• Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key

image

Play button

image

Play button

image

Progress

1/20

Click to flip

20 Cards in this Set

  • Front
  • Back
What is stress incontinence
the involuntary leakage of urine with exertion, or on coughing or sneezing
What is urge incontinence
the involuntary leakage of urine accompanied by or immediately preceded by urgency
Which incontinence is the most common?
stress
What are the obstetric RF for incontinence
> 4000g
3rd degree tear
Forceps
Length (second stage)
What specific examinations can be done to test incontinence
stress provocation test = patient is asked to cough vigourously while the doctor observes for incontinence of urine.
IF the bladder is empty, the test will be negative. NB: a negative test does not rule out stress incontinence. Low sensitivity, high specificity
Bonney's test and Q tip test - Waste of time.
1, 2, or 24 hr Pad test - get patient to walk up stairs, jog/hop etc and weight pad - cannot differentiate stress and urge
What investigations can be done for incontinence
US - used if acute incontinence, mass noted, symptomatic voiding dysfunction, recent UTI (+ renal US), pain
Urodynamics
Cystoscopy - if bad bladder pain, persistent haematuria, past history TCC, recurrent UTI
What are urodynamics
Set of tests that measures function f the urinary tract by measuring various aspects of urine storage and evacuation
Cystometry - evalutes bladder function by measuring pressure and volume of fluid in the bladder during filling, storage and voiding
Uroflowmetry - measures the rate of urine flow
Urethral pressure profile tests urethral function
Leak point pressure measures the bladder or abdominal pressure when leakage occurs
Treatment of stress incontinence
Pelvic floor mm exercises
Mid urethral slings
Intravaginal devices - support and partially compress the urethra (tampon, tampon like devices, continence rings, pessaries)
Operations - laparoscopic and open coposuspension, artificial sphincter
Treatment of urge incontinence (overactive bladder)
Bladder retraining - distraction techniques
Pharmacology - antimuscarinics/anticholintergics e.g., propanthene, oxybutinin (ditropan, Solifenacin (vesicare)
TCAs (Tofranil (night))
Why are anticholinergics/antimuscarinics used to treat overactive bladder
Acetylcholine binds with muscarinic receptors to make the detrusor mm contract
Those drugs block the M3 muscarinic receptors to stop acetylcholine binding therefore inhibiting contraction of the detrusor mm
How effective are anticholinergics/antimuscarinics at treating urge incontinence
Suboptimal
after 3 months 50% stopped therapy
After 6 months - 80% stopped therapy
They mostly stop due to lack of efficacy
Pathophysiology of stress incontinence
Weakness at the urethral sphincter so that the sphincter cannot prevent urine flow in the presence of higher abdominal pressure, such as when coughing
Risk factors for stress incontinence
Pelvic prolapse
pelvic surgery
vaginal delivery
hypoestrogenic state
age
smoking
neurologica/pulmonary disease
Risk factors for urge incontinence
Bladder cancer
Bladder inflammation
Bladder outlet obstruction
Bladder stones
Infection
MS
Spinal cord injury
Which nerve roots contribute to sympathetic control of the urethra?
Via the hypogastric nerve
T10-L2
Which nerve roots contribute to PNS control of the detrusor mm?
Pelvic nerve
S2-S4
What is herniation of the bladder into the vaginal lumen called
Urethra?
Rectum?
Intestines?
Bladder herniation = Cystocele
Urethra herniation = urethrocele
Rectum = rectocele
Intestines = enterocele
RF for uterine prolapse
vaginal childbirth
age
decreased oestrogen
increased intra-abdominal pressure (obesity, chronic cough, constipation, ascites)
congenital (rarely)
collagen disorders
Symptoms of uterine prolapse
Groin/back pain
feeling of heaviness/pressure in the pelvis (worse with standing, lifting, worse at the end of the day, relieved by lying down)
+/- urinary incontinence
Treatment of uterine prolapse
Can try conservative - hormonal therapies to restore lost support and tone (oestrogen), pelvic floor exercises, mechanical support devices (pessaries)
Surgical repair:
Reconstructive surgery - corrects prolapsed vagina OR
Total vaginal hysterectomy +/- surgical prevention of vault prolapse