ABOG Urogynecology and Reconstructive Pelvic Surgery flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Level I vaginal support

The cardinal-uterosacral ligament complex suspends the cervix and upper vagina to the sacrum and lateral pelvic wall; its failure causes uterine or vault prolapse.

Puborectalis muscle function

Part of the levator ani innervated by direct sacral branches; it maintains the anorectal angle and contributes to fecal continence.

POP-Q Stage II

The leading edge of prolapse is within 1 cm of the hymen (above or below); this stage typically includes descent to the hymenal ring.

Sacrocolpopexy

Abdominal or laparoscopic mesh suspension of the vaginal vault to the anterior longitudinal ligament of the sacrum; it has lower recurrence than native-tissue vaginal repair.

Valsalva leak point pressure

Intravesical pressure at which urine leakage occurs with increased abdominal pressure; a value below 60 cm H2O suggests intrinsic sphincter deficiency.

Retropubic versus transobturator sling

Both have similar cure rates for stress incontinence; retropubic slings have more bladder perforation and voiding dysfunction, transobturator slings more groin pain.

Detrusor overactivity

Involuntary detrusor contractions during bladder filling on cystometry; it may be idiopathic or neurogenic and correlates with urgency and urge incontinence.

Maximal urethral closure pressure

Measured by urethral pressure profilometry; a value below 20 cm H2O suggests intrinsic sphincter deficiency and predicts poorer sling outcomes.

Overactive bladder definition

Urgency, with or without urge incontinence, usually with frequency and nocturia, in the absence of infection or other identifiable pathology.

Sacral neuromodulation

Third-line therapy for refractory overactive bladder and non-obstructive retention; a test stimulation precedes permanent implantation of the device.

External anal sphincter innervation

Striated muscle innervated by the pudendal nerve (S2-S4); it provides voluntary squeeze and is assessed by anal manometry.

Sphincteroplasty

Surgical repair of a discrete anal sphincter defect, often from obstetric injury; it is offered for fecal incontinence with an identifiable defect.

Dyssynergic defecation

Paradoxical contraction or failure of relaxation of the puborectalis and anal sphincter during defecation; first-line treatment is biofeedback.

Balloon expulsion test

A test of the ability to expel a rectal balloon; prolonged expulsion time supports a diagnosis of dyssynergic defecation or obstructed defecation.

Mesh erosion after sacrocolpopexy

Vaginal discharge or bleeding from exposed mesh; managed with vaginal estrogen and partial mesh excision, avoiding tension at placement.

Ureteral injury at uterosacral suspension

A known complication of uterosacral ligament suspension; intraoperative cystoscopy with dye confirms ureteral patency and allows prompt repair.

Type I macroporous mesh

Polypropylene mesh with pores larger than 75 micrometers; it allows tissue ingrowth and resists infection and is preferred for pelvic reconstruction.

Autologous fascia graft

Fascia lata or rectus fascia harvested from the patient; preferred in contaminated fields and for pubovaginal slings in intrinsic sphincter deficiency.

Antibiotic prophylaxis timing

Prophylaxis, typically cefazolin, is given within 60 minutes before incision to reduce surgical site infection in pelvic surgery.

Caprini risk score

A validated venous thromboembolism risk assessment tool; it guides selection of mechanical versus pharmacologic prophylaxis in surgical patients.

MRKH syndrome

Mayer-Rokitansky-Kuster-Hauser syndrome: vaginal agenesis with a 46,XX karyotype, normal ovaries, and primary amenorrhea with normal secondary sexual characteristics.

OHVIRA syndrome

Obstructed hemivagina with ipsilateral renal anomaly; presents with cyclic pelvic pain and a pelvic mass, and warrants renal ultrasound evaluation.

Sensitivity formula

Sensitivity equals true positives divided by true positives plus false negatives; a highly sensitive test is useful for ruling out disease.

Number needed to treat

The reciprocal of the absolute risk reduction; it expresses how many patients must be treated for one additional beneficial outcome.

Genital hiatus

A POP-Q measurement from the external urethral meatus to the posterior midline hymen; it reflects levator and perineal support.

Pudendal nerve block

Injection near the ischial spine to anesthetize the pudendal nerve (S2-S4); used for perineal anesthesia and for pudendal neuralgia diagnosis.

Mirabegron

A beta-3 adrenergic agonist used for overactive bladder; it relaxes detrusor smooth muscle and avoids anticholinergic side effects such as dry mouth.

Rectal prolapse

Full-thickness protrusion of the rectum through the anus; definitive treatment is surgical repair via abdominal or perineal approach.

Anorectal manometry

Measures resting and squeeze anal sphincter pressures and the rectoanal inhibitory reflex; used to evaluate fecal incontinence and defecatory disorders.

Urethrolysis

Surgical release of urethral obstruction after sling or suspension, performed for persistent voiding dysfunction or retention refractory to conservative measures.

Graft infection management

Infected synthetic mesh may require removal; synthetic mesh is avoided in contaminated fields, where autologous fascia is preferred.

ERAS protocol

Enhanced recovery after surgery: preoperative carbohydrate loading, multimodal analgesia, and early ambulation to reduce length of stay and complications.