Female SUI

Question 1

What is the prevalence of SUI among women, as stated in the AUA/SUFU guideline?
A) 10-20%
B) Up to 49%
C) 30-40%
D) 50-60%

Answer 1

B) Up to 49%
Explanation:
According to the AUA/SUFU guideline, the prevalence of SUI has been reported to be as high as 49%.
Memory Aid:
Think of a half-full glass of water. The glass isn’t 50% full; it’s just shy of half at 49%. This helps you remember the upper limit of SUI prevalence.

Question 2

Which of the following describes an index patient according to the AUA/SUFU guideline for SUI?
A) Female with prior SUI surgery
B) Female with stage 3 or 4 pelvic prolapse
C) Healthy female considering surgical treatment for pure stress or stress-predominant MUI
D) Female with neurogenic lower urinary tract dysfunction

Answer 2

C) Healthy female considering surgical treatment for pure stress or stress-predominant MUI
Explanation:
The index patient, as defined in the guideline, is an otherwise healthy female considering surgical treatment for pure stress and/or stress-predominant MUI who has not undergone previous SUI surgery.
Memory Aid:
Imagine an “Index Card” with a “Healthy Female” written on it, about to opt for SUI surgery for the first time.

Question 3

The panel recognized that ongoing literature review for the SUI guidelines is essential due to:
A) Rapid technological advancements
B) High rate of surgical complications
C) Increased patient awareness
D) All of the above

Answer 3

A) Rapid technological advancements
Explanation:
The panel states that the landscape of SUI treatment is rapidly changing, requiring ongoing literature review and continual updates.
Memory Aid:
Imagine a fast-spinning globe (world = literature). The faster it spins (rapid advancements), the more often you need to look at it (update guidelines).

Question 4

How is Intrinsic Sphincter Deficiency (ISD) often defined?
A) Leak point pressure < 60 cm H20
B) Maximal urethral closure pressure < 20 cm H20
C) Both A and B
D) Neither A nor B

Answer 4

C) Both A and B
Explanation:
Intrinsic Sphincter Deficiency is often defined as a leak point pressure of less than 60 cm H20 or a maximal urethral closure pressure of less than 20 cm H20.
Memory Aid:
Think of ISD as “InSixty-DeTwenty”, as in “less than 60 cm H20 and less than 20 cm H20.”

Question 5

Who among the following would be classified as a non-index patient?
A) Female with low-grade pelvic organ prolapse
B) Female with a BMI of 40
C) Female with stress-predominant MUI
D) Female with a previous history of SUI but no surgery

Answer 5

B) Female with a BMI of 40
Explanation:
Non-index patients may have high BMI, among other conditions. Females with low-grade pelvic organ prolapse and stress-predominant MUI could be index patients.
Memory Aid:
Non-index patients have “extra” factors like “extra” weight (high BMI).

Question 6

Which of the following is NOT recommended as part of the initial evaluation of patients with SUI desiring to undergo surgical intervention?

A. Focused history, including assessment of bother
B. Cystoscopy
C. Objective demonstration of SUI with a comfortably full bladder
D. Assessment of post-void residual urine

Answer 6

B. Cystoscopy
Cystoscopy is not part of the initial evaluation for SUI patients desiring surgical intervention. The guideline suggests a focused history, physical examination, objective demonstration of SUI, assessment of post-void residual urine, and urinalysis.

Memory Tool: Think “Cysts go bye-bye!”
Cystoscopy isn’t needed in the initial evaluation for SUI.

Question 7

Which condition warrants additional evaluations in patients considered for surgical intervention for SUI?

A. Known or suspected neurogenic lower urinary tract dysfunction
B. Positive cough stress test
C. Valsalva maneuver
D. Negative post-void residual urine

Answer 7

A. Known or suspected neurogenic lower urinary tract dysfunction
According to expert opinion, conditions such as neurogenic lower urinary tract dysfunction warrant further evaluation in these patients.

Memory Tool: Think “Neuro-Needs-Extra”
For neurogenic conditions, extra evaluations are needed.

Question 8

What is the likelihood of having SUI if a woman has a negative clinical history?

A. 16%
B. 34%
C. 50%
D. 73%

Answer 8

B. 34%
A woman with a negative clinical history has a 34% chance of having SUI. Clinical history alone does not definitively diagnose SUI but can give some hints.

Memory Tool: “Negative History, Not Negative SUI”
Even with a negative history, there’s still a chance of SUI.

Question 9

Which of the following best describes the utility of the Q-tip test in diagnosing SUI?

A. High positive likelihood ratio
B. Moderate diagnostic value
C. Poor diagnostic value
D. Only useful for women above 40

Answer 9

C. Poor diagnostic value
Q-tip test has little value for diagnosing SUI. It may provide information on urethral mobility but isn’t strongly indicative of SUI.

Memory Tool: “Q-tip? Quit it!”
For SUI diagnosis, the Q-tip test isn’t all that useful.

Question 10

In an RCT by Albo et al., what was the specificity of the supine empty bladder stress test to predict intrinsic sphincter deficiency (ISD)?

A. 60%
B. 49%
C. 80%
D. 20%

Answer 10

A. 60%
The study found the specificity of the supine empty bladder stress test to predict ISD was 60%.

Memory Tool: “Albo says Six-Oh!”
Albo’s study specified 60% specificity for ISD.

Question 11

Based on the study by Jorgensen et al., what is the sensitivity of the one-hour pad test for diagnosing SUI?

A. 94%
B. 69%
C. 44%
D. 81%

Answer 11

A. 94%
Jorgensen et al. reported a high sensitivity of 94% for diagnosing SUI using the one-hour pad test.

Memory Tool: “Jorgensen Jumps High”
Jorgensen’s one-hour pad test has a high 94% sensitivity.

Question 12

Elevated post-void residual in the presence of SUI may be an indication of:

A. Urethral obstruction
B. Hypocontractility of the bladder
C. Neurogenic lower urinary tract dysfunction
D. Pelvic organ prolapse

Answer 12

B. Hypocontractility of the bladder
Elevated post-void residual (PVR) may indicate hypocontractility of the bladder and can put the patient at risk for retention post-treatment for SUI.

Memory Tool: “High PVR, Low Power”
Elevated PVR could mean the bladder isn’t contracting well.

Question 13

In patients with which of the following conditions may additional evaluations be performed?

A. Prior pelvic prolapse surgery
B. Hematuria
C. Positive Q-tip test
D. Positive cough stress test

Answer 13

A. Prior pelvic prolapse surgery
According to expert opinion, patients with prior pelvic prolapse surgery may benefit from additional evaluations.

Memory Tool: “Prior Prolapse, Probe Further”
Prior prolapse surgery is a signal for further evaluations.

Question 14

Which of the following is recommended as a first-line therapy for SUI?

A. Anticholinergic medication
B. Surgical intervention
C. Pelvic floor muscle exercises
D. Bladder instillations

Answer 14

C. Pelvic Floor Muscle Exercises
First-line therapy often starts with conservative approaches, and pelvic floor muscle exercises are recommended.

Memory Tool: “First, Flex those Floors!”
Pelvic floor exercises come first.

Question 15

Which test is most indicative of urethral mobility in women with SUI?

A. Q-tip test
B. Bladder ultrasound
C. Cystoscopy
D. Uroflowmetry

Answer 15

A. Q-tip test
The Q-tip test is commonly used to assess urethral mobility, despite its limited role in diagnosing SUI.

Memory Tool: “Q-tip Queries Urethra”
Q-tip test is your go-to for assessing urethral mobility.

Question 16

Which of the following is NOT a urethral bulking agent used in the treatment of SUI?

A. Macroplastique
B. Deflux
C. Durasphere
D. Bulkamid

Answer 16

B. Deflux
Deflux is mainly used for vesicoureteral reflux in children, not for SUI treatment in adults.

Memory Tool: “Deflux = Deflected from SUI”
Deflux is not used for SUI; it’s for vesicoureteral reflux.

Question 17

What is the ideal Post-Void Residual (PVR) urine volume to consider surgical intervention for SUI?

A. Less than 50 mL
B. 50-100 mL
C. Less than 150 mL
D. More than 200 mL

Answer 17

C. Less than 150 mL
A PVR less than 150 mL is generally considered ideal for contemplating surgical intervention for SUI.

Memory Tool: “Under 150, Under the Knife!”
For surgical intervention, keep PVR below 150 mL.

Question 18

When is multi-channel urodynamics commonly indicated in the evaluation of SUI?

A. In uncomplicated cases
B. In cases of suspected concomitant detrusor overactivity
C. In all new diagnoses
D. In postmenopausal women only

Answer 18

B. In cases of suspected concomitant detrusor overactivity
Multi-channel urodynamics is indicated if detrusor overactivity is suspected along with SUI.

