Urogynae Flashcards
The muscles of the levator ani complex are the
a. Puborectalis, ischiococcygeus, pubococcygeus
b. Bulbocavernosus, superficial transverse perinei, ischiocavernosus, bulbospongiosus
c. Puborectalis, pubococcygeus, iliococcygeus
d. Pubococcygeus, iliococcygeus, pubovaginalis
c. Puborectalis, pubococcygeus, iliococcygeus
A 50 year old woman presents with an everted vaginal vault 12 years after vaginal hysterectomy. She is sexually active. The PREFERRED treatment would be
a. Control of the prolapse with a pessary
b. Posterior colpoperineorrhaphy
c. Sacrospinous colpopexy or similar procedure
d. Colpocleisis
c. Sacrospinous colpopexy or similar procedure
O
In a nulliparous woman without evidence of prolapse, in the upright anatomical position the normal vaginal axis is
a. Upward and backward at 135 degrees
b. Upward and backward at 230 degrees
c. Upward and backward at 310 degrees
d. Upward and backward at 90 degrees
a. Upward and backward at 135 degrees
O
The lifetime risk of having an operation for genital prolapse is
a. 1 in 5
b. 1 in 9
c. 1 in 20
d. 1 in 35
e. 1 in 100
b. 1 in 9
O
Lifetime risk of requiring an operation for prolapse or incontinence is 11-19%
7% for POP (RANZCOG)
During the performance of a routine abdominal sacrocolpopexy procedure on a woman with a large recurrent enterocele and rectocele, which of the following is MOST CORRECT
a. The most appropriate mesh is a Type 3 polyglactin mesh (multifilament, microporous)
b. The upper end of the mesh should be attached between S1 and S3 at more than one point
c. The procedure should generally include perineorrhaphy
d. The procedure should be supported by a Muscowitz operation
b. The upper end of the mesh should be attached between S1 and S3 at more than one point
O
A low urethral closing pressure is associated with:
a) Grand multiparity
b) External Urethral Sphincter Defect
c) Previous incontinence surgery
d) Poor bladder neck support
b) External Urethral Sphincter Defect
*BUT Actually an internal urethral sphincter defect
?Is answer d) instead
Regarding benefits and risks of the tension free vaginal tape procedure, which of the following statements is correct?
a. The cure rate on 24 hours pad test at 3 years is 94-96%
b. The risk of needing to perform self catheterisation is 0.5-1%
c. The risk of overactive bladder postoperatively is 12-15%
d. The vaginal erosion rate within 3 years is 10-11%
b. The risk of needing to perform self catheterisation is 0.5-1%
O
No difference in de novo OAB - 10%
Cure rate is 85%
Erosion risk 7%
In Australia the MOST COMMON cause of vesicovaginal fistula is
A. Anterior colporrhaphy
B. Radiation
C. Vaginal hysterectomy
D. Abdominal hysterectomy
D. Abdominal hysterectomy
A 50 year old woman presents with an everted vagina 12 years after vaginal hysterectomy. She is sexually active. The PREFERRED treatment would be
A. control of prolapse with Protex pessary
B. posterior colpoperineorrhaphy
C. sacrospinous colpopexy or similar procedure
D. colpocleisis
C. sacrospinous colpopexy or similar procedure
In a RCT of a new repair technique for rectocoele the most appropriate method for determining the outcome of the procedure is:
A. Sim’s speculum exam by surgeon at 3months
B. Bimanual exam by blinded external observer at 3months
C. Validated pelvic organ prolapse questionnaire assessed by the surgeon at 3months
D. POPQ score by blinded external observer at 3months
D. POPQ score by blinded external observer at 3months
O
Which drug exacerbates stress incontinence?
a. Hydralazine
b. Enalapril
c. Propranolol
d. Warfarin
b. Enalapril
ACE-I so cough is a side effect
What is not a cause of urinary retention and overflow incontinence?
a. Fibroids
b. Pregnancy
c. HSV
d. Cholinergic agents
d. Cholinergic agents
A 60 yo otherwise well woman with symptomatic uterine prolapse. Current treatment advice should be?
a. LAVH
b. Vag hyst
c. Sacrospinous colpopexy
d. HRT
e. Ring pessary
b. Vag hyst
M
The five-year success rate of Burch colposuspension for stress incontinence is:
a. 30%
b. 50%
c. 85%
d. 95%
c. 85%
M
The 5 year success rate of anterior repair for stress incontinence is:
a) 90%
b) 70%
c) 50%
d) 40%
d) 40%
All of the following are appropriate treatments of detrusor instability except:
a) Ileal conduit
b) Sacral nerve desensitisation
c) Permanent IDC
d) Cholinergic agents
e) Hydrodistension of the bladder
d) Cholinergic agents
Use ANTI-cholinergic agents
51 yo woman presents with enterocele 3 yrs after Burch. Cause of this is mainly due to:
a) big babies
b) change in vaginal axis
c) menopause
b) change in vaginal axis
The normal axis of the vagina is almost horizontal. Because the vagina is a tubular structure, pulling up on the anterior vagina also elevates the posterior vagina. This can pull the posterior vagina up out of its normal position, opening the rectouterine pouch of Douglas and thereby predisposing patients to enterocele formation, uterine prolapse and vaginal vault eversion
A 50 yo with stress incontinence and cystourethrocele. Which surgical management is most likely to be effective?
