EBCOG part 1 urogyeneacology day 6 EMQ

A Atrophic vaginitis
B Bladder calculus
C Bladder diverticulum
D Bladder endometriosis
E Bladder pain syndrome
F Fibromyalgia
G Pelvic inflammatory disease (PID)
H Peritoneal adhesions
I Sjogren's syndrome
J Systemic lupus erythematosus
K Transitional cell carcinoma
L Urethral diverticulum
M Urinary tract infection (UTI)
N Vesicovaginal fistula

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

1. A 40-year-old woman with no significant past medical history presents with a 10-month history of pelvic pain mainly located to the suprapubic area. She has urinary urgency and frequency but no leakage. The symptoms persist through her cycle. She suffers with constipation but not diarrhoea.

2. A 48-year-old woman presents to clinic with complex symptoms. She has urinary urgency and frequency but also dysuria and postmicturition dribble. A full gynaecological history also reveals dyspareunia. An initial pelvic examination is unremarkable.

A Anti-cholinergics

B Treatment of prolapse

C Botulinum toxin to bladder

D Defer surgery until bladder stable

E Discussion at multi-discliplinary team meeting

F Referral to tertiary urogynaecology centre

G Counselling regarding after-effects of surgery

H Surgery first and then treat overactive bladder symptoms later on

I Do nothing

J Treat urodyamnic stress incontinence and detrusor overactivity simultaneously

K Referral to urologist

Match the most appropriate managementto each scenario:

3. A 51-year-old woman presents with mainly irritative symptoms and occasional stress incontinence and her reason for referral is bothersome prolapse. These are the results of her urodynamic studies: flow rate 50 ml/min, urgency at 162 ml, strong urgency at 308 ml, no urodynamic stress incontinence, definite sensory urgency and phasic detrusor contractions after standing up with full bladder.

4. A 57-year-old woman presents with a cystocele (no vault descent) and urgency symptoms. Urodynamics were performed with pessary in situ at 50 ml/min, filled to 500 ml; urodynamic stress incontinence not demonstrated due to sustained pressure rise, but definite detrusor overactivity observed.

5. A 52-year-old woman presents with mixed symptoms; urodynamics performed on detrusitol, at 50 ml/min, bladder could not be filled beyond 376 ml, strong urge and urgency at 328 ml, poor compliance and severe urodynamic stress incontinence, blood-stained post void residual.

6. A 43-year-old woman, who had a total abdominal hysterectomy three years ago and lower urinary tract symptoms ever since, underwent urodynamic investigation. The study at 50 ml/min shows stable bladder during filling phase and severe urodynamic stress incontinence, but an after-contraction just after voiding.

7. A 74-year-old woman with a previous history of vaginal hysterectomy and anterior repair presents with severe irritative symptoms (mostly urgency) on maximum anticholinergics. Urodynamic studies at 50 ml/min show severe detrusor overactivity with no urodynamic stress incontinence.

A Intermediate release (IR) oxybutynin

B Mirabegron

C Darifenacin

D Oxybutynin patches

E Solifenacin

F Topical oestrogen

G Desmopressin

H Imipramine

I Duloxetine

J Fesoterodine

K Tamsulosin

L Botulinum toxin

M Discussion at multi-disciplinary team meeting

N Percutaneous tibial nerve stimulation (PTNS)

Match the most appropriate management to each scenario:

8. A 64-year-old woman was referred with irritative symptoms of mostly urgency symptoms. Fluid advice was given, as she was drinking about six cups of coffee a day, which mostly corrected the problem. Pelvic examination revealed severe atrophic vaginitis.

9 A 59-year-old woman presents with significant and bothersome urgency and urge incontinence and passes urine six times during the day. However, nocturia was her most bothersome symptom. A trial of anti-muscarinic medication controlled her daytime frequency and urgency, but her nocturia has persisted.

10 A 36-year-old woman is bothered by urgency and urge incontinence. Fluid advice and bladder retraining have been advocated and she has already had a trial of three anti-cholinergic medications. Although she had some improvement with the medication, the tablets were not able to control all of her symptoms and she has had to discontinue her medication due to side-effects.

11 A 23-year-old woman has had a long-standing problem with nocturnal enuresis. She has tried an alarm system and desmopressin in the past with limited success. She would like to try something else, if available.

12 A 42-year-old woman has tried both solifenacin and tolterodine and although both have been successful in controlling her symptoms, she is having very bad side-effects, with both dry mouth and constipation, and would like something else to control her symptoms.