Memory Tool: “Multi-D for Double Trouble”
If detrusor overactivity is suspected, go for multi-channel urodynamics.

Question 19

When should a clinician perform cystoscopy for the evaluation of Stress Urinary Incontinence (SUI) in index patients?
A) Always
B) Never
C) Only when there is a concern for urinary tract abnormalities
D) After every surgical procedure

Answer 19

C) Only when there is a concern for urinary tract abnormalities
Explanation: Cystoscopy is not routinely performed for index patients unless there is a concern for urinary tract abnormalities. It may be indicated if there is microhematuria on urinalysis or other signs of lower urinary tract abnormalities.
Mnemonic: Think “C for Cystoscopy, C for Concern” to remember the conditions for performing cystoscopy in index SUI patients.

Question 20

In what scenario would urodynamic testing not be necessary for the index patient with SUI?
A) When SUI is clearly demonstrated
B) When there is a history of pelvic organ prolapse surgery
C) When there is significant voiding dysfunction
D) When SUI is unconfirmed

Answer 20

A) When SUI is clearly demonstrated
Explanation: Urodynamics testing is not necessary when SUI is clearly demonstrated in otherwise healthy patients.
Analogy: Think of urodynamic testing as a “lie detector” for your bladder; if you’re already “telling the truth” (i.e., SUI is clear), there’s no need for the test.

Question 21

What is the primary goal of SUI treatment according to the AUA/SUFU guideline?
A) To cure the patient
B) To improve Quality of Life (QOL)
C) To perform surgical intervention
D) To completely eliminate symptoms

Answer 21

B) To improve Quality of Life (QOL)
Explanation: The primary goal is to improve QOL. While symptomatic relief is desired, the primary focus is how much the symptoms bother the patient.
Analogy: Treating SUI is like tuning a musical instrument; it’s not about making it perfect, but about making it playable for the musician (i.e., improving the quality of life).

Question 22

Which of the following is NOT an appropriate treatment option to discuss with patients having SUI?
A) Observation
B) Antibiotics
C) Pelvic floor muscle training
D) Surgical intervention

Answer 22

B) Antibiotics
Explanation: Antibiotics are not a standard treatment option for SUI according to the AUA/SUFU guidelines.
Memory Tool: S.O.P.S. = Surgical, Observation, Pelvic floor training, other non-Surgical options. Antibiotics don’t fit the SOPs.

Question 23

Which complication is NOT associated with surgical intervention for SUI?
A) UTI
B) Dyspareunia
C) Hyperactivity
D) Urinary retention

Answer 23

C) Hyperactivity
Explanation: Hyperactivity is not a complication of surgical intervention for SUI.
Mnemonic: Think “U.D.U.” - UTI, Dyspareunia, and Urinary retention are complications, but not Hyperactivity.

Question 24

What has NOT been suggested as an increased risk factor for mesh erosion according to the guidelines?
A) Diabetes
B) History of smoking
C) Obesity
D) Older age

Answer 24

C) Obesity
Explanation: Obesity has not been found to be an increased risk factor for mesh erosion based on the guidelines.
Mnemonic: Think “D.S.A.” - Diabetes, Smoking, and Age. O for Obesity is out.

Question 25

What is a potential storage symptom after SUI surgery?
a. UUI
b. Reduced urine output
c. Dehydration
d. Hyperactivity

Answer 25

a. UUI

Explanation:
De novo storage symptoms like UUI can occur post-SUI surgery. It’s like going grocery shopping for veggies but coming home to realize you suddenly crave chocolate.

Question 26

Patients considering MUS should be informed about what?
a. Patient testimonials
b. FDA safety communication regarding MUS
c. MUS being superior to PVS
d. Its lower cost compared to other surgeries

Answer 26

b. FDA safety communication regarding MUS

Explanation:
It is essential to discuss the FDA safety communication with patients contemplating MUS. It’s all about transparency, like laying your cards on the table in a game of poker.

Question 27

Which non-surgical treatment options may clinicians offer for patients with SUI or stress-predominant MUI?
a) Urethral plugs
b) Anticholinergic medications
c) Estrogen replacement
d) Ureteroscopy

Answer 27

a) Urethral plugs
Explanation: The document states that clinicians may offer urethral plugs, continence pessaries, or vaginal inserts as non-surgical options. Anticholinergic medications and estrogen replacement are not mentioned.
Memory Tool: Think of non-surgical treatments as “building plugs and supports” for the urinary system, much like you’d plug a leak in a dam.

Question 28

What is the evidence level for recommending midurethral sling surgery as a treatment for SUI?
a) Grade A
b) Grade B
c) Grade C
d) Expert Opinion

Answer 28

a) Grade A
Explanation: The document states that the recommendation for midurethral sling surgery has an Evidence Level: Grade A.
Memory Tool: Grade A is like getting an A+ in efficacy and safety for midurethral slings.

Question 29

Which type of midurethral sling has the longest available follow-up data?
a) Retropubic slings (RMUS)
b) Transobturator slings (TMUS)
c) Single incision slings (SIS)
d) Adjustable slings

Answer 29

a) Retropubic slings (RMUS)
Explanation: The document mentions that RMUS (specifically TVT™) is the most widely studied with data that exceeds 15 years follow-up.
Memory Tool: Think of RMUS as the “Retro King” since it has been around the longest and is the most studied.

Question 30

Which of the following is true regarding the effectiveness of RMUS vs TMUS?
a) RMUS has higher long-term success rates
b) TMUS has higher long-term success rates
c) They are statistically equivalent in both short-term and long-term success rates
d) There is not enough data to make a comparison

Answer 30

a) RMUS has higher long-term success rates
Explanation: The document states that slight advantages toward RMUS are seen with longer follow-up (five years).
Memory Tool: RMUS is like a “fine wine,” it gets better (or remains effective) over time.

Question 31

Which of the following adverse events are more likely to occur with TMUS compared to RMUS?
a) Major vascular or visceral injuries
b) Groin pain
c) Voiding dysfunction
d) Suprapubic pain

Answer 31

b) Groin pain
Explanation: According to the document, groin pain is more likely to occur with TMUS.
Memory Tool: Think of TMUS as “Thigh Muscle Under Stress,” which could lead to groin pain.

Question 32

Which of the following surgical treatments for SUI has the least comparative data available?
a) Midurethral sling
b) Autologous fascia pubovaginal sling
c) Burch colposuspension
d) Bulking agents

Answer 32

d) Bulking agents
Explanation: The document discusses the limited comparative data between broad treatment categories but does not specifically mention bulking agents in this context.
Memory Tool: Think of bulking agents as the “silent party members” who don’t talk much because there’s little comparative data on them.

Question 33

In women with stress-predominant urinary incontinence, which TMUS technique may surgeons perform?
a) In-to-out only
b) Out-to-in only
c) Either in-to-out or out-to-in
d) Neither in-to-out nor out-to-in

Answer 33

c) Either in-to-out or out-to-in
Explanation: The document states that surgeons may perform either the in-to-out or out-to-in TMUS technique.
Memory Tool: Think of TMUS as a “two-way street” where you can go either in-to-out or out-to-in.

Question 34

Which retropubic approach has a higher rate of urinary retention?
a) Bottom-up
b) Top-down
c) Both are equal
d) Data is inconclusive

Answer 34

b) Top-down
Explanation: The document mentions that higher rates of urinary retention are associated with the top-down approach.
Memory Tool: “Top-down” traps things at the “top,” just like it traps urine due to higher rates of retention.

Question 35

Which of the following adverse events is more likely with the bottom-up RMUS approach compared to the top-down approach?
a) Bladder and urethral perforation
b) Voiding dysfunction
c) Vaginal tape erosion
d) None of the above

Answer 35

d) None of the above
Explanation: The document states that the bottom-up approach has lower rates of bladder and urethral perforation, voiding dysfunction, and vaginal tape erosion compared to the top-down approach.
Memory Tool: Think of the bottom-up approach as being “gentler on the way up,” causing fewer adverse events.

Question 36

Is a MUS recommended for non-index patients or patients with ISD?
a) Yes, for both
b) No, for both
c) Only for non-index patients
d) Only for patients with ISD

Answer 36

a) Yes, for both
Explanation: The document suggests that a MUS may be considered for both non-index patients and those with ISD after proper evaluation and counseling.
Memory Tool: Think of MUS as a “Multi-Use Sling” that can be used for both non-index patients and those with ISD.

Question 37

Which of the following best describes the long-term comparative outcomes between RMUS and TMUS?
a) RMUS is favored
b) TMUS is favored
c) They are essentially equivalent
d) Data is inconclusive

Answer 37

a) RMUS is favored
Explanation: The document states that some randomized studies conclude in favor of the retropubic approach (RMUS) when it comes to long-term outcomes.
Memory Tool: RMUS is like a “marathon runner,” it tends to perform better in the long run.

Question 38

Which of the following adverse events is more likely to occur with RMUS?
a) Groin pain
b) Vaginal perforation
c) Major vascular or visceral injuries
d) Thigh pain

Answer 38

c) Major vascular or visceral injuries
Explanation: The document notes that RMUS is more likely to lead to major vascular or visceral injuries compared to TMUS.
Memory Tool: Think of RMUS as “Really Major Underlying Surgery,” hinting at a greater risk of major vascular or visceral injuries.

Question 39

What has been the general trend in the literature regarding the choice between RMUS and TMUS?
a) Movement toward favoring RMUS
b) Movement toward favoring TMUS
c) No clear preference
d) Strong favoring of adjustable slings

Answer 39

a) Movement toward favoring RMUS
Explanation: The document mentions that the general gestalt has seen a movement toward favoring the relative durability of RMUS over TMUS.
Memory Tool: Think of RMUS as the “Rising Star,” increasingly favored over time in the literature.

Question 40

Which approach in RMUS has higher rates of bladder and urethral perforation?
a) Bottom-up
b) Top-down
c) Equally likely in both
d) The document does not specify

Answer 40

b) Top-down
Explanation: The document mentions that the top-down approach in RMUS has higher rates of bladder and urethral perforation.
Memory Tool: Think “Top-Down, More Holes Found,” to remember the greater risk of perforation with the top-down approach.

Question 41

Which adverse event is more likely to occur with the out-to-in approach in TMUS?
a) Vaginal perforation
b) Voiding dysfunction
c) Groin pain
d) Suprapubic pain

Answer 41

b) Voiding dysfunction
Explanation: The document states that voiding dysfunction occurs more frequently with the inside-out approach in TMUS.
Memory Tool: Remember “Out-to-In, Hard to Begin (voiding)” for the greater likelihood of voiding dysfunction.

Question 42

What is the role of dynamic lumbopelvic stabilization (DLS) when added to pelvic floor muscle exercises (PFME)?
a) Reduces efficacy
b) Increases immediate efficacy
c) Increases long-term efficacy
d) No effect

Answer 42

c) Increases long-term efficacy
Explanation: The document states that adding DLS to PFME showed improved outcomes at longer follow-up (90 days), but not immediately after training.
Memory Tool: Think of DLS as “Delayed Lift in Success,” emphasizing its long-term benefits when added to PFME.

Question 43

Which of the following statements is true regarding the Single-Incision Sling (SIS) compared to the standard Mid-Urethral Sling (MUS)?
A. SIS has significantly better outcomes than MUS in all aspects.
B. SIS has reduced intraoperative blood loss and operative time compared to MUS.
C. SIS has a higher rate of objective cure rates compared to MUS.
D. SIS has a higher rate of adverse events compared to MUS.

Answer 43

B. SIS has reduced intraoperative blood loss and operative time compared to MUS.

Explanation: According to the material, Kim et al. reported that SIS has reduced intraoperative blood loss, operative time, immediate postoperative pain, and voiding dysfunction when compared to MUS.

Memory Aid: Think of SIS as the “Speedy In-and-out Sling” to remember that it has reduced intraoperative time and blood loss compared to MUS.

Question 44

How do the subjective cure rates between SIS and standard MUS (SMUS) compare?
A. Subjective cure rates are higher in SIS.
B. Subjective cure rates are lower in SIS.
C. Subjective cure rates are similar between the two.
D. There is no data available to compare subjective cure rates.

Answer 44

C. Subjective cure rates are similar between the two.

Explanation: According to the material, subjective cure rates between SIS and SMUS are identified as similar in long-term data.

Memory Aid: Think of “SIS” and “SMUS” as siblings—they’re “Subjectively Similar.”

Question 45

Which treatment option showed significantly higher sexual function scores?
A. Standard MUS (SMUS)
B. Transobturator MUS (TMUS)
C. Single-Incision Sling (SIS)
D. Retropubic MUS (RMUS)

Answer 45

C. Single-Incision Sling (SIS)

Explanation: The material indicates that a meta-analysis of 5 trials using the PISQ-12 found significantly higher sexual function scores in the SIS group.

Memory Aid: Imagine “SIS” standing for “Sexual Intimacy Soars” to remember that SIS has higher sexual function scores.

Question 46

What is the success rate of autologous fascia pubovaginal sling (PVS) according to single-center studies?
A. 50-60%
B. 70-80%
C. 87-92%
D. 95-100%

Answer 46

C. 87-92%

Explanation: According to the material, single-center studies have confirmed between 87% and 92% success with 3- to 15-year follow-up for autologous fascia PVS.

Memory Aid: Think of PVS as “Pretty Very Successful” to remember the 87-92% success rate.

Question 47

Which of the following adverse events has the highest occurrence rate after a SIS procedure according to the material?

A) Recurrent UTI
B) Urinary Retention
C) Sling Failure
D) De novo Urgency

Answer 47

A) Recurrent UTI

Explanation:
The material mentions that complications after SIS procedures include recurrent UTI (5.3%), UTI (4.8%), urinary retention (4.3%), among others. The highest percentage is for recurrent UTI.

Memory Tool:
Think of UTIs as “Unwanted Troublesome Incidents” that show up more frequently after SIS procedures.

Question 48

In a well-conducted RCT, the SISTEr trial compared autologous fascia PVS with Burch colposuspension. What was the outcome?

A) Burch colposuspension had higher success rates.
B) Autologous fascia PVS had higher success rates.
C) Both had equivalent success rates.
D) The trial did not provide conclusive results.

Answer 48

In a well-conducted RCT, the SISTEr trial compared autologous fascia PVS with Burch colposuspension. What was the outcome?

A) Burch colposuspension had higher success rates.
B) Autologous fascia PVS had higher success rates.
C) Both had equivalent success rates.
D) The trial did not provide conclusive results.

Question 49

Question 4: Role of Bulking Agents
What is the main advantage of using bulking agents for the treatment of Stress Urinary Incontinence (SUI)?

A) Permanent cure for SUI
B) No risk of complications
C) Less invasive than sling surgery
D) No need for repeat injections

Answer 49

) Less invasive than sling surgery

Explanation:
According to the material, bulking agents are considered for patients who wish to avoid more invasive surgical management. However, they often require repeat injections and are not a permanent cure. ) Less invasive than sling surgery

Explanation:
According to the material, bulking agents are considered for patients who wish to avoid more invasive surgical management. However, they often require repeat injections and are not a permanent cure.

Question 50

Under which of the following conditions should a synthetic midurethral sling NOT be placed?

A) High BMI
B) Diabetes
C) Urethra inadvertently injured during planned surgery
D) Geriatric age

Answer 50

C) Urethra inadvertently injured during planned surgery

Explanation:
The material mentions that if the urethra is inadvertently injured during a planned midurethral sling procedure, a synthetic sling should NOT be placed due to the risks of mesh erosion.

Memory Tool:
Think of the urethra as a “sensitive garden path.” If it’s damaged, you don’t put “synthetic turf” (mesh) on it due to risks.

Question 51

Which of the following is TRUE regarding geriatric patients (defined as 65 years or older) undergoing incontinence surgery?

A) They have a higher likelihood of successful clinical outcomes compared to younger patients.
B) There is a clear association between age and mesh erosion.
C) They are at lower likelihood of successful clinical outcomes compared to younger patients.
D) They have increased risk of voiding dysfunction compared to younger patients.

Answer 51

C) They are at lower likelihood of successful clinical outcomes compared to younger patients.

Explanation:
According to the material, geriatric patients undergoing incontinence surgery should be counseled that they are at a lower likelihood of successful clinical outcomes compared to younger patients.

Memory Tool:
Imagine geriatric patients as “wise but weary warriors.” They’ve seen many battles (years), but that makes winning new ones (successful clinical outcomes) more challenging.

Question 52

In patients with SUI and a fixed, immobile urethra, which of the following treatments is NOT recommended?

A) Pubovaginal slings
B) Retropubic midurethral slings
C) Urethral bulking agents
D) Transobturator midurethral slings (TMUS)

Answer 52

D) Transobturator midurethral slings (TMUS)

Explanation:
The material suggests that RMUS or PVS may be preferred options in the case of a minimally mobile or non-mobile urethra, and does not mention TMUS as a recommended option.

Memory Tool:
Think of TMUS as the “Troublesome Mate” who doesn’t get along well with the immobile urethra.

Question 53

Which of the following is TRUE regarding patients planning to bear children and the use of synthetic midurethral slings for SUI?

