front 1 anterior repair is the repair of? | back 1 The anterior wall of the front of the vagina - sutures under the urethra stabilising it whilst coughing |
front 2 Stress incontinence? | back 2 leakage with coughing due to weakness of the urethra and supports. |
front 3 Urge incontinence? | back 3 leakage with urgency due to spasms of the detrusor muscle |
front 4 What is urodynamics ? | back 4 measures the pressure inside bladder wall during filling |
front 5 What is unstable bladder? | back 5 rhythmic contractions of the bladder muscle during filling. |
front 6 if a patient leaks with cough or sneeze, I do an anterior repair, if the patient leaks with urgency, I send her to a urologist. | back 6 recommendation |
front 7 what are pessaries used for? | back 7 manage prolapses |
front 8 what surgical procedure is used for prolapse | back 8 anterior repair with or without hysterectomy |
front 9 where is the sacrospinous ligament | back 9 ligament attached to ischial spine and lateral side of sacrum, coccyx |
front 10 main function of the Pendundal artery and nerve | back 10 main nerve of perineum, sensation of external genitalia and skin around anus and perineum. |
front 11 what are current prolapses managed with | back 11 vaginal mesh to strenghten the repair |
front 12 what are the 3 types of urinary incontinence | back 12 - stress incontinence -urge incontinence -voiding dysfunction or incomplete emptying |
front 13 classic features of stress incontinence | back 13 patient leaks when coughing, sneezing, laughing, running, lifting objects |
front 14 what is the structure of the bladder? | back 14 urethra is surrounded by an anatomical sphincter which connects to the pelvic floor. proximal urethra between the bladder and the urethra does not have muscle surrounding it. |
front 15 what effects does prazocin have on the bladder? | back 15 relaxes the muscles at the outlet of the bladder - smooth muscles |
front 16 what are the classic features of urge incontinence | back 16 rushes to the toilet with an urge/desire to urinate, but once there urine has already begun and sometimes before patient has sat down. patient unable to control these symptoms |
front 17 what is also associated with urge incontinence? | back 17 triad of urgency, frequency and nocturia |
front 18 definition of urgency? | back 18 the desire to go to the toilet for fear of leakage. |
front 19 how to define frequency | back 19 voiding more than 8 times per day. (average person voids 4-6 times) |
front 20 what is Nocturia | back 20 being woken by your bladder needing to void, somewhat age dependent |
front 21 kidneys and nocturia | back 21 greater perfusion of kidneys - more urine is made at night |
front 22 three types of urge incontinence | back 22 idiopathic, obstructive, neuropathic detrusor overactivity |
front 23 6 theories of Idiopathic detrusor overactivity | back 23 1. Myogenic = damage to the detrusor muscle 2. Neurogenic = damage to the nerve supply to the detrusor muscle is abnormal 3. Urothelium = (neural receptors) cells lining the bladder become abnormal, sense of urgency is increased. 4. Inflammation = chronic low grade inflammation and abnormal microbiome 5. Artherosclerosis = hardening of the arteries that supply the bladder muscle and nerves. 6. History of bedwetting, daywetting, congential subgroups |
front 24 Obstructive detrusor overactivity | back 24 occurs mainly in men with an enlarged prostate = urethral stenosis |
front 25 which theory applies to obstructive overactivity | back 25 Myogenic and neurogenic |
front 26 Neuropathic detrusor overactivity main categories | back 26 stroke, brain tumours Parkinson's disease Spinal cord injuries and MS Cauda Equina syndrome (rare) |
front 27 Where are the messages arising from the higher brain relayed to? | back 27 Pontine Micturition centre (PONS) |
front 28 Parkinsons disease - lack of relaxation causes the urethral sphincter to remain tight and the outcome of this causes | back 28 incomplete emptying |
front 29 spinal cord injuries and MS cause an abnormality in the urethral relaxation causing | back 29 voiding dysfunction and urge leaking |
front 30 Cauda equina syndrome causes the detrusor muscle to not contract, the person ends up with | back 30 dribbling and worsening retention due to reduces sensation in feeling full in their bladder. |
front 31 can Neuropathic detrusor overactivity be cured? | back 31 No, but it can be managed. |
front 32 if non-responding patients, obstructive and neuropathic detrusor overactivity occurs, who should the patient be referred to? | back 32 Urologist. |
front 33 afferent | back 33 messages sent towards the CNS |
front 34 efferent | back 34 messages sent away from the CNS |
front 35 bladder is half full at 250mls - what occurs during this time | back 35 afferent messages are sent to CNS of the frontal lobe of cerebral cortex (desire to void) |
front 36 if an inappropriate time, the frontal lobe sends an automatic message to ward part of the body | back 36 sacral parasympathetic nerves at S2-S4 |
front 37 The urothelium sends a strong message for the desire to urinate at what mls | back 37 450-500mls |
front 38 what are the definitive underlying problems of idiopathic urge incontinence | back 38 1 -afferent nerves are overly abundant, messages sent to cerebral cortex of frontal lobe with a bladder "full" at 100-150mls. 2- cerebral deferment of micturition is poor, with the inability of their bladder saying "no" to their own bladders. 3- detrusor muscle contractions are overactive, contracting vigorously at a low threshold of bladder filling (250-350ml) - no guarding reflex of the urethral sphincter causing urine to spill. |
front 39 Typical voiding dysfunction/emptying difficulty causes the patient to? | back 39 Strain to commence voiding (hesitancy) |
front 40 what is post micturition dribble incontinence? | back 40 the need to re-void soon after voiding, sometimes the patient will leak when getting off the toilet, sensation of not completely emptying the bladder or urine dribbling. |
front 41 in males micturition dribbling incontinence occurs when males have ? causing ? | back 41 an enlarged prostate causing a urethral obstruction, making it hard to void. |
front 42 what are the two most common reasons for voiding dysfunction in women? | back 42 vaginal prolapse kinking the urethra or previous incontinence surgery which partially obstructs the urethra. |
front 43 what is silent urinary retention | back 43 when a woman has a swollen urethra from second stage labour due to prolonged pushing from the baby's head pushing on the periurethral tissues. |
front 44 what is a bladder chart | back 44 a 3 day chart used to record the capacity of the bladder and fluid intake |
front 45 what does a bladder chart help to distuinguish? | back 45 urge incontinence from stress incontinence |
front 46 how to explain to a patient how to "Double voiding" | back 46 void as normal - sit in normal seated position, once 'finished' stand up up, rotate pelvis to stimulate afferent nerves, sit back down and lean forward with elbows on knees, relax pelvic muscles and remain for 2-3 mins to await further flow. |
front 47 treatment of primary nocturia advise | back 47 drink in morning, ?promote use of lasix, feet up after lunch to promote kidney flow, thirsty in evening, drink small cups of fluid. |
front 48 Chronic constipation can form issues of | back 48 stress incontinence and prolapse due to straining which weakens the pelvic muscles. Also promotes formation of rectocele (prolapse of rectum into vagina) |
front 49 How to treat vaginal atrophy? (vaginal thinning, dryness and inflammation) | back 49 Topical vaginal Oestrogen applicable to both stress and urge incontinence. |