Female SUI Flashcards
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%
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.
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
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.
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
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).
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
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.”
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
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).
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
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.
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
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.
What is the likelihood of having SUI if a woman has a negative clinical history?
A. 16%
B. 34%
C. 50%
D. 73%
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.
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
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.
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%
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.
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%
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.
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
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.
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
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.
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
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.
Which test is most indicative of urethral mobility in women with SUI?
A. Q-tip test
B. Bladder ultrasound
C. Cystoscopy
D. Uroflowmetry
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.
Which of the following is NOT a urethral bulking agent used in the treatment of SUI?
A. Macroplastique
B. Deflux
C. Durasphere
D. Bulkamid
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.
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
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.
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
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.
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
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.
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
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.
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
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).
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
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.
Which complication is NOT associated with surgical intervention for SUI?
A) UTI
B) Dyspareunia
C) Hyperactivity
D) Urinary retention
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.
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
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.
What is a potential storage symptom after SUI surgery?
a. UUI
b. Reduced urine output
c. Dehydration
d. Hyperactivity
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
Which retropubic approach has a higher rate of urinary retention?
a) Bottom-up
b) Top-down
c) Both are equal
d) Data is inconclusive
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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.
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.
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.
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.”