EBCOG Part 1- Urogyenacology -Day 5(S.B.A)

1. A 65 year old lady had a major transection ureteric injury during abdominal hysterectomy for large fibroid uterus. The injury in the upper 1/3rd of the ureter. The following method should be used for repair:

2.A 54 year old sustained bladder injury during laparoscopic assisted vaginal hysterectomy. She had the catheter for 2 weeks. Prior to removal of the catheter she needs:

3. A 48-year-old woman undergoes laparoscopic hysterectomy and bilateral salpingo-oophorectomy, pelvic lymphadenectomy, peritoneal washings and bowel adhesiolysis for International Federation of Gynecology and Obstetrics(FIGO) stage Ib, high-grade serous endometrial cancer. Her blood loss was 1000 mL. A peritoneal pelvic drain is inserted. Her observations are stable an she is apyrexial. Her abdominal drain is straw-coloured fluid and is 500 mL on day 2. Her haemoglobin (HB) is 9 gm% and serum creatinine is 75. Drain fluid creatinine is reported as 90.What is the diagnosis in her case?

4. A 48-year-old woman undergoes laparoscopic hysterectomy and bilateral salpingo-oophorectomy, pelvic lymphadenectomy and peritoneal washings for grade 3 endometrial cancer. It was a difficult operation due to extensive adhesions. Her abdominal drain is straw-coloured fluid and is 500 mL on day 2. She is clinically stable. Her haemoglobin (HB) is 9 gm% and serum creatinine is 75. Drain fluid creatinine is reported as 90.Which of the following is not a sign or symptom of urinary tract injury in her case?

5.A 48-year-old woman undergoes hysterectomy and bilateral salpingo-oophorectomy, pelvic lymphadenectomy and peritoneal washings for grade 3 endometrial cancer. You are the registrar on call for gynaecology and have been asked to review this woman whose urine output is 20 mL for the previous 8 hours (day 1 of the operation). The operation notes reveal that this was a difficult operation due to extensive bowel and pelvic adhesions. She has an abdominal drain which is drained 400 mL. Her urine output is 20 mL in the last 8 hours. She is clinically stable. Her haemoglobin (HB) is 12 gm% and serum creatinine is 75. Drain fluid creatinine is reported as 90. You are suspecting a ureteric injury or occlusion. What is most important investigation that would help in making a diagnosis of ureteric injury or occlusion?

6. A 48-year-old woman undergoes laparoscopic hysterectomy and bilateral salpingo-oophorectomy, pelvic lymphadenectomy, bowel and pelvic adhesiolysis and peritoneal washings for grade 3 endometrial cancer. While dissecting the pelvic side wall, the consultant notices right ureteric injury close to the bladder edge. The urologist on call has been called for opinion and repair.What would be recommended management for her surgically?

7.  A 44-year-old woman undergoes laparoscopic subtotal hysterectomy for fibroids with a blood loss of 500 mL. On day 2 (36 hours post-operation) she develops abdominal pain and looks pale. Her haemoglobin (HB) is reported as 7.8 gm% (pre-operative HB: 13 gm%). She is clinically stable and apyrexial with good urine output. She herself is an A&E nurse and is asking for blood transfusion. You are the registrar on call and have been asked to review this woman and make a plan of management. What should be her immediate management?

8. You have just completed a vaginal hysterectomy for a proceden- tia. However, upon catheterisation, no urine is present in the catheter bag.A cystoscopy is performed and no bladder trauma is identified. In order to assess ureteric function you give indigo carmine and after 5 minutes you observe a blue stream from the right ureteric orifice but none from the left. What would be the next line of management?

9. The main complication of mesh repair in vaginal prolapse:

10. In the female pelvis, the ureter forms an important relation with the ovaries and lies: