Urogynecology — MCQs

Urogynecology Indian Medical PG Practice Questions and MCQs

Question 111: In a case of incontinence of urine, dye filled into the urinary bladder does not stain the pad in the vagina, yet the pad is soaked with clear urine. Most likely diagnosis is:

A. VVF
B. Urethrovaginal fistula
C. Ureterovaginal fistula (Correct Answer)
D. Urinary stress incontinence

Explanation: **Ureterovaginal fistula** - If a **dye-filled bladder** does not stain the vaginal pad but clear urine still soaks it, it signifies that the urine is bypassing the bladder and the staining agent. - This scenario strongly suggests a **ureterovaginal fistula**, where urine directly flows from the ureter into the vagina without passing through the bladder. *VVF* - A **vesicovaginal fistula (VVF)** would result in the escape of **dye-filled bladder urine** into the vagina, staining the pad. - The absence of dye on the pad rules out a direct leak from the bladder into the vagina. *Urethrovaginal fistula* - A **urethrovaginal fistula** would also involve urine passing through the bladder and urethra, leading to the **dye staining the vaginal pad**. - The dye would be present in the urine leaking into the vagina, which directly contradicts the clinical presentation. *Urinary stress incontinence* - **Stress incontinence** involves involuntary leakage of urine from the bladder due to increased intra-abdominal pressure, and this urine would also be **dye-stained**. - This diagnosis does not explain why the urine is clear while the bladder is filled with dye.

Question 112: All are causes of prolapse of cervix EXCEPT:

A. Menopause
B. Chronic cough
C. Delivery of a big baby
D. Regular exercise (Correct Answer)

Explanation: ***Regular exercise*** - **Regular exercise**, especially core-strengthening exercises, can actually help prevent pelvic organ prolapse by strengthening the **pelvic floor muscles**. - It does not contribute to the weakening of support structures necessary for cervical prolapse. *Menopause* - **Estrogen deficiency** during menopause leads to the thinning and weakening of **pelvic connective tissues** and muscles. - This loss of tissue elasticity and strength renders the pelvic organs more susceptible to prolapse. *Chronic cough* - A **chronic cough** significantly increases **intra-abdominal pressure** repeatedly. - This sustained downward force can strain and weaken the **pelvic floor muscles** and ligaments over time, contributing to prolapse. *Delivery of a big baby* - The **vaginal delivery** of a large baby can cause significant **trauma** and stretching to the **pelvic floor muscles**, ligaments, and fascia. - This physical damage can compromise the structural integrity supporting the cervix and other pelvic organs, increasing the risk of prolapse.

Question 113: All of the following surgeries are done in SUI except

A. Aldridge sling
B. Shirodkar sling (Correct Answer)
C. Kelly's stitch
D. Marshall Marchetti Krantz

Explanation: ***Shirodkar sling*** - The **Shirodkar sling** procedure is primarily used for the treatment of **cervical incompetence** in pregnancy, not stress urinary incontinence (SUI). - It involves placing a **cerclage** (suture) around the cervix to reinforce it and prevent preterm birth. *Aldridge sling* - The **Aldridge sling** is a type of **pubovaginal sling**, which is a surgical procedure used to treat SUI. - It involves using a **fascial sling** (often autologous) to support the bladder neck and urethra, increasing outlet resistance. *Kelly's stitch* - **Kelly's stitch**, also known as the **Kelly plication**, is a historical procedure for SUI that involves approximating the **periurethral tissues** anterior to the urethra. - While less common today as a standalone procedure, it aimed to reinforce the bladder neck and improve urethral coaptation. *Marshall Marchetti Krantz* - The **Marshall-Marchetti-Krantz (MMK) procedure** is a well-established **retropubic urethropexy** used for SUI. - It involves suturing the **periurethral tissues** to the **pubic bone** to elevate and stabilize the bladder neck and proximal urethra.

