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13.06.06 Incontinence and prolapse

Causes of incontinence
  • Incontinence
    • Stress
    • Urge
    • Mixed (stress + urge)
    • True (No control over urinary flow)
      • Vesico-vaginal fistula
      • Uretero-vaginal fistula
      • Ectopic ureter
      • Bladder exstrophy
  • Vaginal prolapse
  • Abdo/pelvic mass
  • Diabetes
  • UTI
  • Neurological
  • Drugs

Management of incontinence
  • Duloxetine 
    • SNRI
    • For stress incontinence
  • Oxybutinin
    • M1, M2, and M3 muscarinic acetylcholine receptor antagnoist
    • For urge incontinence
    • Anticholinergic side effects
  • Bladder training
  • Tension-free vaginal tape
    • 85-90% success rate
    • 30 min operation under local anesthetic

Types of prolapse
  • Cystocele
    • Bladder pokes into top of anterior wall of vagina
  • Urethrocele
    • => Descent of the anterior distal wall of the vagina
  • Rectocele
    • Rectum pushes into posterior wall of vagina
  • Enterocele
    • Protrusion of the small intestines and peritoneum into the vaginal canal

Degrees of uterine prolapse
  • 1st degree
    • Descent of cervix into vagina
    • Nothing to see
  • 2nd degree
    • Descent of cervix to vaginal introitus
  • 3rd degree
    • Descent of cervix outside introitus
  • Procedentia
    • Entire uterus outside introitus

Prolapse treatment
  • Anterior repair
  • Posterior repair
  • Vaginal pessaries
    • Ring
    • Gehrung
    • Hodge
    • Cube
    • Donut
    • Gellhorn
  • Vaginal hysterectomy


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