Term
| distribution of incontinence % |
|
Definition
| SUI 60%, UI 20%, mixed 10% |
|
|
Term
| accuracy of diagnosis of SUI and UI on symptoms alone |
|
Definition
|
|
Term
| most sensitive test for SUI |
|
Definition
|
|
Term
|
Definition
|
|
Term
| which is better urethral or vaginal q-tip test |
|
Definition
|
|
Term
|
Definition
|
|
Term
| when can you skip q-tip test |
|
Definition
|
|
Term
| do you need cystometrics to start OAB medication |
|
Definition
|
|
Term
| urge cc amounts for office cystometrics |
|
Definition
| 1st 150-250, strong 250, max 400-600 |
|
|
Term
| indications for cystourethroscopy - 6 |
|
Definition
| refractory urge incontinence, prior unsuccessful procedure, rule out bladder cancer, fistula, foreign body, diverticulia |
|
|
Term
| indications for urodynamics - 10 |
|
Definition
| failed treatment, failed surgery, ISD, retention, emptying dysfunction, neuro disorder, suspect fistula, suspect diverticulia, hematuria without infection, uncertain diagnosis |
|
|
Term
|
Definition
| uroflowmetry, pelvic floor EMG, urethral closing pressure, leak point pressure, pressure voiding study |
|
|
Term
| what is looked at in uroflowmetry - 3 |
|
Definition
| voided volume over time, pressure patterns, recruitment |
|
|
Term
| what is looked at in pelvic floor EMG |
|
Definition
| neuro coordination of bladder and urethra |
|
|
Term
| what is looked at in urethral closing pressure - 2 |
|
Definition
| max closure, functional urethral length |
|
|
Term
| what is looked at in leak point pressure |
|
Definition
|
|
Term
| how do you calculate Valsalva leak point |
|
Definition
| pressure when leaking - pressure at rest |
|
|
Term
| what is looked at in a pressure voiding study - 2 |
|
Definition
| detrusor pressure voiding and urinary flow |
|
|
Term
| two urodynamic values highly suggestive of ISD |
|
Definition
| urethral closing pressure <20 mmHg H2O, leak point pressure <60 |
|
|
Term
| define overactive bladder |
|
Definition
| urge, frequency and nocturia with or without incontinence |
|
|
Term
|
Definition
|
|
Term
| behavorial modifications for UI - 5 |
|
Definition
| decrease caffeine, fluids, smoking, BMI, bladder training |
|
|
Term
| how much does weight loss improve urge incontinence |
|
Definition
|
|
Term
| how much does pelvic PT improve urge incontinence |
|
Definition
|
|
Term
| pelvic PT for urge incontinence - 4 |
|
Definition
| biofeedback, kegals, weighted cones, functional electrical stimulation |
|
|
Term
| surgery for urge incontinence - 2 |
|
Definition
| last resort, bladder augmentation, diversion |
|
|
Term
| how much do medications for urge incontinence help with UI, resolve IU, frequency, increased void volume |
|
Definition
| 60% decrease in IU, 13% resolution, 25% decrease in frequency, 25% increase in voided volume |
|
|
Term
| compare medications, PT, and weight loss success for UI |
|
Definition
| weight loss 55-85% > PT 50-70% > medications 60% |
|
|
Term
| UI receptors, neurotransmitter, and physiologic function of the parasymptathetic response |
|
Definition
| ACTH at the M2-3 receptors cause detrusor contractions and voiding |
|
|
Term
| UI receptors, neurotransmitter and physiologic function of the sympathetic response |
|
Definition
| NE at the B3 receptor causes detrusor relaxation and storage |
|
|
Term
| you want to ____ the parasympathetic and ____ the sympathetic response in UI |
|
Definition
| stop the parasympathetic, help the sympathetic |
|
|
Term
| medications stopping the parasympathetic destrusor contractions - 3 |
|
Definition
| anti-cholinergic, anti-muscarinic, anti-spasmodic |
|
|
Term
| medications that help the sympathetic detrusor relaxation - 2 |
|
Definition
| adrenergic antagonists, symphatomatics |
|
|
Term
| 4 anticholinergic/muscarinics and their receptor |
|
Definition
| oxybutynin M3>M1, tolterodine M3, trospium ?, darifenacin M3 |
|
|
