Question

Personal Information

Name: Mrs. Maggie Meriwether

Age: 56 years old

Gender: Female

Description

Mrs. Meriwether is a 56-year-old woman, who was apparently in good health until six months ago, at which point she started noticing an uncontrollable urge to urinate when she was exercising, lifting weights, sneezing, or coughing. The embarrassing part for her is that, although she has tried to suppress the urge, she has voided in her underwear very often. The problem has become more frequent, and she has to wear a sanitary pad constantly. The patient also shares that she has something protruding through her vagina. She is anxious because she thinks she has a tumor. After conducting a thorough medical interview and physical examination, the doctor diagnoses stress urinary incontinence and cystocele.

Our patient is a mother of four children with vaginal deliveries complicated by shoulder dystocia. During her last pregnancy, she had a whitish and cottage cheese-like vaginal discharge. A year ago, Mrs. Meriwether had an episode of gastroenteritis accompanied by profuse vomiting and diarrhea, which produced moderate dehydration and electrolyte and acid-base imbalances. Our patient also indicates she has had two episodes of right renal colic produced a renal lithiasis. Patient has no history of smoking or alcohol intake.

• Urinary system: Leakage of urine through the urethra during Valsalva maneuver
• Reproductive system: Soft mass protruding through the vagina, mostly when the patient is pushing

Answer the following

1. What could be the cause of the whitish and cottage cheese-like vaginal discharge the patient had in her last pregnancy? Is this common? Why or why not?
2. What is the prognosis of Mrs. Meriwether's cystocele? Can you mention other causes of urinary obstructions?

Answer 1

1.lumpy .... discharge that is white or off white resembling cottage cheese can be yeast infection and that is normal during pregnancy. It won't affect foetus.

But if it is out of control should get treatment.

2.prognsis for cytocele:

• There should be activity changes like avoid weight lifting or straining during bowel movements.
• Keep exercise: that is regular pelvic exercises to make them strong.
• Pessary :is a device placed in the .... to hold the bladder in place.
• Surgery
• Hormone replacement therapy. Etc. 3.Urinary obstruction may also due to stones,tumor,weak bladder,trauma or pelvic fracture.
• Patient had renal lithiasis earlier so that may lead to urinary obstruction.