A) Should proceed with MUS regardless of pregnancy plans
B) Should postpone MUS until child-bearing is complete
C) MUS increases the risk of complications during childbirth
D) Pregnancy has no effect on the efficacy of MUS

Answer 53

B) Should postpone MUS until child-bearing is complete

Explanation:
The material suggests that in most instances, surgical treatment of SUI should be deferred until after child-bearing is complete.

Memory Tool:
Consider MUS as a “Marathon U Should” postpone if a “baby marathon” (pregnancy) is in the near future.

Question 54

What is the main consideration for diabetic women planning to undergo sling surgery for SUI?

A) Increased risk of mesh erosion
B) Improved effectiveness compared to non-diabetic counterparts
C) No impact on outcomes
D) Reduced operative time

Answer 54

A) Increased risk of mesh erosion

Explanation:
Diabetic women should be counseled regarding their higher risk for mesh erosion and reduced effectiveness compared to their non-diabetic counterparts.

Memory Tool:
Think of diabetes as “Mesh’s Sugar Enemy.” Sugar levels in diabetes can erode the effectiveness of mesh.

Question 55

What is TRUE regarding obese patients (BMI > 30) and the clinical effectiveness of slings in SUI?

A) No impact on outcomes
B) Better clinical effectiveness than in those with lower BMI
C) Worse clinical effectiveness than in those with lower BMI
D) Increased risk of mesh erosion

Answer 55

C) Worse clinical effectiveness than in those with lower BMI

Explanation:
The material states that there appears to be a slight correlation suggesting worse clinical effectiveness of slings in obese patients compared to those with lower BMI.

Memory Tool:
Imagine BMI as “Big Mesh Issues,” where the effectiveness of the mesh is compromised in bigger bodies.

Question 56

In geriatric patients (defined as 65 years or older) undergoing incontinence surgery, what should they be counseled about?

A) Higher likelihood of successful clinical outcomes
B) No association between age and mesh erosion
C) Greater risk of mesh erosion
D) Better outcomes with retropubic midurethral slings (RMUS)

Answer 56

B) No association between age and mesh erosion

Explanation:
The material states that no clear association is noted between age and mesh erosion in patients undergoing MUS surgery.

Memory Tool:
Think of geriatric patients as “Ageless Mesh Warriors.” Their age doesn’t make them more prone to mesh erosion.

Question 57

What should be considered when treating patients with SUI and concomitant neurologic disease affecting lower urinary tract function?

A) Bulking agents are contraindicated
B) A detailed evaluation should be performed
C) Synthetic slings are preferred
D) SUI is unrelated to neurologic disease

Answer 57

B) A detailed evaluation should be performed

Explanation:
Patients with neurogenic lower urinary tract dysfunction should undergo a detailed evaluation as they do not fall into the category of an index patient.

Memory Tool:
Think of neurologic disease as “The Plot Twist” in an SUI case that requires a more detailed script (evaluation).

Question 58

What is the main consideration for patients at risk for poor wound healing (e.g., following radiation therapy) when undergoing stress incontinence surgery?

A) No special consideration needed
B) Alternatives to synthetic mesh should be considered
C) Synthetic mesh is preferred
D) Only bulking agents should be used

Answer 58

B) Alternatives to synthetic mesh should be considered

Explanation:
Patients with poor tissue characteristics are at increased risk for complications following synthetic mesh placement. Alternatives to synthetic mesh should be considered.

Memory Tool:
Imagine poor wound healing as a “Weak Link in the Chain,” where synthetic mesh might be the straw that breaks the camel’s back.

Question 59

What is an important consideration when deciding to perform a concomitant anti-incontinence procedure at the time of prolapse surgery?

A) Always perform an anti-incontinence procedure
B) Never perform an anti-incontinence procedure
C) Informed patient decision-making is critical
D) Only synthetic midurethral slings should be used

Answer 59

C) Informed patient decision-making is critical

Explanation:
The decision on whether or not to perform a concomitant anti-incontinence procedure should be a product of a shared decision-making process between the clinician and patient.

Memory Tool:
Think of this as a “Two-for-One Deal” that needs both the customer’s (patient’s) and the store manager’s (clinician’s) agreement.

Question 60

What is the main recommendation for women planning to bear children and considering sling surgery for SUI?

A) They can proceed with sling surgery
B) Sling surgery should be postponed until child-bearing is complete
C) Bulking agents are the only suitable option
D) Autologous fascia slings are recommended

Answer 60

B) Sling surgery should be postponed until child-bearing is complete

Explanation:
The material suggests that in most instances, surgical treatment of SUI should be deferred until after child-bearing is complete.

Memory Tool:
Consider MUS as a “Marathon U Should” postpone if a “baby marathon” (pregnancy) is in the near future.

Question 61

In severe outlet dysfunction or recurrent SUI after surgery, what surgical option may clinicians offer?
A. Insertion of a Foley catheter
B. Placement of an obstructing pubovaginal sling or bladder neck closure
C. Laparoscopic bladder repair
D. Use of synthetic slings

What should be avoided in these severe cases?
A. Traditional pubovaginal slings
B. Catheterizable stoma
C. Synthetic slings
D. AUS implantation

Answer 61

B. Placement of an obstructing pubovaginal sling or bladder neck closure
Explanation: The paragraph states that clinicians may offer the placement of an obstructing pubovaginal sling or bladder neck closure for patients with severe outlet dysfunction or recurrent SUI after surgery.
Memory Tool: Think “B” for “Bladder neck” to remember that option B is the correct choice.

C. Synthetic slings
Explanation: Synthetic slings should be avoided in severe cases because they may require a degree of tension that is not advisable.
Memory Tool: “C” for “Can’t use synthetic”, synthetic slings are not recommended for severe cases.

Question 62

What should be assessed in patients in the early postoperative period?
A. Voiding problems, pain, and other unanticipated events
B. Blood pressure and heart rate
C. Weight and BMI
D. Blood sugar levels

Question 4: What mode of communication is NOT excluded for these assessments?
A. In-person visits
B. Email communication
C. Phone discussion or telemedicine
D. Social media chat

Answer 62

A. Voiding problems, pain, and other unanticipated events
Explanation: Clinicians should communicate with patients in the early postoperative period to assess if they are experiencing any voiding problems, pain, or other unanticipated events.
Memory Tool: Think of “A” as “All the symptoms” that could be alarming postoperatively.

C. Phone discussion or telemedicine
Explanation: The paragraph states that there’s no evidence suggesting phone discussions or telemedicine can’t provide the same postoperative information as in-person visits.
Memory Tool: “C” for “Call or Click” to remember that phone or telemedicine are acceptable.

Question 63

Clinical Vignette 3:
You have a 50-year-old female patient who is about to undergo surgery for SUI. During the preoperative evaluation, poor quality bladder contraction is identified on urodynamic evaluation. What preoperative teaching should be considered?

Question 7:
A. How to control dietary habits
B. Instruction on clean intermittent catheterization (CIC)
C. Proper medication management
D. Blood sugar monitoring

Answer 63

B. Instruction on clean intermittent catheterization (CIC)
Explanation: If there is preoperative concern related to postoperative voiding dysfunction, like poor quality bladder contraction, CIC instruction should be considered as a component of preoperative teaching.
Memory Tool: Think “B” for “Bladder contraction concern” to remember that CIC instruction is vital.

Question 64

Clinical Vignette 4:
It’s been 3 months since the 50-year-old female patient underwent SUI surgery. What should be assessed during this postoperative period?

Question 8:
A. The patient’s weight and diet
B. Blood pressure and cholesterol levels
C. Resolution of SUI, need for pads, ease of voiding, and other urinary symptoms
D. Blood sugar levels and medication review

Answer 64

C. Resolution of SUI, need for pads, ease of voiding, and other urinary symptoms
Explanation: The postoperative period should include an assessment related to the resolution of SUI, the need for pads, ease of voiding, and other pertinent lower urinary tract symptoms.
Memory Tool: Think “C” for “Continence and Comfort” to remember what to assess postoperatively.

Question 65

A 60-year-old woman comes in for her six-month postoperative visit after undergoing SUI surgery. What specific physical exams should be performed?

Question 9:
A. Blood pressure and heart rate measurement
B. An examination of all surgical incision sites
C. Lung auscultation
D. Abdominal palpation

Answer 65

B. An examination of all surgical incision sites
Explanation: Six months postoperatively, a physical exam should include an examination of all surgical incision sites to evaluate healing, tenderness, and any other potential abnormalities.
Memory Tool: Think “B” for “Better check those incisions, Babe” to remember what to focus on during the physical exam.

Question 66

Clinical Vignette 6:
During the same six-month postoperative visit, the patient mentions that she has been experiencing pain during intercourse. What should be assessed explicitly?

