MRCOG Part 2 – Urogynaecology & Pelvic Floor Problems SBAs

In the POP-Q system, what does the point “Aa” represent?

Which of the following is not associated with pelvic organ prolapse?

A 90 year old woman attends her GP following discharge from hospital after her third admission with urinary retention.  On examination, she has a complete procidentia and reports that she has to manually reduce this in order to pass urine.  She has numerous medical comorbidities, including a history of previous pulmonary embolism for which she is on life long warfarin.  What is the most appropriate management?

A 40 year old patient is referred to urogynaecology clinic with significant stress urinary incontinence.  She wishes to discuss surgical options for treatment as she has read about them on the internet.  Which of the following is not a surgical treatment for stress incontinence?

Which of the following is not a symptom of overactive bladder?

Which of the following is not a cause of stress urinary incontinence?

During a urodynamic study, a significant increase in abdominal pressure coinciding with leakage of urine without a rise in detrusor pressure is demonstrated. Which type of incontinence does this finding suggest?

In a urodynamic test, the bladder compliance is noted to be low. Which of the following conditions is most commonly associated with low bladder compliance?

A 48-year-old woman presents with urinary frequency and nocturia. Urodynamic studies show involuntary contractions of the detrusor muscle at low bladder volumes. Which type of urinary dysfunction does this finding suggest?

In the POP-Q system, what does the point “Ap” represent?

During a POP-Q assessment, which value represents the distance from the external urethral meatus to the posterior hymen?

In the POP-Q system, what does the point “C” represent?

During a POP-Q assessment, which measurement is taken to assess perineal body length?

A 65-year-old woman is reviewed as a follow up appointment in Urogynaecology with symptomatic pelvic organ prolapse.  She has tried pelvic floor muscle training and a ring pessary but feels these have not been of benefit. She has a history of chronic constipation and complains of incomplete bowel emptying. On examination, her POP-Q assessment is as follows:

What is the most suitable treatment option for her?

A 65-year-old woman is reviewed as a follow up appointment in Urogynaecology with symptomatic pelvic organ prolapse.  She has tried pelvic floor muscle training and a ring pessary but feels these have not been of benefit. She has a history of chronic constipation and complains of incomplete bowel emptying. On examination, her POP-Q assessment is as follows:

What is the most suitable treatment option for her?

A 45 year old woman presents with urinary incontinence.  She describes leaking on coughing and sneezing, associated with urgency and nocturia where she has to get up 4-5 times per night.  This is affecting her ability to work as a telephone customer service assistant as she finds the urgency very troublesome during her job, despite reducing her caffeine and fluid intake. On examination, she has a normal BMI of 20 and urinanalysis is normal. What is the most appropriate treatment?

Which of the following is not a pharmacological treatment for overactive bladder?

A 59 year old woman undergoes a urodynamic study to evaluate urinary incontinence. The study reveals a high detrusor pressure and a low flow rate during voiding. Which condition is most likely to be associated with this finding?

A 34-year-old woman with relapsing-remitting multiple sclerosis is referred to the urogynaecology clinic with a 6-month history of hesitancy, an interrupted urinary stream and recurrent urinary tract infections. She also reports urgency and occasional urge incontinence. Post-void residual volume on bladder scan is 180 mL. She undergoes video-urodynamics with external urethral sphincter electromyography. During the filling phase, involuntary detrusor contractions are noted. During the voiding phase, a high-amplitude detrusor contraction is recorded (maximum detrusor pressure 95 cmH₂O) accompanied by a low, intermittent flow rate. The sphincter EMG shows increasing electrical activity that coincides with the detrusor contraction rather than falling silent. Fluoroscopy demonstrates a dilated posterior urethra terminating at a closed external sphincter. What is the most likely diagnosis?

A 71-year-old woman presents with a 12 month history of urgency and urge incontinence. She is Para 2 – having had two previous vaginal births and has a history of hypertension for which she takes amlodipine.  Urinalysis is currently negative with a recent mid steam urine sample showing no evidence of infection.  What is the most appropriate next management?