Question 114: A young nulliparous woman has 3rd degree uterovaginal prolapse without any cystocele or rectocele. There is no stress incontinence. Uterocervical length is 3 inches. All other findings are normal. The best treatment plan for her will be :

A. Fothergill's operation (Correct Answer)
B. Shirodkar's abdominal sling
C. Shirodkar's vaginal repair
D. Observation and reassurance till child bearing is over

Explanation: ***Fothergill's operation*** - This procedure, also known as **Manchester operation**, is the best option for this patient with **3rd degree uterovaginal prolapse** and **elongated cervix (3-inch uterocervical length)**. - It involves **cervical amputation**, plication of the cardinal ligaments, and anterior colporrhaphy, effectively addressing the prolapse while preserving the uterus. - While it preserves the uterus, **cervical amputation may impact fertility**, so thorough counseling is essential. However, for severe prolapse in a young woman, this offers a balance between surgical correction and uterine preservation. - The absence of cystocele and rectocele makes this focused procedure ideal without requiring extensive vaginal wall repair. *Shirodkar's abdominal sling* - This procedure is primarily used for **cervical incompetence** to prevent preterm delivery, not for uterovaginal prolapse. - It involves placing a stitch around the cervix via an abdominal approach and is typically performed during pregnancy. *Shirodkar's vaginal repair* - There is no standard gynecological procedure known as "Shirodkar's vaginal repair" for uterovaginal prolapse. - The Shirodkar procedure is specifically a type of **cervical cerclage** to prevent pregnancy loss due to cervical incompetence. *Observation and reassurance till child bearing is over* - While conservative management with pessary can be considered for women desiring future pregnancies, a **3rd degree uterovaginal prolapse** is a severe condition that typically requires surgical intervention. - Delaying definitive treatment for severe prolapse can lead to discomfort, ulceration, urinary complications, and progressive pelvic floor dysfunction.

Question 115: The appropriate choice for treatment of Nulliparous prolapse is :

A. Manchester repair
B. Ward Mayo's operation
C. Pessary treatment (Correct Answer)
D. Sling operation

Explanation: ***Pessary treatment*** - For **nulliparous women** with prolapse, **conservative management** with a pessary is usually the first-line treatment, especially if they desire future fertility or surgery is not indicated. - Pessaries provide **mechanical support** to pelvic organs, alleviating symptoms without surgical intervention. *Manchester repair* - This procedure involves **cervical amputation**, uterine shortening, and repair of the anterior and posterior vaginal walls. - It is generally performed for **elongated cervix with uterine prolapse**, and is overly aggressive for prolapse in nulliparous women, especially if they wish to preserve fertility. *Ward Mayo's operation* - This refers to a **vaginal hysterectomy with anterior and posterior colporrhaphy**, often accompanied by sacrouterine ligament plication. - It is a **definitive surgical treatment** for advanced prolapse, which is typically not indicated for nulliparous women who have not completed childbearing. *Sling operation* - Sling operations, such as **mid-urethral slings**, are primarily used to treat **stress urinary incontinence**, not uterine or vaginal prolapse itself. - While prolapse can co-exist with incontinence, a sling alone would not address the prolapse in a nulliparous woman.

Question 116: Sacrospinous fixation is for strengthening:

A. Apical defect (Correct Answer)
B. Posterior defect
C. Anterior defect
D. Lateral defect

Explanation: ***Apical defect*** - **Sacrospinous fixation** is a surgical procedure commonly used to treat **apical prolapse**, which is the descent of the uterus or vaginal vault. - The procedure involves attaching the vaginal apex to the **sacrospinous ligament**, thereby providing support and preventing recurrence of prolapse. *Posterior defect* - A **posterior defect** typically refers to a **rectocele**, a bulge of the rectum into the posterior vaginal wall. - While sometimes co-occurring with apical prolapse, sacrospinous fixation primarily addresses apical support and not directly the rectocele. *Anterior defect* - An **anterior defect** usually describes a **cystocele**, which is the herniation of the bladder into the anterior vaginal wall. - Surgical correction for cystocele often involves **anterior colporrhaphy** or paravaginal defect repair, which are different from sacrospinous fixation. *Lateral defect* - **Lateral defects** in pelvic floor support are less common and typically refer to problems with the **paravaginal attachments**. - These are usually repaired through specific procedures addressing weaknesses in the lateral support structures, not primarily with sacrospinous fixation.

Question 117: 3rd degree genital prolapse in the first trimester of pregnancy is managed by :

A. Le Fort's repair
B. Right transvaginal sacrospinous colpopexy
C. Fothergill's repair
D. Ring pessary (Correct Answer)

Explanation: ***Ring pessary*** - A ring pessary is a **non-surgical** option often used during pregnancy to support the uterus and prevent further prolapse, especially in the first trimester. - It provides **conservative management**, avoiding surgical risks to both mother and fetus during early pregnancy. *Le Fort's repair* - **Le Fort's repair** is a colpocleisis procedure, typically performed on elderly women who are no longer sexually active, as it surgically obliterates the vaginal canal. It is contraindicated in pregnancy and unlikely to be performed in a woman of childbearing age who is pregnant. *Right transvaginal sacrospinous colpopexy* - This is a **surgical procedure** to correct vaginal vault prolapse by attaching the vaginal apex to the sacrospinous ligament. It is inappropriate for managing prolapse in the first trimester of pregnancy due to surgical risks and potential fetal harm. *Fothergill's repair* - **Fothergill's repair (Manchester repair)** is a surgical procedure that involves cervical amputation, shortening of the cardinal ligaments, and colporrhaphy. This surgery is not suitable during pregnancy due to the risk of miscarriage and is typically reserved for cases of uterocervical elongation causing prolapse in non-pregnant women.

