Urogynecology

Question 1

Stages of POp

Answer 1

1 more than 1 cm above the level of the hymen
2 between 1 cm above and 1 cm below the level of the hymen
3 more than 1 cm below hymen but no further than 2 cm less than TVL
4 complete procidentia/ vault eversion

Question 2

Office evaluation of incontinence

Answer 2

History and physical exam
Urinalysis
Assessment of urethral mobility
Post void residual urine volume measurement 
Demonstration of stress incontinence

Question 3

What is a normal post void residual urine volume

Answer 3

<150 mL Indicates adequate bladder emptying

Question 4

Medication’s for urge incontinence

Answer 4

1. Antimuscarinics- act on M2 and M3 receptors to inhibit detrusor contraction
   CI: urinary retention
   SEs: dry mouth, constipation, narrow angle glaucoma
2. Beta agonist- mirabegron- muscle relaxation and increased bladder capacity
   CI: poorly controlled hypertension, severe renal or liver disease)
3. Detrusor injection of Botox

Question 5

Surgical correction of vaginal vault prolapse

Answer 5

Sacrospinous ligament fixation

Uterosacral ligament suspension

Question 6

What is the indication for abdominal sacral colpopexy?

Answer 6

Recurrent cystocele, vault prolapse, enterocele

Question 7

What’s the work up for urinary incontinence?

Answer 7

History: sx severity, goals for treatment, frequency, dysuria, nocturia, urgency, aggravating factors and timing of leakage in relation to them, PMH, PSH, meds

Physical: prolapse?, cough test, ?GSM, neurological exam, qtip test

UA/UCx
PVR

Question 8

What is a normal post void residual?

What is a normal bladder capacity?

Answer 8

<150cc

350 cc

Question 9

Cystometry

Answer 9

Graphic depiction of bladder and abdominal pressure relative to fluid volume during filling, storage, and voiding to assess bladder capacity and compliance.
Helps determine presence and magnitude of voluntary and involuntary detrusor contraction

Question 10

Uroflowmetry

Answer 10

Measures rate of urine flow and mechanism of bladder emptying.
Coordinated detrusor contraction and urethral relaxation

Question 11

Indications for a urodynamic testing

Answer 11

unclear diagnosis after basic evaluation,
failure to improve after initial treatment,
prior pelvic floor surgery,
or symptoms that do not correlate with physical findings.

Question 12

Uroflowmetry

Answer 12

The patient is asked to empty their bladder into a commode connected to a flowmeter. The average woman can empty a full bladder in 15 to 20 seconds with an average flow rate of 20 mL/sec.
Voiding dysfunction is diagnosed if the flow rate is less than 15 mL/sec with urine volume retention greater than 200 mL.

Question 13

Cystometrography

Answer 13

used to differentiate between urinary stress incontinence or overactive bladder.

Question 14

Urethral pressure profilometry is done at maximum bladder capacity following cystometrography by slowly pulling the pressure catheter along the length of the urethra to record the maximum urethral closing pressure. Maximum urethral closing pressure less than 20 cm H20 is indicative of

Answer 14

Intrinsic sphincter deficiency

Question 15

Risk factors for POP

Answer 15

Obesity
Multiparty
Chronic constipation
FH of POP

Question 16

First line rx for SUI AND URGE INCONTINENCE

Answer 16

Lifestyle modification 
Pelvic floor exercises 
Wt loss 
Fluid changes
Bladder retracing
Timed voiding

Question 17

Management options for stress urinary incontinence

Answer 17

1. Sling
2. Suture suspension- Burch
3. Peri-urethral collagen (bulking)

Question 18

Complications of surgical procedures for incontinence

Answer 18

UTI
unmasking urge incontinence
Urinary retention
Hematoma in space of retzius 
Bladder injury
Ureteral or bowel injury