retention and voiding dysfunction dt obstruction of the sling.
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What are slings BEST used for treating?
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Combined urethral hypermobility and ISD
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What is ISD again?
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Intrinsic sphincteric deficiency
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What is the best treatment for patients with ISD but little or no urethral hypermobility?
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Urethral bulking procedures
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