Question 10:
A. Blood pressure and cholesterol levels
B. New onset surgical site or pelvic pain and dyspareunia
C. Blood sugar levels
D. Weight and diet

Answer 66

B. New onset surgical site or pelvic pain and dyspareunia
Explanation: During the six-month postoperative visit, new onset surgical site or pelvic pain and dyspareunia should be explicitly queried.
Memory Tool: “B” for “Bedroom issues” to remember to ask about dyspareunia.

Question 67

Clinical Vignette 7:
A 55-year-old woman with persistent SUI despite first-line therapy is considering an artificial urinary sphincter (AUS). What should you counsel her about the success rates?

Question 11:
A. The mean complete continence rate is around 30%.
B. The mean complete continence rate is around 80%.
C. The mean complete continence rate is unknown.
D. The mean complete continence rate is around 50%.

Answer 67

B. The mean complete continence rate is around 80%.
Explanation: A meta-analysis found that the mean complete continence rate at a mean follow-up of 22 months was 80%.
Memory Tool: “B” for “Better odds” to remember that AUS has an 80% complete continence rate.

Question 68

B. The mean complete continence rate is around 80%.
Explanation: A meta-analysis found that the mean complete continence rate at a mean follow-up of 22 months was 80%.
Memory Tool: “B” for “Better odds” to remember that AUS has an 80% complete continence rate.

Answer 68

B. Mechanical complications occur at a mean rate of 13%.
Explanation: According to the meta-analysis, mechanical complications have a mean occurrence rate of 13%.
Memory Tool: Think “B” as in “Baker’s dozen,” which is 13, to remember the rate of mechanical complications.

Question 69

You are consulting with a 65-year-old female patient who has severe outlet dysfunction and recurrent stress urinary incontinence (SUI) after a failed surgery. What is one option you may consider for her?

Question 13:
A. A traditional autologous pubovaginal sling
B. A synthetic sling
C. A Foley catheter
D. A bladder pacemaker

Answer 69

A. A traditional autologous pubovaginal sling
Explanation: For patients with severe outlet dysfunction or recurrent SUI after surgical failure, a traditional autologous pubovaginal sling is an option.
Memory Tool: “A” for “Autologous” as in traditional autologous pubovaginal sling.

Question 70

You are planning a three-week postoperative follow-up with a 40-year-old female patient who recently underwent a mid-urethral sling (MUS) operation. Which mode of follow-up has been shown to have no difference in satisfaction, unplanned events, or complications compared to office-based follow-ups?

Question 14:
A. In-person visits
B. Telemedicine
C. Email communication
D. Social media chat

Answer 70

B. Telemedicine
Explanation: Recent studies suggest that telemedicine follow-up has no difference in satisfaction, unplanned events, or complications compared to office-based follow-ups.
Memory Tool: “B” for “Be remote”, indicating that telemedicine is an effective option.

Question 71

A 55-year-old female patient comes in for a six-month follow-up visit after her SUI surgery. What standardized questionnaire may be considered to assess her satisfaction?

Question 15:
A. ICIQ-UI SF
B. PGI-I
C. MMSE
D. GAD-7

Answer 71

B. PGI-I
Explanation: The PGI-I is an easy-to-use and responsive form that correlates well with other outcomes questionnaires and can be used to assess patient satisfaction.
Memory Tool: “B” for “Better ask PGI-I” to assess patient satisfaction.

Question 72

During the same six-month postoperative visit, the 55-year-old female patient asks you what should be assessed regarding her urinary symptoms. What would you include in your assessment?

Question 16:
A. Blood pressure and cholesterol levels
B. Ease of voiding and force of the urinary stream
C. Weight and diet
D. Medication review

Answer 72

B. Ease of voiding and force of the urinary stream
Explanation: Ease of voiding and force of the urinary stream should be assessed in addition to other urinary symptoms.
Memory Tool: “B” for “Bathroom basics” to remember to assess ease of voiding and force of the urinary stream.

Question 73

Question 1: Introduction to Stress Urinary Incontinence (SUI)
Topic: Prevalence of Surgical Procedures for SUI

Clinical Vignette: A 45-year-old woman comes to your clinic with a history of stress urinary incontinence. She is curious about the lifetime risk of undergoing surgical treatment for her condition.

Multiple Choice Options:

A. 5%
B. 14%
C. 25%
D. 40%

Answer 73

Correct Answer: B. 14%

Explanation: The lifetime risk of undergoing a surgical procedure for SUI is approximately 14%.

Memory Tool: Think of “Valentine’s Day” as the day to remember the 14% risk of undergoing surgery for SUI.

Reference Citation: Paragraph 1

Rationale: Understanding the likelihood of undergoing surgical intervention helps in counseling patients about the condition’s natural history and treatment options.

Question 74

Question 2: Evaluation of Patient with SUI
Topic: Diagnostic Tests in SUI

Clinical Vignette: A 50-year-old woman presents with complaints of involuntary urine loss when she sneezes. What is the least essential diagnostic test for her condition?

Multiple Choice Options:

A. History
B. Physical Examination
C. Questionnaires
D. PVR (Post-Void Residual)

Answer 74

Correct Answer: C. Questionnaires

Explanation: Questionnaires are considered nonessential for the diagnosis of SUI and may be performed at the clinician’s discretion. History and physical examination are the most important.

Memory Tool: “H & P are VIP, Q is optional.”

Reference Citation: Paragraph 6

Rationale: Recognizing the essential diagnostic methods for SUI is crucial for efficient patient management.

Question 75

Question 3: Treatment Options for SUI
Topic: Surgical Treatment Options

Clinical Vignette: A 55-year-old woman with a long history of stress urinary incontinence is interested in surgical options. What is NOT a recommended surgical option according to the AUA/SUFU Guidelines?

Multiple Choice Options:

A. Mid urethral sling (synthetic)
B. Autologous fascia pubovaginal sling
C. Burch colposuspension
D. Autologous stem cell therapy

Answer 75

Correct Answer: D. Autologous stem cell therapy

Explanation: The AUA/SUFU Guidelines do not currently recommend autologous stem cell therapy for SUI.

Memory Tool: “Stem Cells Stay Out (SCSO) for SUI.”

Reference Citation: Paragraph 25

Rationale: Knowing what treatments are not recommended is essential for providing evidence-based care.

Question 76

Question 4: Patient Counseling Prior to Surgery
Topic: Risks Associated with SUI Surgery

Clinical Vignette: What risk should all patients be counseled about before undergoing any surgical correction for SUI?

Multiple Choice Options:

A. Osteoporosis
B. Urinary Retention
C. Hypertension
D. Diabetes Mellitus

Answer 76

Correct Answer: B. Urinary Retention

Explanation: Patients should be counseled about the risk of urinary retention after any surgical correction for SUI.

Memory Tool: “Before the URinary Surgery, talk about URinary Retention (UR-UR).”

Reference Citation: Paragraph 32

Rationale: Proper preoperative counseling is key to informed decision-making and setting appropriate expectations for outcomes.

Question 77

Question 5: Mesh Updates and Position Statements
Topic: FDA’s Stance on Mesh for SUI

Clinical Vignette: A 60-year-old woman read about FDA’s concerns about transvaginal mesh and is concerned. What is the FDA’s current stance on the use of mesh mid urethral slings for SUI?

Multiple Choice Options:

A. Strongly discouraged
B. No opinion
C. Supported
D. Pending review

Answer 77

Correct Answer: C. Supported

Explanation: The FDA supports the use of mesh MUS for SUI, distinguishing it from the mesh used for pelvic organ prolapse.

Memory Tool: “FDA Says Okay for SUI Mesh, NOT for POP Mesh.”

Reference Citation: Paragraph 43

Rationale: Understanding current guidelines and regulatory stances is crucial for patient counseling and legal protection.

Question 78

Question 6: Evaluation of the Patient with SUI
Topic: Role of Urodynamics in Index Patients

Clinical Vignette: A 48-year-old woman with stress-predominant mixed urinary incontinence (MUI) comes to your clinic. Her history and physical exam are consistent with SUI. What is the role of urodynamics in this index patient?

Multiple Choice Options:

A. Always necessary
B. Never necessary
C. Optional, if other tests are inconclusive
D. Necessary only if she has a UTI

Answer 78

Correct Answer: B. Never necessary

Explanation: If an index patient has both a history and physical examination that are consistent with SUI or stress-predominant MUI, it is acceptable to proceed with discussion of treatment options without additional testing.

Memory Tool: “Index implies No-Dynamics needed for SUI.”

Reference Citation: Paragraph 11

Rationale: Recognizing when urodynamics is not necessary avoids unnecessary tests and speeds up the treatment process.

Question 79

Question 7: Special Patient Populations
Topic: Elderly Patients with SUI

Clinical Vignette: An 80-year-old woman presents with SUI symptoms. How does her age affect the diagnostic approach?

