FPMRS

Question 1

Level I support

Answer 1

Support at the vaginal apex where the cardinal–uterosacral ligament complex is attached to the pubocervical and rectovaginal fascial rings and suspends the apex of the vagina

Question 2

Level II support

Answer 2

Midvaginal lateral support where the pubocervical fascia is attached laterally to the arcus tendineus fasciae pelvis

Question 3

Level III support

Answer 3

Support via the distal vaginal attachments to the perineal membrane ventrally and perineal body dorsally

Question 4

Benefit in adding pessary when already doing pelvic PT

Answer 4

None! Next best non-surgical intervention is weight loss

Question 5

Risks of retropubic MUS and their percentage

Answer 5

UTI: most common - 30%
Post-op voiding dysfunction/retention: 3-45%
Bladder perforation - 5%
Hematologic events - <3%

Question 6

What is the next step after post-op vesicovaginal fistula is diagnosed?

Answer 6

Evaluate for concominant ureteral injury (12%) with CT urogram OR bilateral retrograde pyelography

Question 7

How long to monitor post-sling retention before surgical intervention?

Answer 7

2-3w of self-cath with documentation of PVR. If not improving and symptomatic, needs sling lysis to prevent chronic issues like OAB and recurrent UTIs. 1-2% of post-op retention patients will need surgical intervention

Question 8

Woman with stage II+ apical prolapse and no urinary symptoms - what is best surgery?

Answer 8

Abdominal sacrocolpopexy (4% recurrent prolapse vs. 15% for vaginal sacrospinous ligament suspension) WITH Burch colposuspension

Question 9

Next step of patient with symptoms of painful bladder syndrome

Answer 9

1) education, self-care, stress management
2) pelvic floor PT
3) amytryptyline or pentosan polysulphate (coating)

Question 10

UTI med with rare AE of interstitial lung disease

Answer 10

nitrofurantoin

Question 11

what is noctural polyuria

Answer 11

More than 35% of of 24hr UOP at night