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