Multiple Choice Options:

A. No change in approach
B. More likely to perform advanced testing
C. Less likely to perform advanced testing
D. Proceed directly to surgery without any testing

Answer 79

Correct Answer: B. More likely to perform advanced testing

Explanation: Elderly patients are generally more complicated than their younger counterparts, and urodynamics often reveals conditions that alter treatment plans or counseling.

Memory Tool: “Elderly = Extra Testing.”

Reference Citation: Paragraph 14

Rationale: Tailoring the diagnostic approach to special populations like the elderly can optimize patient outcomes.

Question 80

Question 8: Treatment Options for SUI
Topic: Non-Surgical Options for SUI

Clinical Vignette: A 40-year-old woman prefers to avoid surgery for her SUI. Which of the following is NOT a non-surgical treatment option?

Multiple Choice Options:

A. Pelvic floor muscle exercises
B. Incontinence pessary
C. Poise Impressa®
D. Botox injections

Answer 80

Correct Answer: D. Botox injections

Explanation: Botox injections are not listed as a non-surgical treatment option for SUI according to the AUA/SUFU Guidelines.

Memory Tool: “Botox is a No-Go for Non-Surgical SUI.”

Reference Citation: Paragraph 24

Rationale: Knowing what non-surgical options are available can help in counseling patients who prefer to avoid surgical intervention.

Question 81

Question 9: Patient Counseling Prior to Surgery
Topic: Unique Risks of Mesh

Clinical Vignette: A 55-year-old woman is considering a mesh mid urethral sling for her SUI. What unique risk must you counsel her on?

Multiple Choice Options:

A. Erosion
B. Diabetes
C. Osteoporosis
D. Cancer

Answer 81

Correct Answer: A. Erosion

Explanation: Patients should be informed about the unique risks of mesh, such as erosion, exposure, and pain.

Memory Tool: “Mesh = Mind the Erosion.”

Reference Citation: Paragraph 34

Rationale: Unique risks associated with specific surgical materials must be discussed to ensure fully informed patient consent.

Question 82

Question 10: When to Avoid Synthetic MUS
Topic: Contraindications for Synthetic MUS

Clinical Vignette: A 60-year-old woman has a history of pelvic radiation and wants to undergo surgery for her SUI. Is synthetic MUS recommended?

Multiple Choice Options:

A. Yes, it’s safe.
B. No, it should be avoided.
C. Yes, but with caution.
D. Requires further testing.

Answer 82

Correct Answer: B. No, it should be avoided.

Explanation: In women with a risk of poor tissue healing, such as a history of pelvic radiation, synthetic MUS should be avoided.

Memory Tool: “Radiation = No Synthetic Relation.”

Reference Citation: Paragraph 59

Rationale: Being aware of contraindications for specific treatments helps in making an evidence-based decision for patient care.

Question 83

Question 11: Obesity and SUI
Topic: Impact of Obesity on SUI Treatment

Clinical Vignette: A 45-year-old obese woman wants surgical treatment for her SUI. What should you counsel her regarding the impact of her weight on treatment outcomes?

Multiple Choice Options:

A. Obesity has no impact on treatment outcomes.
B. Obesity improves treatment outcomes.
C. Obesity worsens both subjective and objective cure rates.
D. Obesity only affects subjective cure rates.

Answer 83

Correct Answer: C. Obesity worsens both subjective and objective cure rates.

Explanation: Obesity results in lower subjective and objective cure rates at both 1 and 5 years of follow-up, regardless of the surgical approach.

Memory Tool: “Obesity Obstructs Outcomes.”

Reference Citation: Paragraph 66

Rationale: Understanding how obesity affects treatment outcomes allows for better patient counseling and tailored treatment plans.

Question 84

Question 12: Special Cases - Pelvic Organ Prolapse
Topic: SUI After Prolapse Reduction

Clinical Vignette: A 50-year-old woman with pelvic organ prolapse but no SUI is considering surgery. What should she be counseled about regarding SUI?

Multiple Choice Options:

A. SUI will definitely improve.
B. SUI may worsen after prolapse reduction.
C. SUI is not related to prolapse.
D. SUI will definitely worsen.

Answer 84

Correct Answer: B. SUI may worsen after prolapse reduction.

Explanation: For patients with prolapse but no or minimal SUI, they should be counseled that SUI may worsen after prolapse reduction.

Memory Tool: “Prolapse Pushes, SUI Surfaces.”

Reference Citation: Paragraph 70

Rationale: Understanding the relationship between pelvic organ prolapse and SUI allows for comprehensive patient counseling.

Question 85

Question 13: Outcomes Assessment
Topic: Postoperative Catheter Management

Clinical Vignette: A woman has undergone surgery for SUI. What factors influence the decision to leave a catheter post-procedure?

Multiple Choice Options:

A. Only surgeon’s preference
B. Type of procedure and concomitant procedures
C. Patient’s age
D. Cost of the catheter

Answer 85

Correct Answer: B. Type of procedure and concomitant procedures

Explanation: The choice to leave a catheter post-procedure depends on the type of procedure, concomitant procedures performed, intraoperative concerns, patient factors, and surgeon preference.

Memory Tool: “Catheter Calls for Comprehensive Consideration.”

Reference Citation: Paragraph 79

Rationale: Knowing the factors that influence postoperative catheter management allows for better postoperative care.

Question 86

Question 14: Outcomes Assessment
Topic: Postoperative Follow-up Timing

Clinical Vignette: A 60-year-old woman underwent a mid urethral sling procedure for SUI. When should she ideally have her first postoperative visit?

Multiple Choice Options:

A. Within 1 week
B. Within 2 to 4 weeks
C. Within 6 months
D. Within a year

Answer 86

Correct Answer: B. Within 2 to 4 weeks

Explanation: In practice, it is helpful to check a post-void residual at 2 to 4 weeks postoperatively.

Memory Tool: “2 to 4 Weeks to Peek at the Leak.”

Reference Citation: Paragraph 81

Rationale: Timely postoperative assessment allows for early identification and management of potential issues.

Question 87

Question 15: Synthetic MUS Risks
Topic: Counseling on Synthetic MUS

Clinical Vignette: A 55-year-old woman is considering a synthetic mid urethral sling for her SUI. What should she be specifically counseled about?

Multiple Choice Options:

A. Risk of diabetes
B. Risk of cancer
C. Risk of erosion and pain
D. Risk of hypertension

Answer 87

Correct Answer: C. Risk of erosion and pain

Explanation: Patients should be specifically informed about the unique risks of synthetic mesh, such as erosion and pain.

Memory Tool: “Synthetic Sling = Speak of Erosion and Sting.”

Reference Citation: Paragraph 34

Rationale: Accurate counseling on the unique risks associated with synthetic materials ensures that the patient can make an informed decision.

Question 88

Question 16: Fixed/Immobile Urethra
Topic: Treatment Options for Fixed/Immobile Urethra

Clinical Vignette: A 40-year-old woman presents with SUI and has a fixed, immobile urethra. Which treatment option is generally recommended?

Multiple Choice Options:

A. Synthetic MUS
B. Urethral bulking
C. Autologous fascia PVS
D. Observation only

Answer 88

Correct Answer: C. Autologous fascia PVS

Explanation: For patients with a fixed, immobile urethra, an autologous fascia PVS is generally recommended as it has the best overall chance of success for treating SUI.

Memory Tool: “Fixed Urethra? Fascia is the Fix!”

Reference Citation: Paragraph 72

Rationale: Recognizing the best treatment for specific clinical scenarios like a fixed/immobile urethra allows for more effective patient management.

Question 89

Question 17: Mesh Litigation Cases
Topic: Mesh Litigation

Clinical Vignette: You are reading about litigation cases involving mesh slings. What percentage of nearly 74,000 mesh litigation cases involve mid urethral slings alone?

Multiple Choice Options:

A. About one-third
B. About two-thirds
C. About one-fourth
D. About three-fourths

Answer 89

Correct Answer: B. About two-thirds

Explanation: Approximately two-thirds of nearly 74,000 mesh litigation cases involve mid urethral slings alone.

Memory Tool: “Two-thirds of the Trouble comes from Mid Urethral Slings.”

Reference Citation: Paragraph 42

Rationale: Understanding the legal scrutiny surrounding mesh slings helps in better counseling and decision-making.

Question 90

Question 18: Postoperative Retention
Topic: Postoperative Voiding Issues

Clinical Vignette: A patient complains of weak stream and urinary hesitancy after undergoing SUI surgery. What should be your immediate action?

Multiple Choice Options:

A. Wait and observe for natural improvement
B. Teach clean intermittent catheterization or place an indwelling catheter
C. Administer diuretics
D. Advise the patient to consume more fluids

Answer 90

Correct Answer: B. Teach clean intermittent catheterization or place an indwelling catheter

Explanation: Patients with voiding complaints such as weak stream or urinary hesitancy should be seen promptly for catheterization.

