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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