Term
| which anticholinergic/muscarinics has most dry mouth |
|
Definition
|
|
Term
| which anticholinergic/muscarinics has most constipation |
|
Definition
|
|
Term
| which anticholinergic/muscarinics is best for elderly why |
|
Definition
| tropsium, less crosses BBB |
|
|
Term
| which anticholinergic/muscarinics has the least side effects |
|
Definition
|
|
Term
| contraindications anticholinergic/muscarinics - 3 |
|
Definition
| narrow angle glaucoma, urinary retention, gastroparesis |
|
|
Term
| anticholinergic/muscarinics SE - 9 |
|
Definition
| dry mouth, constipation, GERD, dry eye, blurry vision, confusion, drowsiness, imbalance, urinary retention |
|
|
Term
| antispasmodic medications - 4 |
|
Definition
| hycosamine, dicyclomine, flonoxate, propantholine |
|
|
Term
| antiadrenergic medication |
|
Definition
|
|
Term
|
Definition
| worsening HTN if already has HTN, nasopharyngitis, UTI, HA, dry mouth, diarrhea, tachycardia, back pain |
|
|
Term
| which has more se anticholinergic/muscarinics or antiadrenergics |
|
Definition
| anticholinergic/muscarinics |
|
|
Term
| contraindications of mirabegron - 3 |
|
Definition
| uncontrolled HTN, end stage CKD, significant liver disease |
|
|
Term
| sympatromimetic medidcations - 4 |
|
Definition
| antihistamine, ephedrine, pseudophedrine, phenylpropanolime |
|
|
Term
| indication for botulinium for UI |
|
Definition
| refractory, must be non-obstructive |
|
|
Term
| how is botlinium for UI done |
|
Definition
| 10-10 injections into detrusor avoiding the trigone 100cc, repeat in 6-12mo (200cc if neurogenic) |
|
|
Term
| how long does botlinium for UI last |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| UTI, retention, hematuria, pain, weakness |
|
|
Term
| contraindications botulinium for IU - 4 |
|
Definition
| dysphagia, myasthenia, respiratory issues, pregnancy |
|
|
Term
| cure rate for sacral neuromodulation for UI |
|
Definition
|
|
Term
| cure rate for botulinium for IC |
|
Definition
|
|
Term
| 2 types of sacral neuromodulation for UI |
|
Definition
| Sacral S2/3, tibial S2 dorsal root |
|
|
Term
| testing for sacral neuromodulation for UI - 3 |
|
Definition
| bellowing below the perineum, plantar flexion of the big toe, tapping on perineum |
|
|
Term
| requirement for sacral neuromodulation of UC |
|
Definition
|
|
Term
| how long do you try out sacral neuromodulation for UI before having the surgery |
|
Definition
|
|
Term
|
Definition
| DIAPPERS - delirium, infection, atrophy, pharmacy, pregnancy, excessive urine (DM), restricted mobility, stool impaction |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| how much does weight loss improve SUI |
|
Definition
| 8% loss improves it by 47% |
|
|
Term
| how much does pelvic PT improve SUI |
|
Definition
|
|
Term
| how much does pessary improve SUI |
|
Definition
|
|
Term
| how often do people DC pessary without specific reason or issue |
|
Definition
|
|
Term
| how often does urinary retention from pessary resolve |
|
Definition
|
|
Term
| how much does urethral bulking cure and improve SUI |
|
Definition
|
|
Term
| how much does a sling improve SUI |
|
Definition
|
|
Term
| for SUI in general order the slings from best to worst |
|
Definition
| TVT > TOT > autologous fascial sling > burch |
|
|
Term
| for SUI order the slings from best to worst for ISD |
|
Definition
| TVT > TOT > autologous fascial sling > burch |
|
|
Term
| what is a burch procedure |
|
Definition
| abdominal retropubic urethropexy - attach endopelvic fascia and urethra to BL iliopectinal/coopers ligaments with gortex increasing the urethral closure pressure, also fixes cystocele |
|
|
Term
| risks of sling 3 and how to fix it 1 |
|
Definition
| bleeding - bone wax, pressure, voiding dysfunction, long surgery |
|
|
Term
| what is a autologous fascial neck sling |
|
Definition
| a pubovaginal sling made of rectus fascia graft, it is attached to the rectus fascia via retropubic space |
