Term
| what is the angle of the pelvic floor to the force of inlet? |
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Definition
| the pelvic floor is horizontal to the force of the inlet |
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Term
| what does the lordotic curve allow? |
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Definition
| humans to walk in the upright position as well as transmission of abdominal forces horizontally into the pelvis |
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Term
| what is the innervation to the female urethra? |
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Definition
| *internal urethra: outer circular and inner smooth muscle innervated by the parasympathetic pelvic nerves. *striated muscles/pelvic floor (musculature surrounding the internal urethra/smooth muscle): innervated by muscle cells coming from the anterior horn of the spinal cord (onuf's nucleus) |
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Term
| what is the connection between the striated musculature surrounding the urethra and vagina? |
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Definition
| the striated muscle surrounding the urethra (levator ani) integrates with musculature at the top of the vagina |
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Term
| what muscles can be strengthened to help w/female incontinence? what is their innervation? |
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Definition
| the external and levator muscles (pelvic floor) which are innervated by onuf's nucleus |
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Term
| what is the path of the parasympathetics innervating the internal urethral sphincter? |
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Definition
| they come down from the aorta on the hypogastric arteries and form a plexus, giving off postganglionic fibers which innervate the bladder |
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Term
| what is the part of the brain called which controls micturition? |
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Definition
| the pontine micturition center (relay station for ascending and descending bladder information from the spinal cord) |
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Term
| what is the anatomic "sling" that holds the urethra in position in females? |
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Definition
| the levator ani muscle is connected to the urogenital sphincter which connects into the pubes and takes its muscle fibers off of the pubes and holds the vagina, urethra bladder and rectum in a relationship anteriorly like a sling |
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Term
| what is a cystocele due to? |
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Definition
| a deficient levator ani muscle |
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Term
| what is a common cause of deficient levator ani muscle in the elderly? |
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Definition
| loss of estrogen, collagen |
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Term
| how can the pudendal nerve (innervates levator ani) become physiologically injured in the female? |
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Definition
| pressure during labor. 80 mm pressure is enough to damage the pudendal nerve (under the ischial spine), and 240 mm can be exerted during pregnancy. labor may last as long as 8 hrs, which is sufficient time to damage this nerve (via both compression/stretching). |
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Term
| how are the levator ani attached under the pubes? |
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Definition
| the pubourethral ligaments (collagen type 1 fibers) |
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Term
| what does the alpha sympathetic control in the bladder? beta |
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Definition
| alpha: sphincter tone. beta: allow relaxation of the bladder (for filling). |
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Term
| what is the parasympathetic innervation to the bladder (and generally the pelvis)? |
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Definition
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Term
| how does MS affect the pt's ability to urinate? |
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Definition
| MS can create a lesion between the pons and micturition center - leads to a closure problem of the urethra |
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Term
| what should the posterior urethral angle be in the female? what happens when this angle is disrupted? |
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Definition
| less than 90 degrees to the horizontal plane - if this angle is disrupted: funneling (bladder/urethra will swing at an obtuse angle = formation of a cystocele/urethrocele) |
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Term
| what is stress incontinence type 0? |
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Definition
| complaint of incontinence w/o demonstration of leakage |
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Term
| what is stress incontinence type 1? |
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Definition
| incontinence in response to stress, but w/little descent of the bladder neck/urethra |
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Term
| what is stress incontinence type 2? |
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Definition
| incontinence in response to stress w/2 cm descent of the bladder neck and urethra |
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Term
| what is stress incontinence type 3? |
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Definition
| the bladder neck and urethra are wide open w/o bladder contraction, intrinsic urethral damage, or denervation of the urethra. this is likely due to prolapse of bladder and bladder neck which fills up with urine and exerts downward pressure. for dx, need to perform: cystometry, video urodynamics, and urethral urodynamics. tx: possible artificial sphincter. |
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Term
| beyond the vaginal exam where else needs to be examined on many women? |
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Definition
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Term
| what is the marshall marchetti technique? |
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Definition
| sutures placed in the periurethral fascia+vaginal wall to correct a dropped urethra |
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Term
| what is the bursch procedure? |
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Definition
| this uses sutures into the vaginal wall for additional securing of the urethra |
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Term
| what is the system used for clinical evaluation of urethral support |
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Definition
| the baden walker system which divides pelvic floor prolapse into 4 grades |
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Term
| what are the different surgical procedures for pelvic floor prolapse? |
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Definition
| anterior colporrhaphy, paravaginal defect repair, site-specific defect repair, and anterior wall prolapse repair w/mesh |
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Term
| what materials are used for the mesh support in repairing pelvic floor prolapse? |
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Definition
| polypropylene, polyethylene terephthalate, and polytetrafluoroethylene |
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