UroGyn Prolog Flashcards

Question

dont get jets

Answer 1

give IV fluid bolus (assuming no cardiac complication)

Answer 2

- cut the sling (1-2%) if significant retension (6w post op with high PVR)

Answer 3

- 1st line treatmetn: estrogen cream | - 2nd line: remove exposed area (not entire sling)

Answer 4

burch procedure (beacuse there is probably underlying urinary stress incontinence that will show it's self once the prolapse is fixed, and good data supports ppx doing the burch even if you can't prove they have stress currently (questions stem in fact had retention)

Answer 5

- 6w or more in duration - painful bladder feeling in absecne of infection or other causes - have associated urinary urgency and frequency wtih subsequent pain - some reports a hx of UTIs with negative cultures and refractory to abx - assocaited with lots of psych shit - often have poor treatment response (no obvious etiology to treat, and a wide variety of treatments haven't been found reliably to be helfpul, many women get lots os different treatment to no avail). - likely multifactorial - 1st line treatment: PFPT (dont' need cystoscopy anymore to dx it, can do it clinically)

Answer 6

- 1st line: ppx abx - -- nitrofuranton is awesome (theoretical risk of chronic intersitial lung diease though, therefore can't give to someone with COPD) - -- methanamine hippurate plus Vit C (methenamine salts inhibit urinary tract infections by hydrolyzing the urine into formaldehyde, which is bacertiostatic, therefore there is no bacterial resistence possible to the ppx med. It works by increasing the acidity of the urine (and your body, so you get GI upset). - vaginal estrogen also helpful (but increasing from 2x daily to 3x daily probably isn't going to help much)

Answer 7

- for apical prolapse (which will also fix anterior prolapse often, or you can add on an anterior repair)

Answer 8

- fixes stress urinary incontinence

Answer 9

- mesh exposure 30% (next most common were UTI 20% , visceral injury 4%, bleeding, fistula 1%) - small exposure, then do vaginal estrogen, or antibotics or PFPT >> cut out small area of mesh >>>>>>>> take out entire sling

Answer 10

- monofiliment (less erosion) and macroporous (>75 microns, least infection)

Answer 11

- take the stitch out because this sounds like nerve pain

Answer 12

- mesonephric duct - (80% of time associated with dupliated urainry system - dx after potty trainign with constant urinary leakage

Answer 13

- must be ABOVE T6

Answer 14

- when during a concominant urethral diverticula repair surgery, beacuse it increases the risks the diverticula will come back - instead want autologious sling - or you can do two separate procedures and wait until urethtral diverticula is healed from first surgery (cause mid urethral is better.

Answer 15

- immediate closure now recommended if >5mm defect - when no infection is present, do a simpled layered approach - <5mm defect can often close on own, so you can expected wait - temporarly diversion is limited to peopel who fail first time repair

Answer 16

- risk factors: age > loose stool - medical management of loose stool > surgical repair (beacuse surgical repairs suck) - loperimide is often sufficient

Answer 17

- usually stretch/tempary vascuar compression in myelin - usually resolves on own days to months - but early PT is recommended - femoral from self retaining abdominal retractors - obturaror (adduction) for paravaginal sutures - sicatic causes leg/patellar pain S2-4 (not lumbar)

Answer 18

- voiding diary - bedsdie commod (need to prevent falls which are life threatening in older women) - usually multifactorial, so not just urge incontinence (pee on way to toliet in middle of night) - no meds if really only occurs at night

Answer 19

- really great, 90-100% success without recurreance - the chance of a rectoral prolapse aftwresad is very unlikey, so if have rectal fullness, incontenence, and incomplete bowel evacuatino, then likely they have anew problem of rectal PROLAPSE. - thsi question is testing your knowlde of how good the colpocliesis is - also higher incidence in women with colpocliesis than normal women - no all cases come through the vagina completely, so they sit at the introitus and confuse patiens on why thye feel rectally full and have incontinenece - evaluate always with straining on comod, cannot replicat on back. if can't replicate, then do defecography - fix with mesh (ideally intraabdominally, but can do perineally for pt that are bad extended surgery candidates)

Answer 20

- often have 6-12w of bladder shock, regardles of future outcomes. Indwelling catheter and then straight cath when able. - however as spinal cord injury progresses/develops, can cuase other problems which cause leakign between catheterizations (bladder distention restrcition and detursor overactivty) - longterm bladder control is best maintained fro most with straight cath and anticholinergics to reduce blader activity - if this starts to not work, this can lead to kidney problems. - therefore, need to surgically intervene. - ileoystoplasty (make new bladder flat with intestineal tissue and then just straight cath, coudl make new abdominal urine exit but often problematic, so if can straight cath, try to keep urethral opening)

Answer 21

usually anticholinergics

Answer 22

- replace teh sling - the bleeding will stop on own usually - no repair needed i dont' see in the answer - if bleeding doesn't stop, then you can coaguate with monopolar energy source via cystoscopy

Answer 23

- w/o needs posterior repair - w/ needs sacral colpoperineopexy :) - no mesh for posterior repair along

Answer 24

- direct seeding from vagina on mesh to sacrum where attached - s. aureus is most common

Answer 25

- sacral nerve roots - pain and numbness to buttock that raidates down back of thigh to popliteal fossa (makes sense) - plaecd in USL at level of ischial spine - entrapement suspected, then need to take out sutures immeidately - S2-4 is where this is located

UroGyn Prolog Flashcards

(49 cards)