EBCOG Part 1- Urogyenacology -Day 4(E.M.Q)

A. Abdominal sacropexy
B. Colpocleisis
C. Paravaginal repair
D. Pelvic floor exercise
E. Posterior vaginal wall repair
F. Ring pessary
G. Sacrospinous vault fixation
H. Shelf pessary
I. Traditional anterior repair
J. Uterosacral ligament suspension

1. A 48-yr old woman presents with something coming down for the past 6 months. She has previously had a vaginal hysterectomy for heavy periods. She is sexually active and denies any bladder or bowel symptoms. On examination she has stage 3 vault prolapse and stage 1 anterior prolapse.

2.A 60-yr old woman presents with something coming down and difficulty emptying her bowels. She has had a vaginal hysterectomy and posterior repair 5 years ago and was well for the first 2 years post-operation. She does not report any urinary symptoms. She is not sexually active. Examination reveals a stage 2 posterior wall prolapse, stage 1 vault descent, and a well- supported anterior vaginal wall.

3. A healthy, 58-yr old sexually active woman presents with a sensation of a bulge down below and difficulty sometimes initiating urinary voiding. On examination she has stage 2 anterior compartment prolapse. The vault is well supported, as is the posterior vaginal wall. She is having to spend increasing amounts of time caring for her invalid child and is keen on a definitive treatment as soon as possible.

4. A 77-yr old healthy woman presents once again to her gynaecologist with symptoms suggestive of prolapse. She has struggled for many years with this problem, and indeed has undergone a number of surgeries, including vaginal hysterectomy, to treat prolapse in all 3 compartments. The problem has recurred and examination shows a recurrence of stage 2-3 prolapse. Pessaries have previously been poorly tolerated. She is not sexually active.

5. A 54-yr old woman who had has three children presents with a sensation of a bulge down below with no urinary or bowel symptoms. On examination she has stage 2 anterior compartment prolapse. There is no uterine descent and the posterior vaginal wall is well- supported.

A Anterior and posterior colporrhaphy
B Anterior colporrhaphy
C Artificial urinary sphincter
D Augmentation cystoplasty
E Colpocleisis
F Fenton's procedure
G Intramural bulking agents
H Laparoscopic colposuspension
I Marshall—Marchetti—Krantz procedure
J Open colposuspension
K Posterior colporrhaphy
L Tension-free vaginal tape
M Transobturator tape
N Urinary diversion
0 Vaginal hysterectomy


For each of the following clinical scenarios, choose the single most appropriate surgi-cal intervention from the list of options above. Each option may be used once, more than once or not at all.

6. A woman attends the urogynaecology clinic with symptoms of stress incontinence that have not responded to conservative measures. She is keen for surgical intervention but wishes to avoid synthetic meshes and tapes as she has read adverse reports in the media.

7. A 45-year-old woman presents with urinary frequency and urgency and a diagnosis of idiopathic detrusor overactivity is made. This has not responded to conservative measures and she is ready to proceed with surgical intervention.

8. A 90-year-old woman with hypertension and type 2 diabetes presents with worsening uterovaginal prolapse that is not being controlled with shelf pessaries.