Urinary Incontinence And Pelvic Organ Prolapse

Front 1

What is urinary incontinence?

Back 1

1. Condition where involuntary urinary loss occurs

2. Result of a rise in intravesical pressure that exceeds intraurethral pressure in the absence of a bladder contraction

Front 2

What is the 2nd MCC of urinary incontinence?

Back 2

1. Detrusor instability

Front 3

What does abdominal pressure transmission to the urethra depend on?

Back 3

1. Support of proximal urethra from surrounding fibrous and muscular tissues

Front 4

What is mixed incontinence?

Back 4

1. Combined stress incontinence and detrusor instability

Front 5

What is overflow incontinence?

Back 5

1. Defect in urination causing the marked dissension of the bladder

2. Leads to leaking as the pressure eventually overrides an intact sphincter

Front 6

What is a urogenital fistula?

Back 6

1. Anatomical defect causing a tract between the urinary system and some other system

Front 7

What are the primary support structures of the urethra?

Back 7

1. Arcus tendineus fascia

2. Levator ani

Front 8

What is the MCC of damage to the fibromuscular support to the urethra?

Back 8

1. Pregnancy and vaginal delivery

Front 9

What are the MCC of detrusor hyperreflexia?

Back 9

1. MS

2. CVA

3. Spinal injuries or tumors

4. Congenital spinal cord abnormalities

Front 10

What should be included in a PE for incontinence?

Back 10

1. Lumbosacral neurologic evaluation

2. Urine culture

3. Measurement of residual urine

4. Assessment of urethral mobility

Front 11

What is the use of oral phenazopyridine in incontinence?

Back 11

1. Colors the urine orange

2. Can help patients distinguish between urine and vaginal fluids

Front 12

How can an estrogen deficiency contribute to incontinence?

Back 12

1. Urethra and trigone are estrogen dependent

Front 13

How can spinal cord lesions lead to genital prolapse?

Back 13

1. Can lead to detrusor-sphincter dyssynergia

Front 14

What dermatomes should you specifically test in genital prolapse?

Back 14

1. L2-S2

Front 15

What genital reflex should you test in suspected prolapse?

Back 15

1. Bulbocavernosus reflex test

Front 16

How do you demonstrate the mobility of the urethra?

Back 16

1. Q-tip test

Front 17

How do you do the Q-tip test?

Back 17

1. Measure resting and straining angles several times

2. Positive for urethral hypermobility when straining angle is >30-35 degrees

Front 18

Is flow pattern or peak flow more important when assessing incontinence?

Back 18

1. Flow pattern

Front 19

What are the MCC of intermittent flow patterns?

Back 19

1. Urethral atrophy

2. Inflammation

3. Pain

4. Fear

Front 20

What is eyeball cystometry?

Back 20

1. Self-retaining catheter is placed transurethrally

2. Bladder progressively filled by sterile water 50 mL at a time

3. Syringe held approximately 15 cm above patient's pubic bone

4. Ask patient 'when is the first strong urge to void?'

Front 21

What suggests involuntary bladder contractions in eyeball cystometry?

Back 21

1. Rising meniscus

Front 22

How do you perform stress testing?

Back 22

1. Have patient cough to increase intra-abdominal pressure to reproduce stress incontinence

2. Urination with cough is positive

Front 23

What are the first-line tx for stress incontinence?

Back 23

1. Lifestyle--- weight loss, caffeine reduction, fluid management

2. Kegels

3. Biofeedback

Front 24

What are the surgical tx for stress incontinence?

Back 24

1. Tension-free transvaginal sling

2. Burch

3. MMK

4. Bulking procedures

Front 25

What is the non-pharmacologic tx for detrusor instability?

Back 25

1. Bladder re-training

2. Biofeedback

Front 26

What is the pharmacologic tx for detrusor instability?

Back 26

1. Anti-muscarinics-- M2 and M3

2. Tri-cyclic anti-depressants

Front 27

Where is a stress-free vaginal sling anchored?

Back 27

1. Obturator internus muscle

Front 28

What is a cystocele?

Back 28

1. Prolapse of the bladder

Front 29

What is a rectocele?

Back 29

1. Prolapse of the rectum

Front 30

How do you grade prolapses?

Back 30

1. Stage 0- no prolapse

2. Stage 1- Leading edge of the prolapse is greater than 1 cm above hymen

3. Stage 2- Leading edge is =/- 1 cm from hyemn

4. Stage III- More than 1 cm below hymen but not the total vaginal length

5. Stage IV- Complete eversion of the vagina

Front 31

What should a PE consist of for prolapse?

Back 31

1. Speculum exam

2. Urinary stress test after replacement of prolapse

Front 32

How do you medically tx prolapse?

Back 32

1. Pessary- non-surgical supportive or space occupying device to reduce prolapse

Front 33

How do you surgically tx prolapse?

Back 33

1. Hysterectomy with re-suspension

2. Colporraphy