Memory Tool: “Hesitant Stream? Immediate Catheter it Seems!”

Reference Citation: Paragraph 84

Rationale: Quick and appropriate action is essential for dealing with postoperative voiding issues to prevent further complications.

Question 91

Question 19: When to Avoid Synthetic MUS
Topic: Contraindications for Synthetic MUS

Clinical Vignette: A woman has a urethral injury during synthetic MUS placement. What should be the immediate action?

Multiple Choice Options:

A. Continue with synthetic MUS placement
B. Repair the urethra and place synthetic MUS
C. Avoid synthetic MUS and consider a non-mesh alternative
D. Cancel the surgery and reschedule

Answer 91

Correct Answer: C. Avoid synthetic MUS and consider a non-mesh alternative

Explanation: Placement of synthetic MUS in the setting of a urethral injury is contraindicated as it places the patient at high risk of mesh erosion.

Memory Tool: “Urethral Hurt? Mesh Must Desert!”

Reference Citation: Paragraph 54

Rationale: Understanding when to avoid certain treatments is crucial for patient safety and optimal outcomes.

Question 92

Question 20: Role of UDS in Elderly Patients
Topic: Urodynamics in Elderly Patients

Clinical Vignette: An 80-year-old woman presents with SUI symptoms. Should urodynamics be considered in her evaluation?

Multiple Choice Options:

A. No, age is irrelevant for UDS
B. Yes, UDS often reveals conditions that alter treatment plans in the elderly
C. No, UDS is never necessary for SUI
D. Yes, UDS should be done for all ages

Answer 92

Correct Answer: B. UDS often reveals conditions that alter treatment plans in the elderly

Explanation: Elderly patients are generally more complicated than their younger counterparts, and UDS often reveals conditions that alter treatment plans.

Memory Tool: “Elderly Eval? UDS Reveals!”

Reference Citation: Paragraph 27

Rationale: Knowing the role of advanced testing in specific patient populations helps tailor diagnostic approaches.

Question 93

Question 21: Obesity and SUI Surgery
Topic: Obesity and Surgical Outcomes

Clinical Vignette: A 45-year-old obese woman desires surgical correction for her SUI. What should you counsel her regarding the surgery outcomes?

Multiple Choice Options:

A. Obesity has no impact on surgical outcomes.
B. Obesity results in higher subjective and objective cure rates.
C. Obesity results in lower subjective and objective cure rates.
D. Obesity improves SUI and surgery is not recommended.

Answer 93

Correct Answer: C. Obesity results in lower subjective and objective cure rates.

Explanation: Obese women should be counseled that obesity results in both lower subjective and objective cure rates following SUI surgery.

Memory Tool: “More Weight, Less Cure Rate!”

Reference Citation: Paragraph 75

Rationale: Understanding the impact of obesity on surgical outcomes is essential for patient counseling and expectation management.

Question 94

Question 22: Weight Loss and SUI Improvement
Topic: Weight Loss and SUI

Clinical Vignette: What average weight loss has been associated with a 15% to 18% improvement in SUI?

Multiple Choice Options:

A. 1-2 kg
B. 3.4-7.7 kg
C. 8-10 kg
D. 15-20 kg

Answer 94

Correct Answer: B. 3.4-7.7 kg

Explanation: An average weight loss of 3.4 to 7.7 kg can lead to a 15% to 18% improvement in SUI.

Memory Tool: “Shed 3-8 kg, Improve SUI by 15-18%!”

Reference Citation: Paragraph 78

Rationale: Weight management as a non-surgical option for SUI is important for comprehensive patient counseling.

Question 95

Question 23: Pelvic Radiation and SUI
Topic: Effects of Pelvic Radiation

Clinical Vignette: A woman with a history of pelvic radiation presents with SUI. What additional test should you consider?

Multiple Choice Options:

A. Q-tip® tests
B. Pad tests
C. Urodynamics
D. None, proceed with surgery

Answer 95

Correct Answer: C. Urodynamics

Explanation: In cases of significant pelvic radiation where the bladder may be affected, UDS should be considered.

Memory Tool: “Radiation Revelation? UDS Investigation!”

Reference Citation: Paragraph 81

Rationale: Special diagnostic considerations are needed for patients with complicating medical histories like pelvic radiation.

Question 96

Question 24: Postoperative Follow-Up Timing
Topic: Postoperative Assessment

Clinical Vignette: How soon should a patient ideally be seen for assessment following SUI surgery?

Multiple Choice Options:

A. Within 1 week
B. Within 6 months
C. Within 1 year
D. As needed based on symptoms

Answer 96

Correct Answer: B. Within 6 months

Explanation: According to the AUA/SUFU Guideline, patients should be seen and examined within 6 months of their surgical procedure.

Memory Tool: “Six Months for Surgery Check!”

Reference Citation: Paragraph 84

Rationale: Knowing the recommended follow-up timing ensures proper postoperative care and monitoring.

Question 97

Question 25: Treatment for High Stage POP
Topic: Pelvic Organ Prolapse and SUI

Clinical Vignette: A patient with high stage POP wants treatment for potential SUI. What testing could be considered in lieu of formal UDS?

Multiple Choice Options:

A. Simple cystometrics
B. Q-tip® tests
C. Pad tests
D. No testing required

Answer 97

Correct Answer: A. Simple cystometrics

Explanation: For high stage POP, simple cystometrics or a pessary test can be considered in lieu of formal UDS testing.

Memory Tool: “High Stage POP? Simple Cysto’s on Top!”

Reference Citation: Paragraph 70

Rationale: Tailoring diagnostic tests for special patient populations helps in better management.

Question 98

Question 26: Treatment for Elderly Patients with SUI
Topic: Elderly Patients and SUI

Clinical Vignette: You are treating an 80-year-old woman for SUI. What diagnostic consideration is particularly relevant for this patient population?

Multiple Choice Options:

A. Urodynamics are generally not needed.
B. Advanced testing like UDS is more likely to be performed.
C. Age is not a factor in diagnostic considerations.
D. Always proceed with surgery without any testing.

Answer 98

Correct Answer: B. Advanced testing like UDS is more likely to be performed.

Explanation: Elderly patients are generally more complicated and UDS often reveals conditions that alter treatment plans or counseling.

Memory Tool: “80s require UDS to AID!”

Reference Citation: Paragraph 31

Rationale: Understanding the special considerations for elderly patients helps in better diagnosis and treatment planning.

Question 99

Question 27: Choice of Anti-incontinence Procedure with Sacrocolpopexy
Topic: Anti-incontinence Procedure Choice

Clinical Vignette: A patient is undergoing sacrocolpopexy for POP. What anti-incontinence procedure has shown higher rates of stress-specific continence when performed concurrently?

Multiple Choice Options:

A. Burch colposuspension
B. Autologous fascia PVS
C. Synthetic MUS
D. Urethral bulking agents

Answer 99

Correct Answer: C. Synthetic MUS

Explanation: Compared to Burch, synthetic MUS had a higher rate of stress-specific continence when performed concurrently with sacrocolpopexy.

Memory Tool: “Sac & Syn for the Win!”

Reference Citation: Paragraph 73

Rationale: Selecting the most effective anti-incontinence procedure when POP is also being treated is crucial for comprehensive care.

Question 100

Question 1: Stress Urinary Incontinence in Index Patient
Topic: Stress Urinary Incontinence in the Index Patient

Question: A 44-year-old, gravida 2, para 2 woman presents with complaints of worsening urinary incontinence, especially with cough and sneeze. She has normal daytime frequency and nocturia 0–1 time/night. What is the most appropriate next step in her management?

Options:
A) Perform Urodynamic Studies (UDS)
B) Immediate surgical intervention
C) Antibiotic treatment for suspected UTI
D) Discuss both conservative and surgical options

Answer 100

Correct Answer: D

Explanation: Given that the patient is an index patient (healthy, with straightforward SUI), both conservative and surgical options should be discussed. UDS or cystoscopy are not required in index patients prior to proceeding with surgery.

Memory Tool: “Index” equals “In-Depth Discussion” - In index patients, discuss all options.

Reference Citation: Paragraph 2 (Clinical Case Scenarios)

Rationale: This question emphasizes the importance of patient counseling and understanding guideline recommendations for the index patient, which states that all options, conservative and surgical, should be discussed.

Question 101

Question 2: Management of Bladder Perforation During MUS
Topic: Intraoperative Complications - Bladder Perforation

Question: During placement of a mid-urethral sling (MUS), a right-sided bladder perforation is noted on cystoscopy. What should be the next course of action?