A 70 year old woman is seen in Urogynaecology clinic.  She is known to have Stage 3 uterine prolapse and has unsuccessfully tried vaginal ring pessaries for six months without benefit.  Her BMI is 21 and pelvic ultrasound is normal.  She requests surgical treatment and after counselling, opts to have a vaginal hysterectomy with anterior colporrhaphy.  Which of the following is recommended prior to surgery?

A 60 year old nulliparous woman presents with urinary frequency, nocturia and urgency with occasional leakage of urine on coughing.  She is post-menopausal and has irritable bowel syndrome.  Her BMI is 34 and on examination, she has Stage 1 anterior prolapse but no uterine descent or posterior prolapse.  She had previously tried solifenacin but found the side effects intolerable.  What is the next most appropriate management?

What is the most frequently occurring risk of sacrospinous fixation (SSF)?

A 50 year old woman presents with overactive bladder symptoms, particularly nocturia which is affecting her quality of life significantly. She has no significant past medical or surgical history and does not take any regular medications. She had tried lifestyle modifications including pelvic floor exercises, bladder retraining as well as fluid restriction. She has had a trial of solifenacin for 4 weeks but has had no real resolution of her nocturia.  What is the most appropriate management?

A 70-year-old woman presents with urinary frequency, urgency, nocturia and incontinence. She has reduced her caffeine intake, restricts her fluids in the evening and has had bladder retraining as well as supervised pelvic floor exercises. Whilst there has been some improvement of her symptoms, she still finds them quite troublesome, and they are affecting her quality of live. Her medical history includes glaucoma and hypertension for which she takes latanoprost and amlodipine. What treatment should now be considered?

Which of the following complications is most common after Burch colposuspension?

A 60-year-old post-menopausal woman present with overactive bladder symptoms and she has not noticed significant benefit from bladder retraining.  She has lost 7kg of weight and her BMI is now normal.  She has hypertension which is well controlled with ramipril.  Which of the following should be recommended as first line medical treatment?

A 52-year-old woman undergoes subtracted cystometry for investigation of mixed urinary incontinence. At one point during the filling phase, the intravesical pressure (Pves) is recorded as 45 cmH₂O while the abdominal pressure (Pabd), measured via a rectal catheter, is recorded as 30 cmH₂O. What is the detrusor pressure (Pdet)?

A 55-year-old woman attends for free (non-invasive) uroflowmetry as part of her assessment for voiding symptoms. Before interpreting the maximum flow rate (Qmax) and flow pattern, the clinician notes that the voided volume must reach a minimum threshold for the study to be considered reliable. What is the minimum voided volume generally required for a uroflowmetry result to be interpretable?

A 48 year-old woman is seen in the Urogynaecology clinic with stress urinary incontinence symptoms.  She has had three previous Caesarean sections and has a BMI of 40.  On examination, there is Stage 3 uterine prolapse with poor pelvic floor contraction and leakage on coughing in a supine position. What is the most appropriate first line treatment?

A 44-year-old woman has debilitating urgency, frequency and urgency urinary incontinence that markedly affects her quality of life. She has failed conservative treatment. Conventional multichannel filling cystometry is entirely normal, with no demonstrable detrusor overactivity, despite her reporting typical symptoms during the test. What is the most appropriate next investigation?

A 49-year-old woman with overactive bladder symptoms is being assessed. What is the minimum recommended duration over which she should complete a bladder diary?

A 56-year-old woman attending the urogynaecology clinic is asked to keep a record at home over several days. She is instructed to document the time and volume of every void, each episode of urinary leakage, her fluid intake, episodes of urgency, and pad usage. What is the correct term for this type of chart?

A 61-year-old woman completes a three-day frequency–volume chart. Reviewing the chart, the clinician notes that the largest single voided volume recorded across the three days is 480 mL. Which of the following parameters does this value provides a clinical estimate of?

A 72-year-old woman complains of waking three times each night to pass urine. Her three-day bladder diary shows a 24-hour urine output of 2000 mL, of which 820 mL is produced overnight (including the first morning void). Her maximum voided volume is 350 mL, and her daytime voiding frequency is normal. What is the most likely explanation for her nocturia?