|
|
Term
| indications for autologous fascial neck sling - 4 |
|
Definition
| surgery with a diverticular repair or fistula repair, prior mesh, fixed urethra |
|
|
Term
| SE autologous fascial neck sling - 3 |
|
Definition
| UTI, retention, urge incontinence |
|
|
Term
| which has higher urge incontinence autologous sling or burch |
|
Definition
|
|
Term
| which has higher voiding dysfunction autologous sling or burch |
|
Definition
|
|
Term
| medications (off label) that can be used for SUI |
|
Definition
| a-antagonists, tofranil, duloxetine, estrogen (but ACOG says this isn't a "treatment") |
|
|
Term
| #1 complication of MUS and rate |
|
Definition
|
|
Term
| rate of perforation during MUS |
|
Definition
|
|
Term
| what do you do if you perf during MUS and its still bleeding |
|
Definition
| monopolar cautery with cystoscopy |
|
|
Term
| rate of voiding dysfunction TVT vs TOT |
|
Definition
|
|
Term
| which has higher urinary retention TVT or TOT |
|
Definition
|
|
Term
| rate of LE neuro symptoms in TVT TOT how do you treat it |
|
Definition
| TVT 4%, TOT 10%, NSAIDS, PT |
|
|
Term
| rate of vessel injury in MUS |
|
Definition
|
|
Term
| which has higher vessel injury TVT TOT |
|
Definition
|
|
Term
| what vessels are commonly injured in MUS - 2 |
|
Definition
| obturator, periurethral plexus of santarini in the space of retzius (hematoma) |
|
|
Term
| management of bleeding during MUS - 7 |
|
Definition
| pressure, distend bladder, 30cc foley, floseal, vaginal packing, may need to open to access space of retzius or ligate the hypogastric |
|
|
Term
| rate of leaking at 1y TVT TOT |
|
Definition
| TVT 81% TOT 78% - I don't know why it also says somewhere else that the TVT has better long term outcomes for SUI, confused |
|
|
Term
| rate of complete MUS failure, TVT TOT |
|
Definition
|
|
Term
| which has higher urge incontinence TVT TOT |
|
Definition
|
|
Term
| which has higher dysparunea TVT TOT |
|
Definition
|
|
Term
| which has higher bowel injury TVT TOT |
|
Definition
|
|
Term
| which has higher mesh complications TVT TOT |
|
Definition
|
|
Term
| % of MUS that will need another treatment because it didn't work great |
|
Definition
|
|
Term
| % of MUS that fail their DOS voiding trial |
|
Definition
|
|
Term
| % of MUS that require sling release |
|
Definition
|
|
Term
| temporary factors that cause failed voiding trial and how long do they last |
|
Definition
| swelling, constipation, 1-2wk |
|
|
Term
| what is the goal PVR for voiding trials after a sling |
|
Definition
| there isn't one compare pre and post op, or just use <150 |
|
|
Term
| treatment of urinary retention after sling |
|
Definition
| cath for 4-6wk total then need to try and stretch tape, if that dosent work then release it |
|
|
Term
| how can PT help after a sling |
|
Definition
| reduces scar tissue but does not help urinary retention |
|
|
Term
|
Definition
|
|
Term
| incidence of elective primary CD |
|
Definition
|
|
Term
| 3 ways primary elective CD changes incontinence and POP |
|
Definition
| SUI is decreased x2, POP is decreased in 5-10y, UI is decreased at 2y but not long term |
|
|
Term
|
Definition
stage 1 <1cm, inside vagina
stage 2 +/- 1cm
stage 3 +1-2cm
stage 4 >+2cm |
|
|
Term
| conservative management for POP - 7 |
|
Definition
| weight loss, decreased coughing or activities with Valsalva, kegals, functional electrical stim, weighted cones, pessary |
|
|
Term
| what is E2 used for in POP |
|
Definition
|
|
Term
|
Definition
| UL attachment on the R to avoid the rectum to the lateral 1/3 of the SSL to avoid the sciatic and pudendal nerves |
|
|
Term
| what are the nerves you could poke in a SSLS where are they |
|
Definition
| lateral and deep to spine - sciatic and pudendal nerves. |
|
|
Term
| what causes sciatic nerve entrapment |
|
Definition
| too lateral too deep on SSLS |
