EBCOG Part 1 High Yield Questions – Urogynaecology

A 40-year-old woman with two children reports symptoms of stress urinary incontinence but would like to avoid surgery as she has not completed her family yet.

Which of the following medication would you prescribe to improve herssymptoms?

2. A 70-year-old patient with overactive bladder symptoms undergoes an urodynamic test. She has a first sensation of filling at 70 mL with a concomitant detrusor pressure of 2 cmH,O. The bladder is filled to 300 mL when she reporte lower abdominal pain, urgency to pass urine and the filling is stopped. At the end of the cystometry the detrusor pressure of 20 cmH, and no detrusor overactivity is detected.

Which of the following descriptions in relation to the above test can be associated lower urinary tract dysfunction and neurological conditions?

3. A womancomplains of urinary incontinence only when she coughs. Urodynamic assessment shows an increase in the detrusor pressure immediately after coughs with concomitant urinary leakage. which is her urodynamic diagnosis?

4. A 27-year-old woman has a history of voiding difficulties. At uroflowometry she voids 120 mL of urine with a peak-flow rate of 16 mL/sec, a bell-shaped curve and a post-void residual of 20 mL.Which of the following is correct?

5. A patient has a long-standing history of stress-predominant urinary incontinenceand frequency. The clinician is thinking of inserting a retropubic tape to treat her Stress urinary incontinence, but he would like to exclude any underlying detrusor overactivity (DO). Which is the most sensitive test to diagnose DO?

6. A 40-year-old woman presents with dyspareunia, dysuria and post-void dribbling She is known to suffer from recurrent urinary tract infections and 2 years previously she had a retropubic tension-free vaginal tape. Videourodynamics is  performed.

Which of the following findings could explain her symptoms?

7. A 30-vear-old nulliparous woman presents with new onset symptoms of overactive bladder. She is known to suffer from diabetes mellitus type 1 since childhood. Urodynamics show a bladder capacity of 300 mL and repetitive detrusor contractions, a maximum detrusor pressure of 120 cmH.O with no associated incontinence.

Which of the following diagnosis could explain her symptoms?

8. A 65-year-old patient presents with new onset symptoms of vaginal swelling,constipation and occasional urinary leakage on exertion. She underwent a colposuspension for stress urinary incontinence few years ago.

Which of the following can be attributed to her previous continence surgery?

9. Pelvic organ prolapse involves multiple anatomical and functional systems and iscommonly associated with gastrointestinal symptoms.

What is highly unlikely to be caused by prolapse?

10. McCall’s culdoplasty is performed at the time of a vaginal hysterectomy to treat orprevent:

11. When pelvic floor muscle training of a symptomatic pelvic organ prolapse (POP)can be considered?

12. What is the lifetime risk of undergoing a single operation for prolapse or incontinence?

13. Which operation for upper vaginal prolapse (uterine or vault) isassociated withlower rate of recurrence?

14. There is a clear link between vaginal delivery and symptoms and signsof pelvicorgan prolapse in urogynaecological patients.
How much is the risk increased when women who had a forceps delivery are compared with women who had a caesarean section?

15. The pelvic organ prolapse – quantification (POP-Q system is an objective sitespecific system for describing, quantifying and staging pelvic support in women.
What is used as a fixed point of reference?

16. You see a 62-year-old woman in your gynaecology clinic. She
presents with urgency, daytime frequency, nocturia and urge leakage.
What is your initial step in management?

17. You see a 52-year-old woman in your urodynamics clinic. T e uroowmetry curve is bell shaped with a maximum ow rate (Qmax) of 23 ml/s. T e postvoid residual is 50 ml, and multichannel cystometry shows involuntary detrusor contractions during the lling phase which are provoked by the sound of running tap water. T e maximum cystometric capacity is 450 ml. What is the most appropriate diagnosis?

18. You see a 54-year-old para 3 in your gynaecology clinic who presents with a 9-month history of urinary leakage with both exercise and coughing. T ere is no urgency or frequency, and she is otherwise well with no previous pelvic surgery. On examination she has a BMI of 24 kg/m2. T ere is evidence of urine leakage on cough and a grade 1 cystocele.What is your rst-line treatment?

19.You see a 60-year-old para 4 in your gynaecology clinic who presents with a 12-month history of urine leakage with exercise and associated urgency. She reports some improvement of the urgency and urge incontinence on oxybutynin. She is otherwise well and has no previous pelvic surgery. Urodynamic studies show detrusor overactivity, urodynamic stress incontinence, normal cystometric capacity and no voiding dysfunction. She is keen for surgical management.Which of the following describes her risk of worsening of urge symptoms following synthetic midurethral tape?

20. You see a 58-year-old para 4 in your gynaecology clinic for her follow-up appointment. She gives a 10-month history of frequency, urgency and nocturia. She tells you that conservative management, including two antimuscarinic drugs and mirabegron, has not worked adequately. What intervention would you o er her next?