Options:
A) Abort the procedure immediately
B) Remove and replace the trocar, leave catheter postoperatively
C) Administer additional antibiotics
D) Perform open surgical repair of the bladder

Answer 101

Correct Answer: B

Explanation: The correct course of action for bladder perforation during MUS placement is to remove and replace the trocar. A catheter can be left postoperatively for 24 to 72 hours for adequate bladder healing.

Memory Tool: “Bladder Bump? Better Bring (the trocar) Back” - If there’s a bladder perforation, bring the trocar back out and replace it.

Reference Citation: Paragraph 4 (Clinical Case Scenarios)

Rationale: This question tests knowledge on how to manage a common intraoperative complication during MUS placement.

Question 102

Question 3: Management of Urethral Perforation
Topic: Intraoperative Complications - Urethral Perforation

Question: What is the management of urethral perforation during MUS placement?

Options:
A) Proceed with the placement of the MUS
B) Remove the trocar and inspect the urethra
C) Leave a Foley catheter and proceed with MUS
D) Administer additional antibiotics

Answer 102

Correct Answer: B

Explanation: In case of urethral perforation, the trocar should be removed and the urethra inspected. Mesh sling placement should be aborted.

Memory Tool: “Urethral Uh-oh? Undo and Understand” - If there’s urethral perforation, undo the procedure and understand the extent of the injury.

Reference Citation: Paragraph 6 (Clinical Case Scenarios)

Rationale: The question covers a less common but more serious intraoperative complication, emphasizing the need to abort the MUS placement.

Question 103

Question 4: De novo Overactive Bladder
Topic: Postoperative Complications - De novo Overactive Bladder

Question: A patient develops new symptoms of urinary urgency and frequency after successful MUS placement. What is the appropriate management?

Options:
A) Immediate sling revision
B) Reassurance and offer anticholinergics or beta-3 agonist
C) Urgent cystoscopy
D) Administer antibiotics for suspected UTI

Answer 103

Correct Answer: B

Explanation: De novo OAB symptoms are relatively common after MUS placement. These new symptoms will likely resolve within 1 to 3 months and anticholinergics or a beta-3 agonist can be offered in the interim.

Memory Tool: “New OAB? No Obvious Action, But…” - New Overactive Bladder symptoms don’t require immediate action, but medications can be offered.

Reference Citation: Paragraph 12 (Clinical Case Scenarios)

Rationale: This question explores the management of a common postoperative complication after MUS placement.

Question 104

Question 5: Postoperative Urinary Retention
Topic: Postoperative Complications - Urinary Retention

Question: A patient is unable to void with a high residual (>200 ml) in the post-anesthesia care unit after MUS placement. What should be the immediate next step?

Options:
A) Perform an immediate sling revision
B) Replace a Foley catheter and schedule a clinic visit
C) Administer anticholinergics
D) Initiate clean intermittent catheterization immediately

Answer 104

Correct Answer: B

Explanation: In the immediate 1- to 2-week postoperative period, a Foley catheter should be replaced if the patient has complete retention. The patient should be scheduled to return to the clinic for a repeat trial of void.

Memory Tool: “Can’t Pee? Foley’s Free” - If the patient can’t pee postoperatively, a Foley catheter should be reinserted.

Reference Citation: Paragraph 10 (Clinical Case Scenarios)

Rationale: This question covers the important postoperative complication of urinary retention and its immediate management.

Question 105

Question 6: Counseling Points for MUS
Topic: Counseling for Synthetic Mid Urethral Sling (MUS)

Question: Which of the following is NOT a key counseling point for a patient undergoing synthetic mid urethral sling (MUS) placement?

Options:
A) Effectiveness is well-documented at short-, medium-, and long-term follow-up
B) It is the most studied surgical treatment for female SUI
C) Antibiotics are required postoperatively
D) Mesh-specific risks include exposure into the vagina and perforation into the lower urinary tract

Answer 105

Correct Answer: C

Explanation: Antibiotics are not required postoperatively as a key counseling point for MUS placement. Other points like effectiveness, being the most studied, and mesh-specific risks are important to discuss.

Memory Tool: “ABCs of MUS Counseling: A-Effectiveness, B-Best Studied, C-NO Continual Antibiotics”

Reference Citation: Appendix 3 (Clinical Case Scenarios)

Rationale: This question tests the examinee’s knowledge on what information should be included during patient counseling for MUS placement.

Question 106

Question 7: Indications for Urodynamics
Topic: Urodynamics Prior to Surgery

Question: For which of the following patients is urodynamic testing (UDS) indicated prior to surgical intervention?

Options:
A) Index patient with straightforward SUI
B) Patient with suspected neurogenic lower urinary tract dysfunction
C) Patient with Stage 0–2 POP
D) Otherwise healthy patient with no prior surgical interventions for SUI

Answer 106

Correct Answer: B

Explanation: UDS is indicated for patients with known or suspected neurogenic lower urinary tract dysfunction prior to surgical intervention. It’s not required for index patients or those with straightforward SUI.

Memory Tool: “Neuro Needs UroD” - Neurogenic issues need Urodynamic studies.

Reference Citation: Appendix 2 (Clinical Case Scenarios)

Rationale: This question assesses the understanding of specific indications for UDS prior to surgical interventions.

Question 107

Question 8: Recurrent SUI After MUS
Topic: Recurrent SUI Years After MUS

Question: A patient returns 5 years after successful MUS placement, reporting recurrent SUI. What could be offered to her?

Options:
A) Immediate repeat of MUS
B) Urethral bulking, repeat MUS, or autologous PVS
C) Antibiotics for suspected UTI
D) Anticholinergics

Answer 107

Correct Answer: B

Explanation: In patients reporting recurrent SUI years after initial MUS, they can be offered options like urethral bulking, repeat MUS, or autologous PVS.

Memory Tool: “5-Year Flip? Feel Free to Fix or Fill” - 5 years after MUS, you can either fix (repeat MUS) or fill (urethral bulking).

Reference Citation: Paragraph 16 (Clinical Case Scenarios)

Rationale: This question explores long-term failure of MUS and the available options for management.

Question 108

Question 9: Management of De novo Overactive Bladder
Topic: Postoperative Complications - Persistent De novo Overactive Bladder

Question: A patient still has symptoms of overactive bladder a few months after MUS placement. What diagnostic procedures should be considered?

Options:
A) Uroflowmetry and PVR
B) Immediate sling revision
C) Antibiotics for suspected UTI
D) Urethral bulking

Answer 108

Correct Answer: A

Explanation: For patients with persistent de novo OAB symptoms a few months out from surgery, uroflowmetry and post-void residual (PVR) can help assess for obstruction.

Memory Tool: “Persistently Puzzling Pee? PVR Please!” - Persistent overactive bladder symptoms warrant a PVR and uroflowmetry check.

Reference Citation: Paragraph 14 (Clinical Case Scenarios)

Rationale: This question is designed to test the understanding of how to manage persistent de novo OAB symptoms postoperatively.

Question 109

Question 10: Anti-Incontinence Procedures
Topic: Surgical Skill Requirements for Anti-Incontinence Procedures

Question: Which of the following is NOT a requirement for surgeons performing anti-incontinence procedures?

Options:
A) Knowledgeable in pelvic anatomy
B) Ability to manage potential surgical complications
C) Specialization in gynecology
D) Ability to describe potential surgical complications

Answer 109

Correct Answer: C

Explanation: Specialization in gynecology is not a stated requirement for performing anti-incontinence procedures. Surgeons should, however, be knowledgeable in pelvic anatomy and be able to describe and manage potential surgical complications.

Memory Tool: “Anatomy, Ability, Articulation, NOT Area” - Requirements for surgeons include knowledge in anatomy, ability to manage complications, and articulation (describing complications), but not specialization in a specific area like gynecology.

Reference Citation: “DID YOU KNOW?” section (Clinical Case Scenarios)

Rationale: This question addresses the requirements for surgeons performing anti-incontinence procedures, testing the understanding of surgical guidelines.

Question 110

Question 11: Indications for Urodynamics (Complex Cases)
Topic: Urodynamics in Complex Cases

Question: Which of the following is an indication for urodynamic studies (UDS) prior to surgical intervention for stress urinary incontinence?

Options:
A) Simple stress-predominant MUI
B) Low grade POP (stage 0–2)
C) Inability to make a definitive diagnosis by history or symptoms
D) No prior surgical interventions for SUI

Answer 110

Correct Answer: C

Explanation: UDS is indicated when there’s an inability to make a definitive diagnosis by history or symptoms. It’s not routinely required for straightforward cases of SUI or low-grade POP.

Memory Tool: “Confused? Consider UDS” - If the diagnosis is unclear based on history or symptoms, consider UDS.

Reference Citation: Appendix 2 (Clinical Case Scenarios)

Rationale: This question aims to test the understanding of when UDS is indicated in complex or unclear cases.