Urogynecology Practice Questions

Q: Which of the following statements regarding bladder changes during pregnancy is FALSE?

Bladder capacity is increased.. **Explanation:** The correct answer is **C (Bladder capacity is increased)**. This statement is false because, in reality, **bladder capacity decreases** during pregnancy. This reduction is primarily due to the progressive enlargement of the uterus, which exerts direct mechanical pressure on the bladder, and increased pelvic hyperemia. **Analysis of Options:** * **Option A (Correct Statement):** Bladder pressure rises significantly due to the weight of the gravid uterus. It typically increases from a baseline of ~8 cm H2O in early pregnancy to ~20 cm H2O at term. * **Option B (Correct Statement):** Both absolute and functional urethral lengths increase during pregnancy. This is a compensatory mechanism to maintain urinary continence despite the increased intra-abdominal and intra-vesical pressure. * **Option D (Correct Statement):** Maximum intraurethral pressure increases (from ~70 to ~93 cm H2O) to counteract the increased bladder pressure, helping to prevent stress incontinence. **Clinical Pearls for NEET-PG:** 1. **Frequency of Micturition:** This is a physiological hallmark of pregnancy. In the first trimester, it is due to hormonal changes and uterine enlargement; in the third trimester, it is due to the engagement of the fetal head. 2. **Trigone Changes:** The bladder trigone becomes elevated, and the posterior margin (interureteric ridge) becomes thickened due to hyperemia and hypertrophy of the bladder muscle. 3. **Ureteric Dilatation:** Progesterone causes smooth muscle relaxation, leading to physiological hydroureter and hydronephrosis (more common on the **right side** due to dextrorotation of the uterus and the cushioning effect of the sigmoid colon on the left). 4. **Glucosuria:** The GFR increases, but the tubular reabsorption of glucose does not always keep pace, leading to physiological glucosuria (which can predispose to UTIs).

Q: Bonney's test demonstrates which of the following?

Stress urinary incontinence. **Explanation:** **Bonney’s Test** (also known as the Marshall-Marchetti test) is a clinical provocative test used to diagnose **Stress Urinary Incontinence (SUI)**. 1. **Mechanism of the Correct Answer:** SUI occurs due to hypermobility of the bladder neck or weakness of the urethral sphincter. During the test, the patient is asked to cough with a full bladder, which results in the leakage of urine. The clinician then places two fingers in the anterior vaginal fornix to elevate the bladder neck (without compressing the urethra) and asks the patient to cough again. If the elevation **prevents** the leakage of urine, the test is positive, confirming that the incontinence is due to the loss of the posterior urethrovesical angle (SUI). 2. **Why Incorrect Options are Wrong:** * **Urge Incontinence:** This is caused by detrusor overactivity. Physical elevation of the bladder neck does not stop the involuntary detrusor contractions. * **Overflow Incontinence:** This results from an overdistended bladder (due to obstruction or acontractile muscle). It is diagnosed by measuring high post-void residual volume, not by provocative stress tests. * **Prolapse of the Uterus:** While often associated with SUI, prolapse is diagnosed via a pelvic examination (Sims’ speculum) and graded using the POP-Q system. **NEET-PG High-Yield Pearls:** * **Q-tip Test:** Used to measure urethral hypermobility (positive if the angle is >30°). * **Gold Standard Investigation:** Urodynamic studies (Cystometry) are the gold standard for differentiating types of incontinence. * **First-line Treatment for SUI:** Pelvic floor exercises (Kegel’s). * **Surgical Gold Standard for SUI:** Mid-urethral slings (TVT - Tension-free Vaginal Tape or TOT - Transobturator Tape).

Q: Baldy webster operation is done in case of:

Retroversion of uterus. **Explanation:** The **Baldy-Webster operation** is a surgical procedure historically used for the correction of a **retroverted uterus**. **1. Why the Correct Answer is Right:** The primary goal of this operation is to bring a retroverted uterus into an anteverted position. In this procedure, the **round ligaments** are picked up, passed through an opening made in the broad ligament (under the utero-ovarian ligament), and then sutured together behind the posterior wall of the uterus. This "shortening" of the round ligaments pulls the fundus forward, maintaining it in a permanent state of anteversion. **2. Analysis of Incorrect Options:** * **A & D (Prolapse):** Uterine prolapse is managed by procedures that provide apical support (e.g., Ward-Mayo, Manchester operation, or Sacrocolpopexy). Baldy-Webster does not provide the vertical support necessary to treat descent. For prolapse in young females (<40 years), the **Fothergill’s (Manchester) operation** or **Shirodkar’s abdominal sling** are the preferred uterine-sparing surgeries. * **C (Inversion of Uterus):** Acute inversion is managed by manual replacement (Johnson’s maneuver), while chronic inversion requires surgical techniques like **O'Sullivan’s (hydrostatic)**, **Huntington’s**, or **Haultain’s** procedures. **3. Clinical Pearls for NEET-PG:** * **Gilliam’s Operation:** Another surgery for retroversion where round ligaments are brought through the internal inguinal ring and sutured to the rectus sheath. * **Indications for Retroversion Surgery:** Most cases of retroversion are physiological and asymptomatic. Surgery is only considered if it causes severe dyspareunia or is associated with endometriosis/fixed retroversion. * **High-Yield Association:** Remember **"Round Ligament = Baldy-Webster"** to quickly differentiate it from sling surgeries used in prolapse.

