TEALE FENNING Medical Education    FAQ   Search   Memberlist   Usergroups   Register   Profile   Log in to check your private messages   Log in  mrcog courses for doctors Stress Incontinence          TEALE FENNING Forum Index -> MRCOG Part 2: Short Answer Essays View previous topic :: View next topic   Author Message bronwyn Guest Posted: Sun Jan 21, 2007 9:34 pm    Post subject: Stress Incontinence Another one to practice A 42 year old woman presents to GOPD with a history of leaking while walking her dog a) How would you asssess her (10) b) Debate indications for urodynamic testing (5) c) Urodynamics show USI. What treatment options would you discuss with her? (5) Back to top Abik Century Club Joined: 15 Jan 2007 Posts: 243 Location: Poole Posted: Mon Jan 22, 2007 12:35 pm    Post subject: great question bron! Couldn't you just tell her to hire a dog-walker!!! Back to top bronwyn Guest Posted: Mon Jan 22, 2007 12:45 pm    Post subject: You could certainly suggest it under conservative measures for treatment! Or tell her to buy a cat......they don't need walking Back to top Abik Century Club Joined: 15 Jan 2007 Posts: 243 Location: Poole Posted: Mon Jan 22, 2007 1:07 pm    Post subject: Good luck tomorrow! Back to top bronwyn Guest Posted: Mon Jan 22, 2007 1:43 pm    Post subject: Thanks! Thought you were skiing this week? Was that a lie to stay at home and study like a ?! Back to top Abik Century Club Joined: 15 Jan 2007 Posts: 243 Location: Poole Posted: Mon Jan 22, 2007 2:41 pm    Post subject: No - skiing feb 3rd to 10th. Went to Cotswolds for family birthdays (incl. mine ) but now back to study like a Abs Back to top bronwyn Guest Posted: Mon Jan 22, 2007 7:23 pm    Post subject: HAPPY BIRTHDAY to you!!!!!! Hope it was a blast! Back to top Nick Raine-Fenning Course Director Joined: 27 May 2006 Posts: 2055 Location: Nottingham Posted: Mon Jan 22, 2007 7:34 pm    Post subject: Abik wrote: Couldn't you just tell her to hire a dog-walker!!! I was thinking along the same lines. Where was she leaking? Happy Birthday Abi _________________ "Teale Fenning Medical Education" delivering evidence-based, exam-orientated learning since 1997 Back to top wolverine Century Club Joined: 16 Jan 2007 Posts: 394 Posted: Tue Jan 23, 2007 12:25 am    Post subject: Happy birthday Abi, you made me laugh!! But why the title is stress incontinence? Detrusor overactivity may be provoked in the view of the weeing dog.... Back to top mridulaben Century Club Joined: 08 Nov 2006 Posts: 137 Location: Brunei Posted: Tue Jan 23, 2007 11:08 am    Post subject: Re: Stress Incontinence bronwyn wrote: Another one to practice A 42 year old woman presents to GOPD with a history of leaking while walking her dog a) How would you asssess her (10) b) Debate indications for urodynamic testing (5) c) Urodynamics show USI. What treatment options would you discuss with her? (5) Fall apart JOKES!! How many of u really weeeeeid after this question, especially after the 2 stem, am Let me try Urinary incontinence is not uncommon or life threatening but embarrassing for the lady, so is much underreported. In fact has to be considered seriously as affects the quality of life.It is involuntary leakage of urine at unwanted places and time. So start with detailed history to see in which category she belongs to. Detailed history of type of incontinence, as assctd with cough, laugh, lifting heavy wt, exercise, how many times in a day or night, urge, ability to control, affect on her quality of life, complaints regarding prolapse, excacerbating/ relieving factors, drug history, sexual dysfunction, drinking habits, post void dribble, chr. cough, constipation, pelvic surgery, damage to pelvic floor during child birth Examination to rule out pregnancy, abdominal or pelvic mass. Thorough assessment of pelvic floor, bimanual exam., P/S to detect any defects inant. or post. compt, check for leakage at coughing. examine in both supine& upright. Also check for senses and voluntary pelvic floor muscle contraction, anal wink reflex. I/V includes Urine M/C, blood sugar, frequency-volume chart, urodynamic testing, PAD TEST??? Indications for UDS includes multiple urinary symptoms i.e urge incontinence, stress incont., frequency, voiding disorder, prior to bladder neck surgery, previous unsuccessful continence surgery, neuropathic bladder disorder Uroflowmetry detects the flow rate, normal is more than 15ml/s for 150 ml. It is simple, non invasive easy to perform. Mainly where voiding disorder is suspeted, not particularly helpfu in diagnosis of incontinence, nor particularly helpful in predicting outcome of surgery.When combined with USG for reidual urine provides information on efficiency of emptying Cystometry is measurement of pressure-vol relationship. Gives the type of incontinece & certainly surgical treat. should not be considered without urodynamic assessment. It is invasive , but does'nt need antibiotic cover, takes about 30 mins. Few centres now offer ambulatory urodynamics which is more physiological and diagnosis better than routine, part. helpful in detrusor overactivity. Videourodynamics involves use of contrast media and so offers facility for anatomical structure, bladder morphology, function of bladder neck, bladder base support, VUR. It is part. helpful in complex cases. UPPM gives relationship bet. intravesical & uretheral pressure. It can assess ability of urethera to exert a positive closure preesure to prevent leakage, helps in planning appropriate intervention surgically Conservative M/G- Pelvic floor exercises, biofeedback, electrical stimulation, vaginal cones, urethral devices Pharmacological- DULOXETINE Surgical- Colposuspension( Burch. MMK), laparoscopic colpo, TVT, Sling surgery, TOT, Periurethral inj. Few details with success rates, C/Ps to be mentioned Back to top Abik Century Club Joined: 15 Jan 2007 Posts: 243 Location: Poole Posted: Tue Jan 23, 2007 1:40 pm    Post subject: Great answer! And thanks for all the Happy Birthdays - I had a lovely day. I would add in assessment her fertility wishes - I know she is only 42 but may be wanting a child / further children and obviuosly this would significantly affect management. Anal wink reflex?? - I've missed that one!! Indications for urodynamics now have been narrowed by the guidelines to non-response to anti-cholinergics or planned surgical procedure for GSI. As far as I am aware the evidence for UDS prior to surgical correction of GSI is limited. The main indications are for exclusion of women with poor flow rates to try to reduce those at risk of long-term bladder dysfunction/catheterisation post surgery. I'm not sure, however, that UDS do this to a significant degree. Duloxetine has now been sidelined as it doesn't seem to work! Back to top mridulaben Century Club Joined: 08 Nov 2006 Posts: 137 Location: Brunei Posted: Wed Jan 24, 2007 10:35 am    Post subject: Thanks abik, was not aware of Duloxetine. Latest guidelines still mention it , will check. Back to top wolverine Century Club Joined: 16 Jan 2007 Posts: 394 Posted: Wed Jan 24, 2007 12:59 pm    Post subject: Latest guidlines dispute duloxetine as first line treatment in USI but could be given second line in women who prefer medical from surgical or are not suitable for surgical (young with uncompleted families? frail elderly?) But don't forget! This is a NICE guideline (National Institute of Clinical Economics) Back to top Nick Raine-Fenning Course Director Joined: 27 May 2006 Posts: 2055 Location: Nottingham Posted: Thu Jan 25, 2007 7:58 pm    Post subject: This is a good question and an even better debate - I've learnt a lot! This came up or similar in the EMQ and I think you are due a urogynae question. I think the role of UDs is an excellent point to debate and one most people would fall down on if not familiar with the test and recent guidelines (that would incldue me!). _________________ "Teale Fenning Medical Education" delivering evidence-based, exam-orientated learning since 1997 Back to top mridulaben Century Club Joined: 08 Nov 2006 Posts: 137 Location: Brunei Posted: Fri Jan 26, 2007 11:22 am    Post subject: 1. Guidelines r not clear about, UDS before Medical treatment in OAB syndrome. They just mention not indicated before conservative treatment. Can somebody clear my doubt. 2. In Colposuspension procedures, or TVT in GSI, is one of the principles behind surgery, increased uretheral resistance also besides correction of position of bladder neck? Back to top Nick Raine-Fenning Course Director Joined: 27 May 2006 Posts: 2055 Location: Nottingham Posted: Fri Jan 26, 2007 3:45 pm    Post subject: I am no urogynaecologist but ... mridulaben wrote: 1. Guidelines r not clear about, UDS before Medical treatment in OAB syndrome. They just mention not indicated before conservative treatment. Can somebody clear my doubt? I see no reason why they are needed prior to anything but surgical intervention. If they work and the patient is happy - everyone is happy! mridulaben wrote: 2. In Colposuspension procedures, or TVT in GSI, is one of the principles behind surgery, increased uretheral resistance also besides correction of position of bladder neck? Yes and yes Repositioning of the bladder neck / utertho-vesicle angle is the key however. N _________________ "Teale Fenning Medical Education" delivering evidence-based, exam-orientated learning since 1997 Back to top mridulaben Century Club Joined: 08 Nov 2006 Posts: 137 Location: Brunei Posted: Sat Jan 27, 2007 10:45 am    Post subject: Thanks nick Back to top Display posts from previous: All Posts1 Day7 Days2 Weeks1 Month3 Months6 Months1 Year Oldest FirstNewest First         TEALE FENNING Forum Index -> MRCOG Part 2: Short Answer Essays All times are GMT Page 1 of 1   Jump to: Select a forum Announcements----------------Forum AnnouncementsExam InformationCourse Announcements Examinations----------------MRCOG Part 1: EMCQsMRCOG Part 2: MCQ & Past Paper questionsMRCOG Part 2: EMQs - Extended Matching QuestionsMRCOG Part 2: Short Answer EssaysMRCOG Part 2: Objective Structured Clinical Examination - the OSCEDRCOG: the Diploma ExaminationMFFP: Membership of the Faculty of Family Planning and Reproductive Health Care of the RCOGPLAB: The Professional and Linguistic Assessment Board test General Discussion----------------Open ForumRCOG News & UpdatesThe Study Buddy SchemeKey Facts in O&GGuidelines & ProtocolsRecommended ReadingUseful WebsitesThe Market PlaceHow things work in the UKHow do you say that? Teale Fenning Courses----------------Our UK CoursesOur Overseas CoursesOur Correspondence CourseCourse AdministrationCourse FeedbackAccommodationOther Courses Training & Career Development----------------Basic Speciality Training in O&GSubspeciality Training & Special Skills ModulesAcademic TrainingResearch & AuditThe Curriculum Vitae or CVInterview SkillsMedical EducationPublication & Presentation SkillsTraining Courses, Conferences, & MeetingsThe Job MarketClinical Attachments  You cannot post new topics in this forum You cannot reply to topics in this forum You cannot edit your posts in this forum You cannot delete your posts in this forum You cannot vote in polls in this forum Powered by phpBB © 2001, 2005 phpBB Group