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URINARY INCONTINENCE . . . CONT.

antibiotics estrogen creams, ring used vaginally (Estring) estrogen raises sensory threshold for involuntary detrusor contractions decreasing urgency, frequency

OVERFLOW INCONTINENCE

overdistension of bladder and loss of urine r e s u l t s f r o m n e u r o g e n i c b l a d d e r u n d e r a c t i v i t y o f d e t r u s o r o r h y p o t o n i c b l a d d e r a s s o c i a t e d w i t h • lower motor neuron disease s p i n a l c o r d i n j u r y a u t o n o m i c n e u r o p a t h y ( i . e . d i a b e t i c s ) c a n a l s o o c c u r w i t h o u t f l o w o b s t r u c t i o n

Diagnosis urodynamics • large bladder capacity

Treatment cholinergic agents bethanechol (Urecholine) to increases bladder tone and contractility intermittent self-catheterization

GYNECOLOGICAL ONCOLOGY

Figure 7. Vulva and Perineum

Printed with permission from Williams Obstetrics, 14th ed, F.G. Cunningham, P.C. McDonald and N.F. Gant (eds.), Appleton and Lange, 1993

incidence of malignant lesions • endometrium > cervix > ovary > vulva > vagina

VULVA

any suspicious lesion of the vulva should be biopsied multiple biopsies are needed

Benign Vulvar Lesions malignant potential (< 5%) • greatest risk when cellular atypia found on biopsy squamous cell hyperplasia (hyperplastic dystrophy) • post-menopausal • pruritus • thickened raised lesions with whitish plaques • may have cellular atypia on biopsy • treated with corticosteroid cream lichen sclerosis • mostly post-menopausal • pruritus • dyspareunia

MCCQE 2000 Review Notes and Lecture Series

Notes

Gynecology 35

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