|
|
Term
| management of sciatic nerve entrapment |
|
Definition
| if POD0 or POD1 remove all permanent sutures, if absorbable treat with narcotics and neuropathics |
|
|
Term
| prevention of sciatic nerve entrapment |
|
Definition
| elevate ligament off wall when suturing |
|
|
Term
| #1 nerve injury with SSLS |
|
Definition
|
|
Term
|
Definition
|
|
Term
| vessels you can poke in SSLS - 3 |
|
Definition
| medial 2cm from spine inferior gluteal artery. hypogastric plexus. pudendal vessels lateral and deep to the spine. |
|
|
Term
|
Definition
| suspension of the A/P endopelvic fascia ring to the rectal pillar into the pararectal space |
|
|
Term
| complication specific to USLS |
|
Definition
|
|
Term
| complication specific to SSLS |
|
Definition
|
|
Term
|
Definition
| attach vault to the anterior longitudinal ligament over the sacral prominentary |
|
|
Term
| indications for sacrocopopexy - 5 |
|
Definition
| <60yo, > stage 3 prolapse, short vaginal, BMI >26, intraabdominal pathology |
|
|
Term
| vessel you can poke in sacrocopopexy |
|
Definition
|
|
Term
| complications specific to sacrocopopexy - 5 |
|
Definition
| ileus/SBO 2.7%, mesh erosion 4.2%, vertebral disciitis, VTE 0.6% |
|
|
Term
| cause of vertebral disciitis |
|
Definition
| hematogenous spread from sacrocopopexy to L5-S1 |
|
|
Term
| bugs causing vertebral disciitis - 5 |
|
Definition
| #1 S aureus, candidia, GBS, mycoplasma TB, pseudomonas |
|
|
Term
| signs of verrebral disciitis - 4 |
|
Definition
| LBP, weakness, NO NEURO SX, MR with T2 enhancement |
|
|
Term
| treatment of vertebral disciitis |
|
Definition
| broad spectrum abx, no response need to debride |
|
|
Term
| prevention of vertebral disciitis |
|
Definition
| avoid >1-2mm below promontory drop |
|
|
Term
| what are the 2 methods of SUI prevention in POP surgery and how successful are they |
|
Definition
| Burch is for sacrocopopexy (SUI 44 to 24%), MUS is for vaginal surgery (SUI 49 to 24%) |
|
|
Term
| indications/criteria for vaginal obliteration - 4 |
|
Definition
| normal pap, not sexually active, normal EMBx, comorbidities excluding from other surgeries |
|
|
Term
| risk of regret vaginal obliteraion |
|
Definition
|
|
Term
| satisfaction rate vaginal obliteration |
|
Definition
|
|
Term
| risks of vaginal obliteration in general - 3 |
|
Definition
| incontinence (place sling at time of procedure), urinary retention, rectal prolapse |
|
|
Term
|
Definition
| lefort keeps the uterus, colpopectomy does not |
|
|
Term
| complications specific to lefort and prevention of it |
|
Definition
| increased urinary retention if pre-op retention, sling is placed at time of procedure, use MUS because autologous fascial increases that retention risk x3 |
|
|
Term
| what procedure is done with a colpectomy |
|
Definition
|
|
Term
|
Definition
| cervicospinous ligament fixation and sacrcopexy |
|
|
Term
| outcome comparison for hysteropexy |
|
Definition
| little data, seems similar to USLS/SSLS |
|
|
Term
| outcome comparison for ileococcygeus |
|
Definition
| similar to SSLS but less vascular and nerve injuries |
|
|
Term
| which has a higher overall complication rate - SSLS vs SCP |
|
Definition
|
|
Term
| which has higher neuro pain rates - USLS, SSLS, ICG |
|
Definition
|
|
Term
| which has higher rates of dysparunea - SSLS, SCP, ICG |
|
Definition
|
|
Term
| which has higher rates of recurrent POP (in general) - SSLS, SCP, ICG |
|
Definition
|
|
Term
| which has higher rates of reoperation - USLS, SSLS, SCP, ICG |
|
Definition
| USLS > SSLS/ICG 16% > SCP 7% |
|
|
Term
| which has higher apical failure - USLS, SSLS, SCP, ICG |
|
Definition
| SSLS 19%, USLS/ICG 10% > SCP 4% |
|
|
Term
| which has higher anterior failure - USLS, SSLS, SCP, ICG |
|
Definition
| USLS 30% > SSLS/ICG 14% > SCP 7% |
|
|
Term
| which has higher bleeding - SSLS, ICG |
|
Definition
|
|
Term
