Transcript POPurinaryDD

POP – Pelvic Organ Prolapse
General
1. The vagina is a virtual space only.
2. The vaginal axis is 45 degrees posterior, toward the rectum.
3. The Uro-Genital Diaphragm extends from the pubic
symphysis anteriorly to the coccyx posteriorly.
4. The uretero-vesicle angle is usually 90 degrees at the base of
the bladder.
5. The levator muscles are at the vaginal introitus.
Specifically
1. Urethrocele
2. Cystocele
3. Cystourethrocele
4. Enterocele
5. Rectocele
Urinary Incontinence
1. Stress
2. Urgency
3. Mixed
POP/Bladder Clinical Cases
Case #1 23 yo comes in with 5 day history of frequent urination that burns when
she voids.
Case #2 35 yo comes in with SEVERE cramps when she pees and she also has lowgrade constant pain if she pushes into her lower abdomen just above her pubic
bone. Urine analysis is negative for WBC or bacteria.
Case #3 45 yo comes in with 7 bladder infections, one after the other, frequently
progressing to blood in the urine.
Case #4 55 yo comes in with progressive irritation of the bladder and frequent
voiding of small amounts of urine. UAs x3 have been negative.
Diagnosis Options
Bladder infection
Interstitial cystitis
Bladder cancer
Atrophic bladder mucosa
Stress Urinary Incontinence
Urgency Incontinence
Mixed Incontinence
Treatment Options
Case #5 45 yo has 5 children and loses 10 drops of urine every time she coughs.
Case #6 45 yo has 5 children and wets her pants, losing 4 ounces of urine every
time she leaks.
Case #7 45 yo sometimes wets her pants and sometimes loses urine just when she
exercises.
Antibiotics
Cystoscopy
Bladder biopsy
Double void x 3 days
2-minute void x 3 days
Pessary
Support surgery