Urogynaecology Extra Questions

1. The nerve that is susceptible to entrapment injuries during sacrospinous liga- ment fixation as it runs behind the lateral aspect of the sacrospinous ligament is the:

2. The main complication of mesh repair in vaginal prolapse

3. Painful bladder syndrome is characterised by all of the below except

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

5. Which of the following is not true about postpartum voiding dysfunction?

6. Vault prolapse can be prevented at the time of vaginal hysterectomy by

7. Ms. XY is 60 years old. She presents with a picture of mixed incontinence with stress as a predominant feature. A urinary tract infection has been ruled out. She does not smoke or consume caffeine. A grade 1 cystocele is noted on examination. Which of the following treatment options are best suited to her?

8. Ms. XY is 60 years old. She presents with symptoms suggestive of an overactive bladder. Urine dip is negative for leucocytes and nitrites. She does not smoke or consume caffeine. Examination reveals no prolapse. Which of the following is the most appropriate advice?

9. Ms. XY is 60 years old. She presents with symptoms suggestive of an overactive blad- der. Urine dip is negative for leucocytes and nitrites. She does not smoke or consume caffeine. Examination reveals no prolapse. Conservative therapies and OAB drugs have failed to improve her symptoms. After an MDT discussion, a decision is reached to try botulinum toxin A. Which of the following is an appropriate starting dose of the toxin?

10. XY is 70 years old. She presents to the urogynaecology specialist nurse with the complaint of feeling a bulge per vaginam. She has had a TAH + BSO 15 years ago. Which of the following points on the POP-Q system will not be recorded as a part of her assessment?

11. Which of the following is not true about duloxetine?

12. Which of the following is a contraindication to suprapubic catheterisation?

13. All of the following statements regarding anterior wall repair are true except

14. Which of the following is not an example of a problem arising from pelvic floor dysfunction?

15. ’Long-term’ intraurethral catheters are kept in situ for at the most:

16. Ms. XY is 70 years old. She presents to the urogynaecology specialist nurse with the complaint to feeling a bulge per vaginum. She has had a TAH +BSO 15 years ago. Which point corresponds to the vaginal vault/cuff scar on the POP –Q (pelvic organ prolapse quantification system)?

17. A 57-year-old, post menopausal woman complains of ‘something coming out of her vagina’ and difficulty in opening her bowels. She had four children uneventfully with vaginal births. Her last child birth was 18 years back. The most likely diagnosis is

18. Which of the following statements about urethral diverticulum is true?

19. Ms. XY is 55 years old. She suffers from symptoms of an overactive bladder. Bladder retraining has not helped her. Her recent urine analysis is negative for infection. What is next step in her management?

20. A third-degree perineal tear is defined as:

21. An 84-year-old patient who had a previous history of vaginal hys- terectomy presents with a stage 3 vault prolapse. The patient has limited mobility and has previously had difficulty with the use of vaginal pessaries. What is the most appropriate treatment option?

22. A 55-year-old patient presents with a history of urinary symptoms of urgency, increased frequency and nocturia. The patient states that she does not have symptoms of hesitancy and feels as though she empties her bladder completely. What would be the first line of management?

23. A 39-year-old patient presents with symptoms of leakage of urine upon coughing, sneezing and during exercise. The symptoms started following the birth of her second child 18 months ago. What would be the first line of management?

24. A patient presents as an emergency with urinary retention. Upon taking a history, you also discover that the patient has been having hematuria for several weeks. What is an absolute contraindication to inserting a suprapubic catheter?

25. A 56-year-old para 4 woman presents with a vault prolapse. The patient is sexually active and urodynamic investigations fail to reveal urodynamic stress incontinence even after reduction of the prolapse. The patient is keen on having surgery. Which of the following operations should be offered?

26. A39-year-oldpara1patientpresentswithstressincontinencewith no other urinary symptoms. What would be the first line of management?

27. A patient is undergoing a vaginal hysterectomy for uterine pro- lapse and at the end of the procedure it is noted that the vault of the vagina descends to 3 cm above the hymenal ring. What should be considered in order to prevent further descent of the vault in the future?

28. A fit and healthy 52-year-old patient with confirmed detru- sor overactivity has tried three different medical treatments (Oxybutynin, Solifenacin, Mirabegron). The procedure that should be offered to the patient is.

29. A 38-year-old patient is suffering with stress incontinence. Her BMI is 32 kg/m2 and the patient is interested in lifestyle manage- ment for her incontinence. What is the most important lifestyle change that you would recommend?

30. A 38-year-old patient is suffering with symptoms of an overac- tive bladder. Her BMI is 25 kg/m2 and the patient is interested in lifestyle changes. What is the most important lifestyle change that you would rec- ommend?

31. A 38-year-old patient is suffering with symptoms of an overac- tive bladder. Her BMI is 25 kg/m2 and the patient is interested in lifestyle changes. What is the most important lifestyle change that you would rec- ommend?

32. A patient presents with symptoms of a prolapse. On examination, the pelvic organ quantification score is Aa 0, Ba 0, C −5, D −7, Ap −2 Bp −2 tvl 9, gh 4, pb 3. The patient wants her prolapse to be treated surgically. What is the correct diagnosis and surgical treatment?

33. A woman presents with symptoms of a prolapse. On examination, the pelvic organ quantification score is Aa −2, Ba −2, C −5, D −7, Ap 0 Bp 0 tvl 9, gh 4, pb 3 The patient wants her prolapse to be treated surgically. What is the correct diagnosis and surgical treatment?

34. A 32-year-old multiparous woman has confirmed urodynamic stress incontinence and admits that she has not completed her family. What management would you propose for this patient?

35. A 28-year-old woman presents with a history of pelvic pain, uri- nary urgency, increased frequency and nocturia. The pelvic pain tends to occur during bladder filling and is relieved by voiding and you suspect that the patient has interstitial cystitis. What other mandatory investigation is required in order to make an accurate diagnosis?

36. A 64-year-old patient presents with a history of increased urinary frequency, nocturia, urgency and occasional urgency incontinence. What would be the next line of management?

37. An 84-year-old patient presents with symptoms of urgency, urgency incontinence and nocturia. The patient is taking several different medications for other medical conditions. A diagnosis of overactive bladder is made. The general practitioner has already tried Oxybutynin but the patient had side effects (central nervous system) and this was stopped.
Which anticholinergic medication would you now consider?

38. A 52-year-old patient presents with a history suggestive of an overactive bladder, but also complains of fecal incontinence. The patient has tried conservative measures and various anti cholinergics with no significant benefit. Urodynamic testing confirms detrusor over activity and some void- ing dysfunction. What is the best surgical option for this patient?

39. 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?

40. A 48-year-old morbidly obese woman has a sister who recently had surgical treatment for prolapse. She is therefore interested in finding more about the impact of obesity on the development of prolapse. The occurrence of which type of prolapse shows the most significant increase in association with morbid obesity?

41. A woman is contemplating having either a Sacrospinouscolpopexy (no mesh) or a Sacrocolpopexy (with mesh). The patient is keen on having a Sacrocolpopexy but is concerned about novo prolapse. What is the incidence of de novo prolapse (cystocele), after Sacro- colpopexy and Sacrospinouscolpopexy?

Sacrocolpopexy                      Sacrospinouscolpopexy
A.    2%.                                                        4%
B.    8%.                                                        8%
C.    1 4%                                                       12%
D.   24%                                                        12%
E.    31%                                                        14%