Prolapse/Diverticula/Fistula
T or F. Pessaries can concomitantly help with pelvic organ prolapse and stress urinary incontinence.
True
Bactrim
Name 4 of 6 listed risk factors for female SUI?
higher parity, increasing age, Caucasian race, smoking, lung disease and obesity
Medicare reimbursement for: Complex cystometrogram w/ voiding pressure studies in physician office. (within $50)
$320
If you do urethral pressure as well then $345
Which approach of synthetic slings is associated with more voiding dysfunction and obstruction: transobturator vs retropubic?
Retropubic
The retropubic approach is more likely to cause voiding dysfunction and is thought to be more obstructive than the obturator approach. The retropubic approach does appear to have better results in patients with concomitant ISD
For a vesicovaginal fistula the most effective repair is multi-layer, tension free, closure with interposition of well-vascularized tissue. There has been some efficacy shown with fulguration and catheter drainage in what types of VV fistuals?
<5mm
What is the detrussor leak point pressure that is associated with upper tract deterioration?
40cm H20
Name the two major mechanisms for female SUI.
1. Intrinsic sphincter deficiency
2. Urethral hypermobility
Which Christmas song was banned by many American radio stations in 2018?
The 1944 Christmas tune "Baby, It's Cold Outside" was banned by radio stations across the country -- and even in Canada -- for its lyrics that some said were inappropriate in the wake of the #MeToo movement.
T or F. Synthetic slings treat SUI due to ISD.
False
Midurethral slings and retropubic suspensions are designed to correct hypermobility but will not adequately manage ISD; in these cases urethral bulking agents and/or autologous slings should be considered.
Classic triad (symptoms) of a urethral diverticula?
1. Dribbling
2. Dyspareunia
3. Dysuria
Typical detrussor pressure at which males void.
40-60cm H20
Following URS, clinicians may omit ureteral stenting in patients meeting all of the following criteria. Need to name 4 of 5
1. Those without suspected ureteric injury during URS
2. Those without evidence of ureteral stricture or other anatomical impediments to stone fragment clearance
3. Those with a normal contralateral kidney
4. Those without renal functional impairment
5. Those in whom a secondary URS procedure is not planned.
T or F. In vesicovaginal fistula repair post op management with anticholinergics, catheter drainage, vaginal estrogen and antibiotics may be helpful.
Name the highest grossing Christmas movie of all time.
Home Alone
How many Americans buy/have artificial Christmas trees vs real? Must be within 7%
82%
In 2018, 82 percent of Christmas trees in American households were artificial, while over 95 million households displayed a Christmas tree, according to the American Christmas Tree Association.
There are 8 patient factors listed in the core curriculum describing the patients who should get abx. Name 5 of 8.
Patients with neurogenic lower urinary tract dysfunction, elevated PVR, asymptomatic bacteriuria, immunosuppression, age over 70, an indwelling catheter, external urinary collection device, or on clean intermittent catheterization
Name 3 of 4 essential components of work-up of woman you would do in the office with incontinence before you do a sling.
History/Physical
PVR
UA - to assess for hematuria or UTI
Office stress test
In the classic Christmas movie, How The Grinch Stole Christmas, the Grinch was described with three words. What are they? (Hint: it is also in the grinch song)
Stink, Stank, Stunk
T or F. Future pregnancy is a contraindication for a midurethral sling.
True
A relative contraindication for open surgery and midurethral sling is a woman who anticipates a future pregnancy. She is probably better served with conservative therapy or injectable agents since it would seem prudent that a woman finish childbearing and the resulting pelvic floor trauma before having any open surgical repair.
Name three imaging modalities used to assess/better delineate a urethral diverticula.
1. MRI - best
2. VCUG
3. Positive pressure urethrography - double balloon urethral catheter
Name the percent of patients with actual urge incontinence (within 5%) who do not show detrussor overactivity on UDS.
40%
Importantly, the absence of DO on UDS in patients with urgency incontinence and mixed incontinence does not exclude it as a causative agent for their symptoms. Up to 40% of patients with urge incontinence do not have DO on UDS
Synthetic mesh slings are contraindicated in a female with SUI if she has one of what four things?
1. Concurrent urethrovaginal fistula
2. Urethral erosion from mesh
3. Intraoperative urethral injury
4. Urethral diverticulum
The movie Miracle on 34th Street is based on a real-life department store. What is it?
Macy's
Cure rate of macroplastique urethral bulking injection? Need to be within 7%
49%
A longitudinal series following 85 women >3 years after Macroplastique had stable outcomes with persistent improvements and a 49% cure rate.67 Patient factors that may improve continence after the procedure are age over 60 and having less severe incontinence with 2.5 or less SUI episodes per day
Also can be better with ISD