a) Retropubic urethropexy
b) Anterior repair with Kelly sutures
c) Aldridge sling
d) Sacrospinous fixation of periurethral ligaments
a) Retropubic urethropexy
This has the highest success rates of surgical treatment of GSI, with the Burch being treatment of choice. MMK involves placing sutures from the pubocervical fascia directly into the pubic symphysis. Success rates are comparable but advantages of the Burch include correction of
co-existing cystocoele, lack of osteitis pubis and firmer point of fixation
Which of the following are true about vesico-vaginal fistulas?
a) site can be accurately localised with an IVU
b) characteristically appear by day 3 post hysterectomy
c) are usually situated above the trigone of the bladder
d) are common following appropriately repaired crush injuries of the bladder
e) large fistula causes a large urine leak
c) are usually situated above the trigone of the bladder
Mostly occur after TAH, typically day 10 post op. Use tampon test and methylene dye into bladder to diagnose (IVU will diagnose urethral fistula)
Which of the following is not associated with detrusor instability?
a) genitourinary stress incontinence
b) dementia
c) multiple sclerosis
d) interstitial cystitis
e) autonomic neuropathy
a) genitourinary stress incontinence
Urge incontinence is not caused by failure of urethral support or closure, but rather by uninhibited contractions of detrusor muscles
Drugs which worsen stress incontinence, correct option:
a) amiodarone
b) phenoxybenzamine
c) phenylephedrine
d) tolbutamide
b) phenoxybenzamine
Alpha and Beta agonist
What is true of incontinence?
a) 25% of nursing home residents are affected
b) Incontinence is often the trigger for institutionalisation of elderly folk
c) Incontinence is a normal part of ageing
d) Kegel’s exercise will obtain 80% rate of complete cure in older women
e) Estrogen has been proven in RCT to improve GSI
b) Incontinence is often the trigger for institutionalisation of elderly folk
Kegel’s exercise according to Novak’s has been shown to cure 32% of patients with GSI and improve the remaining 68%.
50-60% of nursing home patients have urinary incontinence
Concerning the investigation of urodynamics. Select the incorrect option:
a) GSI does not occur with bladder pressure below 30cm water
b) Urodynamics cannot distinguish between functional and neuropathic detrusor instability
c) In order to calculate detrusor pressure, it is necessary to measure intravaginal or rectal pressure
a) GSI does not occur with bladder pressure below 30cm water
Urethral closing pressure <20cmH20
Sexually active 27 year old has 2/52 hx of urgency and dysuria. Came to casualty, MSU collected and commenced on Cefalexin. There was no growth on the MSU. Her symptoms persist. Next?
a) repeat MSU
b) Quantitative analysis of urine WBC
c) Urethroscopy
d) Chlamydia swabs of urethra and cervix
d) Chlamydia swabs of urethra and cervix
Which of the following is the commonest cause of urinary incontinence?
a) Genito urinary stress incontinence
b) Detrusor instability
c) Detrusor-urethral dysenergia
d) Neurogenic bladder
e) Drug therapy
a) Genito urinary stress incontinence
Post-op Burch colposuspension, patient complains of severe pain in one groin. Cause?
a) Space of Retzius haematoma
b) Ilioinguinal nerve damage
c) Pubic bone trauma
d) UTI
b) Ilioinguinal nerve damage
Space of Retzius: area between the bladder and symphysis pubis
- can get haematomas
But UNILATERAL groin pain more consistent with ilioinguinal nerve injury
A primiparous patient has a normal vaginal birth including 4h continuous lumbar epidural anaesthesia. She was catheterised twice in labour with an in-out catheter. 6 hours after delivery she was unable to void. An indwelling catheter was inserted and drained 1500mLs. The catheter was left in overnight and removed the next day. She voided small amounts during the day, 50-100mL at a time. A second indwelling catheter was inserted and drained 700mL. The cause of the urinary retention was:
a) Urethral spasm
b) Urethral trauma
c) Detrusor failure
d) Parasympathetic blockade caused by the epidural anaesthesia
c) Detrusor failure
A woman had midcavity forceps under epidural for prolonged stage 2. 4 hrs after delivery the bladder was noted to be distended, she voided 200ml of urine and the residual was 700 ml. She was able to void 100-200 ml at each time. 12 hrs later, IDC was inserted and noted residual of 1000ml. Which of the following is correct?
a) urethral dysfunction
b) detrusor dystonia
c) parasympathetic block secondary to epidural
d) probanthine should be started
e) bethenacol 25mg qid
b) detrusor dystonia