| which has higher nerve injury - SSLS, ICG |
|
Definition
|
|
Term
| which has higher posterior failure - SSLS, ICG, SCP |
|
Definition
|
|
Term
| paravaginal vs anterior repair |
|
Definition
| paravaginal has more success but more complications |
|
|
Term
| what is a urethropexy for |
|
Definition
|
|
Term
| mesh improves outcomes but worsens - 4 |
|
Definition
| EBL, OR time, erosion, repeat surgery needed |
|
|
Term
| #1 site of prolapse recurrecnce |
|
Definition
|
|
Term
| recurrence of anterior prolapse after anterior repair |
|
Definition
|
|
Term
| #1 complication anterior repair |
|
Definition
|
|
Term
| complications of anterior reapir 9 |
|
Definition
| cystotomy, ureter injury, uethra injury, bleeding, fistula, UTI, retention, UI, SUI |
|
|
Term
| rate of GU injury in anerior repair |
|
Definition
|
|
Term
| rate of retention in anterior repair |
|
Definition
|
|
Term
| if you were to use a graft for a posterior repair, which is not recommended, what does it attach to - 3 |
|
Definition
| SSL, arcus tentinous fascia, fascial rectal vaginalis or cervix |
|
|
Term
| success rate posterior repair |
|
Definition
|
|
Term
| #1 complication posterior repair |
|
Definition
|
|
Term
| complications posterior repair 6 |
|
Definition
| dysparunea, hematoma, wound breakdown, rectovaginal fistula, fecal incontinence, defecatory dysfynction |
|
|
Term
| % of people who can be fitted with a pessary |
|
Definition
|
|
Term
| rate of pessary complications |
|
Definition
|
|
Term
| anatomic requirement for pessary |
|
Definition
|
|
Term
| after fitting a pessary when do they return for follow up |
|
Definition
|
|
Term
| when should a patient remove their pessary |
|
Definition
| ideally nightly, but minimum weekly |
|
|
Term
| if someone cant remove their own pessary what do you do |
|
Definition
| have them come in q1-6mo for removal and exam for excoriations |
|
|
Term
|
Definition
| DC, pain, constipation, ulcer fistula |
|
|
Term
| top 3 reasons people quit pessaries |
|
Definition
| DM, SUI, lack of family support |
|
|
Term
| space occupying pessaries |
|
Definition
| gelhorn, donught, inflatoball, cube |
|
|
Term
| what is a ring pessary for |
|
Definition
| stage 2-3 apical and anterior prolapse |
|
|
Term
| what is a genrung pessary what is it for |
|
Definition
| a bridge, anterior and posterior prolapse |
|
|
Term
| what is a hodge/lever pessary, what is it for |
|
Definition
| rectangle, narrow introitus |
|
|
Term
| what pessary is best for stage 4 prolapse |
|
Definition
|
|
Term
| what are the 3 types of biological grafts |
|
Definition
| absorbable, encapsulation causes fibrosis, remodeling |
|
|
Term
| which is the biological graft that is ideal for prolapse |
|
Definition
|
|
Term
| do biological grafts help with prolapse |
|
Definition
|
|
Term
|
Definition
| monofilament polypropylene microporous (>5 micron) |
|
|
Term
|
Definition
| expanded polyteterfluorethylene microporous (>10 micron) |
|
|
Term
|
Definition
| polyethylene multifillament |
|
|
Term
| compare erosion, extrusion, infection, and scar rigidness in the types of mesh |
|
Definition
| type 1 is the lowest for all of them, type 2 is the highest for all of them, type 3 causes erosion and infection |
|
|
Term
|
Definition
|
|
Term
|
Definition
| passage of the mesh out of the tissue |
|
|
Term
|
Definition
| erosion of the mesh into viscera |
|
|
Term
| symptoms of mesh erosion 5 |
|
Definition
| VB, DC, UTI, pain, dysparunea |
|
|
Term
| diagnosis of mesh erosion - 3 |
|
Definition
| cysto, procto, colonoscopy |
|
|
Term
| what type of mesh erosion is it ok for expectant management |
|
Definition
| asymptmatic and type 1 mesh |
|
|
Term
| 3 steps of management for mesh exposure |
|
Definition
| estrogen 6-12wk, flap/excision if refractory, sling if refractory |
|
|
Term
| when is a trigger point injection used for mesh complications |
|
Definition
|
|