Question 118: Risk factors for stress urinary incontinence are all except

A. Obesity
B. Hypertension (Correct Answer)
C. Smoking
D. Pregnancy

Explanation: ***Hypertension*** - While hypertension is a significant health concern, it is **not directly a recognized risk factor** for stress urinary incontinence. - Risk factors for stress urinary incontinence primarily involve factors that increase **intra-abdominal pressure** or weaken pelvic floor support. *Obesity* - **Increased intra-abdominal pressure** due to excess weight places constant strain on the pelvic floor muscles and urethral sphincter. - This persistent pressure can lead to weakening of the supporting structures, predisposing to **stress urinary incontinence**. *Smoking* - Smoking is associated with chronic cough, which repeatedly increases **intra-abdominal pressure**, potentially leading to pelvic floor muscle weakness. - It also affects **collagen synthesis**, which can weaken connective tissues supporting the bladder and urethra. *Pregnancy* - The growing uterus during pregnancy places significant **mechanical stress** on the pelvic floor muscles and ligaments. - **Hormonal changes** during pregnancy can also relax connective tissues, further contributing to pelvic floor laxity.

Question 119: In Procidentia which of the following is true?

A. Both uterus and vagina outside the introitus (Correct Answer)
B. Uterus in vagina cervix outside the introitus
C. Uterus and cervix in vagina
D. None of the options

Explanation: ***Both uterus and vagina outside the introitus*** - **Procidentia** is defined as the most severe form of **pelvic organ prolapse**, where the **uterus, cervix, and the entire vaginal canal** protrude completely outside the vaginal introitus. - This condition represents a **third-degree uterine prolapse**, signifying the failure of multiple pelvic support structures. *Uterus in vagina cervix outside the introitus* - This description corresponds to a **second-degree uterine prolapse**, where the **cervix** is visible outside the introitus, but the uterine body remains within the vagina. - In **procidentia**, both the uterus and the entire vagina are external. *Uterus and cervix in vagina* - This scenario describes either a normal anatomical position or a **first-degree uterine prolapse** where the cervix has descended but remains within the vagina. - For **procidentia**, there must be complete prolapse beyond the introitus. *None of the options* - This option is incorrect because the first statement accurately defines **procidentia** as the complete prolapse of both the uterus and the vagina outside the introitus.

Question 120: Bonney's test is done for:

A. Stress incontinence (Correct Answer)
B. Urinary retention
C. Urge incontinence
D. Urinary fistula

Explanation: ***Stress incontinence*** - **Bonney's test** is used to assess if **urethral support** can alleviate **stress urinary incontinence (SUI)**. - During the test, the bladder neck is elevated manually or with instruments to mimic surgical correction, and the patient is asked to cough. If leakage stops, it suggests that surgical correction of urethral hypermobility may be beneficial. *Urinary retention* - **Urinary retention** involves the **inability to empty the bladder**, which is not assessed by Bonney's test. - This condition is typically diagnosed by measuring **post-void residual volume**. *Urge incontinence* - **Urge incontinence** is characterized by an **involuntary leakage of urine** accompanied by a sudden, strong desire to void. - This condition is primarily associated with **detrusor overactivity** and is not evaluated by Bonney's test. *Urinary fistula* - A **urinary fistula** is an **abnormal connection** between two epithelialized organs, allowing urine to leak. - Diagnosis involves imaging studies or dye tests to identify the abnormal tract, not Bonney's test.

Practice by Chapter

Pelvic Floor Anatomy and Function

Practice Questions

Urinary Incontinence: Classification

Practice Questions

Stress Urinary Incontinence

Practice Questions

Overactive Bladder and Urge Incontinence

Practice Questions

Pelvic Organ Prolapse: Classification

Practice Questions

Cystocele and Urethrocele

Practice Questions

Uterine Prolapse

Practice Questions

Rectocele and Enterocele

Practice Questions

Surgical Management in Urogynecology

Practice Questions

Conservative Management Approaches

Practice Questions

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