Urogynaecology ( Platinum ) – SBA

1. Mrs. Razanza , 60year old, presented with mass per vagina.On examination she has Grade 3 prolapse on POPQ. After counselling she has decided for vaginal hysterectomy. At the end of hysterectomy, vault descends to introitus. What measure would you take to prevent vault prolapse?

2. What is the commonest pelvic floor dysfunction symptoms found to be quite high after primary pelvic organ prolapse surgery?

3. Mrs. LilLy, 56 year has come with Mass per vagina. She was operated for prolapse 3 years back. After discussing pros and cons, agreed for abdominal sacrocolpopexy.Lily wants to know incidences of sacral myelitis .

4. Mrs. LilLy, 56 year has undergone Sacrospinous fixation 2 days back. She has come with severe buttock pain. You explained to her that this is one of the common complications of procedure. She wants to know how long it takes to get resolved

5. All are true regarding supervised pelvic floor muscle training for the treatment of urinary incontinence except

6. Mrs. Adams, 45 year old, has presented with stressincontinence. It is affecting her quality of life. She wants to try conservative measures. On examination she has poor levator ani tone.

7. Bladder training is the first-line treatment to women with urgency or mixed urinary incontinence. What is the minimum duration it should be offered? 

8. A 65 year old woman presented with incontinence. She is very old and fragile. After exploring all options, she refuses all treatment and chooses absorbent containment products as long-term management of urinary incontinence. How frequently she should be reviewed ?

9. Mrs. Lucy, 45 year old woman, has presented with frequency, dysuria and urgency since 6 weeks.No history of leak during coughing or laughing.This is her first visit to hospital. You offer her bladder diary for initial assessment. She asks for the minimum number of days it needs to be filled. 

10. Mrs.X is 30 year old woman with urgency, frequency and leaking of urine. Urodynamic studies confirm she has overactive bladder. She is otherwise fit and healthy. She has tried bladder training without any benefit. She stopped medicines because of excessive side effects.She was relieved by 100units of Botox A injection which lasted for 4months. Now she has come with recurrence of symptoms. You advise her botulinum toxin type A to 200 units. When should she be reviewed ?

11. A 70-year-old lady has presented with frequency, urgency, troublesome nocturia and leak. She is otherwise without any comorbidities. She was advised to start medicines for her overactive bladder. Which drug is most appropriate for her ?

12. 50 year old lady has presented with frequency, urgency and leak. She is otherwise without any comorbidities . She has tried her bladder training which is of little benefit.She was advised to start oxybutynin for her overactive bladder. When she should be reviewed ?

13. Use of Desmopressin in woman with incontinence in all of the following except

14. Mrs. Rasha, 55-year-old, has come with mass per vagina. On examination with pop q leading edge < –1 cm. After discussing various management options, she wants conservative management. She is sexually active.

15. Mrs. Brown, 58-year-old, presents with mass per vagina. She has undergone vaginal hysterectomy for grade 3 uterovaginal prolapse. On examination – her Total vaginal length is 10cm. On pop q – Leading edge > +1 cm but < + 8.cm. She is not sexually active.

16. Mrs.Singh, 80 year old presented with mass per vagina. She is living alone; she is known hypertensive and diabetic; well controlled. On examination Procidentia is noted. She is looking for definitive management. She is not sexually active

17. Ms. X a 59-year-old woman, P2, is referred with urinary leakage when coughing, sneezing, lifting, bending and changing position and she has had to wear incontinence pads. On examination her BMI is 30 and there is evidence of lower genital tract atrophy; there is no demonstrable stress incontinence. Filling cystometry shows: an early first desire to void at 75 ml; urgency at 140 ml associated with high pressure detrusor contraction, which reached 40 cm/H2 0 and resulted in completed bladder emptying. What is the probable diagnosis?

18. Ms. X had a difficult forceps delivery with multiple labialtears  and a tear involving 50% of the EAS but intact mucosa and IAS. Which grade you will classify her tear?

19. Mrs, Rosy , 53 year old complaining of frequency , urgency , nocturnal and urinary incontinence . She is yoga teacher , she is embarrassed by leaking in certain yoga postures .she is referred by her GP who treated her bladder training and supervised pelvic floor exercises which was of little benefit

Her urodynamic study is enclosed .whats your diagnosis ?

20. Mrs, Adams 70year old complaining of frequency , urgency , nocturnal and urinary incontinence referred by her GP who treated her with bladder training .whcih was not at all effective she didn’t want to start any medications .Her urodynamic chart is enclosed . What’s your diagnosis ?

21. Mrs. Mishra, 67 year old complaining of frequency , urgency , nocturnal and urinary incontinence  referred by her GP who treated her with immediate release oxybutinin

Tablets . She developed side effects and stopped treatment . She is smoker ,smokes  10cigarettes per day Urodynamic  study performed . Drinks glass of wine and 2 cups of coffee every  day , Filling cystometry is enclosed .what’s your diagnosis ?

22. All are true regarding Urinary bladder injury during laparoscopy except

23. The most common type of ureteric injury is

24. The percentage of Ureteric injuries that are not recognised intraoperatively 

25. While performing a vaginal hysterectomy, the most effective way of preventing an enterocele is