Pelvic Relaxation and Urogynecology

Question 1

What kind of incontinence increases with age?

Answer 1

Urge incontinence

Question 2

Most common cause of fecal incontinence?

Answer 2

Obstetric trauma

Trauma causes direct damage to anal sphincter or to pudendal nerve… rectal sphincter can be completely lacerated, but as long as the patient retains functional puborectalis sling, a high degree of continence will be maintained.

Anal sphincter weakness may also be caused by other nontraumatic etiologies, such as spinal cord injury.

Question 3

Which of the following factors is least important in the development of POP in 65 yo patient?

a. Chronic cough
b. Chronic constipation
c. Chronic HTN
d. Childbirth trauma
e. Menopause

Answer 3

c. Chronic HTN

Question 4

A 43 yo G2P2 woman is being evaluated for hysterectomy for abnormal uterine bleeding that has not responded to conservative mgmt. She mentions during her evaluation that she has a 2-year hx of leaking urine when she coughs, sneezes, or laughs. She does NOT appreciate a sense of urgency. She has to wear a pad when she leaves the house. She has tried Kegel exercises, but has not had any improvement. PVR is normal. What is the most appropriate surgical procedure to manage this problem?

a. Marshall-Marchetti-Krantz (MMK) procedure
b. Mid-urethral sling
c. Anterior colporrhaphy with Kelly plication
d. Burch retropubic colposuspension
e. Stamey transvaginal needle suspension

Answer 4

b. Mid-urethral sling

= procedure of choice for women undergoing primary surgery for uncomplicated SUI

MMK = type of bladder neck suspension (no longer used)

Stamey = needle urethropexy (no longer used)

Question 5

Suburethral mass

Answer 5

Urethral diverticulum

Question 6

46 yo woman has grade 2 anterior vaginal wall defect (cystocele). Best tx plan?

a. Anticholinergic meds
b. Abx therapy with Bactrim
c. Le Fort colpocleisis
d. Anterior colporrhaphy and mid-urethral sling

Answer 6

d. Anterior colporrhaphy and mid-urethral sling

Question 7

Obese 46 yo G6P1051 with type 1 diabetes since the age of 12 years presents to your office with a chief complaint of urinary incontinence. She has been menopausal since age of 44 years. Her diabetes has been poorly controlled for many years. She often cannot tell when her bladder is full, and she will urinate on herself without warning. Which of the following factors in this patient’s hx has likely contributed the most to the development of her urinary incontinence?

a. Menopause
b. Obesity
c. Obstetric hx
d. Age
e. Suboptimal diabetic control

Answer 7

e. Suboptimal diabetic control

Neuropathy of bladder –> loss of sensation

Question 8

How to assess for vesicovaginal fistula?

Answer 8

Physical exam and in-office dye study