Q: What is the preferred surgical treatment for ureterovaginal fistula?

Ureteroneocystostomy. **Explanation:** Ureterovaginal fistula (UVF) most commonly occurs as a complication of radical pelvic surgeries (like Wertheim’s hysterectomy). The primary goal of management is to restore urinary continuity. **1. Why Ureteroneocystostomy is correct:** Most ureteric injuries leading to UVF occur in the **lower third** of the ureter, near the vesicoureteric junction. **Ureteroneocystostomy** (re-implantation of the ureter into the bladder) is the gold standard treatment because it provides a tension-free, definitive repair with a high success rate. If the ureter is too short to reach the bladder, techniques like a Psoas hitch or Boari flap are utilized to bridge the gap. **2. Why other options are incorrect:** * **End-to-end anastomosis (Ureteroureterostomy):** This is preferred for injuries in the **upper or middle third** of the ureter. In the lower third, the blood supply is often compromised, making anastomosis prone to strictures or breakdown compared to re-implantation. * **Ureteroileal conduit:** This is a form of urinary diversion used after total cystectomy (e.g., for bladder cancer). It is too invasive and unnecessary for a simple fistula repair. * **Implantation into the colon (Ureterosigmoidostomy):** This is an obsolete method of urinary diversion associated with high risks of metabolic acidosis, ascending infections, and late-onset malignancy. **High-Yield Clinical Pearls for NEET-PG:** * **Most common cause of UVF:** Total Abdominal Hysterectomy (TAH). * **Diagnostic Test:** **Double Dye Test**. In UVF, the vaginal swab is soaked with clear urine (from the ureter) but not the dye (from the bladder). * **Gold Standard Investigation:** Intravenous Pyelogram (IVP) or CT Urogram to locate the site of injury. * **Initial Management:** If the fistula is small, a trial of conservative management with a **JJ stent** for 4–6 weeks may be attempted before surgery.

Question 1

What is the surgery for genuine stress urinary incontinence?

Accepted Answer

Retropubic urethropexy

Answer

Kelly's plication

Answer

Halsted's operation

Answer

Spinelli's operation

Question 2

What is the characteristic manifestation of a uretero-vaginal fistula?

Accepted Answer

Continuous incontinence

Answer

Overflow incontinence

Answer

Hydronephrosis

Answer

Stress incontinence

Question 3

Genital prolapse is best repaired after how many months of childbirth?

Accepted Answer

6 months

Answer

1 month

Answer

2 months

Answer

3 months

Question 4

Which of the following statements regarding bladder changes during pregnancy is FALSE?

Accepted Answer

Bladder capacity is increased.

Answer

Bladder pressure in primigravida increases from 8 cm H2O early in pregnancy to 20 cm H2O at term.

Answer

Absolute and functional urethral lengths are increased.

Answer

Intraurethral pressure is increased from 70 to 93 cm H2O.

Question 5

What is the most appropriate method for collecting urine for culture in a patient with a vesicovaginal fistula?

Accepted Answer

Foley's catheter

Answer

Suprapubic needle aspiration

Answer

Midstream clean catch

Answer

Sterile speculum

Question 6

Bonney's test demonstrates which of the following?

Accepted Answer

Stress urinary incontinence

Answer

Urge incontinence

Answer

Overflow incontinence

Answer

Prolapse of the uterus

Question 7

After undergoing a partial cystectomy for carcinoma of the rectum, a 76-year-old woman develops a vesicovaginal fistula. The repair will have a higher chance of success if which of the following occurs?

Accepted Answer

Repair is performed more than 6 months after the causative operation.

Answer

Scar tissue is not excised.

Answer

The bladder wall is closed under tension.

Answer

Repair is performed within 7-14 days of the onset of symptoms.

Question 8

Baldy webster operation is done in case of:

Accepted Answer

Retroversion of uterus

Answer

Congenital prolapse

Answer

Inversion of uterus

Answer

Prolapse in females <40 years of age

Question 9

A 38-year-old woman complains of chronic pelvic pressure. Further questioning reveals chronic lower back pain, constipation, difficulty in walking, and dyspareunia. Pelvic examination shows the uterine cervix lying low within the vaginal canal but not protruding through the introitus. What is the most likely diagnosis?

Accepted Answer

Uterine prolapse

Answer

Cystocele

Answer

Femoral hernia

Answer

Rectocele

Question 10

What is the preferred surgical treatment for ureterovaginal fistula?

Accepted Answer

Ureteroneocystostomy

Answer

End-to-end anastomosis with ureteric catheter support

Answer

Ureteroileal conduit

Answer

Implantation into the colon

Urogynecology — MCQs

Urogynecology — MCQs

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