Urogynecology Practice Questions

Q: True about Latzko technique of genitourinary fistula repair is

Partial colpocleisis.. ***Partial colpocleisis.*** - The Latzko technique involves **denuding the vaginal epithelium** around the fistula and then imbricating the vaginal wall over the defect, effectively performing a **partial colpocleisis**. - This technique achieves fistula closure by sealing the defect without formally excising the tract, relying on tissue apposition and healing. *Lengthens upper vagina.* - The Latzko technique typically involves the **approximation of vaginal walls**, which can lead to a **slight shortening or narrowing** of the vagina, not lengthening. - This is a consequence of the imbrication of vaginal tissue used to close the fistula. *Excision of fistulous tract completely.* - The Latzko technique is a **transvaginal approach** that focuses on **denuding the edges** of the fistula and then **imbricating layers of vaginal tissue** over it, rather than completely excising the fistulous tract. - Complete excision of the tract is more common in more complex or difficult fistula repairs, often requiring an abdominal approach. *Weakens surrounding tissues.* - This technique aims to **strengthen the repair site** by bringing together healthy vaginal tissue and using multiple layers of sutures to create a durable closure. - The goal is to provide a robust repair that supports the weakened area, not to further compromise tissue integrity.

Q: Which surgical procedure has the highest incidence of ureteric injury?

Radical hysterectomy. ***Radical hysterectomy*** - This procedure involves extensive dissection to remove the uterus, cervix, and surrounding parametrial tissue, which places the **ureters at high risk of injury** due to their close proximity to the surgical field. - The **ureter** runs directly through the **parametrium** (cardinal and uterosacral ligaments), which are ligated and excised during a radical hysterectomy, making it the procedure with the highest incidence of ureteral injury. *Vaginal hysterectomy* - While ureteric injury can occur, it is generally less common than in radical hysterectomy due to the less extensive dissection and different angle of approach. - The risk is present during clamping and ligating the **uterosacral and cardinal ligaments** but is typically lower than with a radical approach. *Anterior colporraphy* - This procedure primarily involves the anterior vaginal wall and bladder, usually without deep pelvic dissection that would place the ureters at significant risk. - The main risks are typically related to the bladder itself, rather than the ureters, as the dissection is superficial to the ureteral course. *Abdominal hysterectomy* - While there is a risk of ureteric injury, especially during the ligation of the **uterine arteries** and cardinal ligaments, the dissection is less extensive than in a radical hysterectomy. - Standard abdominal hysterectomy involves less parametrial dissection, thus exposing the ureters to a lower, though still present, risk of injury compared to radical procedures.

Q: In Procidentia which of the following is true?

Both uterus and vagina outside the introitus. ***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.

Q: Cause of decubitus ulcer in uterine prolapse is :

Friction. ***Friction*** - In uterine prolapse, the **cervix and vaginal walls protrude outside the introitus** and become exposed to the external environment. - The prolapsed tissue undergoes **constant friction against clothing, undergarments, and opposing skin surfaces** during walking, sitting, and daily activities. - This continuous mechanical trauma leads to **mucosal abrasion, drying, keratinization, and eventually ulceration** (decubitus ulcer). - Decubitus ulcers in prolapse are primarily **traumatic/mechanical** in nature, caused by prolonged pressure and friction on the exposed tissue. *Trauma* - While trauma contributes to ulcer formation, it is more accurately described as part of the **friction and pressure mechanism** rather than a separate cause. - Friction is the more specific and primary mechanism, whereas trauma is a broader term that encompasses the injury. *Intercourse* - Sexual intercourse is generally **not implicated** as a cause of decubitus ulcers in uterine prolapse. - It might cause superficial irritation but is not the primary pathophysiological mechanism for ulcer formation. *Venous congestion* - While **venous congestion can occur** in prolapsed tissue, it is **not the primary cause** of decubitus ulcers. - The ulcers are predominantly caused by **mechanical factors** (friction and pressure) rather than vascular compromise. - Venous congestion may contribute to tissue edema but does not explain the characteristic ulceration pattern seen in prolapse.

Q: Which of the following cannot be treated by laparoscopy?

Genital prolapse. ***Genital prolapse*** - Among the options listed, **genital prolapse** is the condition LEAST suited for complete laparoscopic management, particularly in the context of this examination question. - While **laparoscopic sacrocolpopexy** and **sacral hysteropexy** exist for vault prolapse and uterine prolapse respectively, these procedures were less established at the time of this exam (2012) and require advanced laparoscopic skills. - Most cases of **genital prolapse**, especially complete pelvic organ prolapse, traditionally require **vaginal surgical approaches** or **open abdominal procedures** for comprehensive repair of multiple compartment defects. - The complex anatomical reconstruction needed for severe prolapse (anterior, posterior, and apical compartments) is more challenging via laparoscopy compared to the other listed conditions. *Non descent of uterus* - **Non-descent vaginal hysterectomy** can be performed with **laparoscopic assistance (LAVH/LDVH)** or as **total laparoscopic hysterectomy (TLH)**. - Laparoscopy facilitates dissection of uterine attachments, ligation of vessels, and removal of the uterus with minimal morbidity. *Ectopic pregnancy* - **Ectopic pregnancy** is a standard indication for laparoscopic surgery, performed routinely worldwide. - Procedures include **laparoscopic salpingectomy** (removal of affected tube) or **salpingostomy** (conservative surgery preserving the tube). - Offers advantages of minimal invasiveness, reduced recovery time, and excellent visualization. *Sterilization* - **Laparoscopic tubal sterilization** is one of the most common laparoscopic procedures performed. - Methods include application of **Filshie clips, Falope rings**, or **electrocautery** to occlude fallopian tubes. - Gold standard for permanent contraception with minimal morbidity.

Q: Bonney's test is done for:

Stress incontinence. ***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.

Q: Fourteen weeks pregnancy with third degree prolapse. Best management will be:

Ring pessary. ***Ring pessary*** - A **ring pessary** is the most appropriate management for a **third-degree uterine prolapse** during pregnancy, especially in the second trimester (14 weeks). - It provides **mechanical support** to the uterus, relieving symptoms and potentially allowing the pregnancy to progress without surgical intervention. *No treatment* - Leaving a **third-degree prolapse untreated** during pregnancy can lead to complications such as cervical erosion, infection, miscarriage, or preterm labor, making it an unsuitable option. - The patient would experience significant discomfort and potential obstruction, which needs active management. *Foot end elevation* - While **foot end elevation** can temporarily relieve some pelvic pressure, it is not an effective or sufficient treatment for a **third-degree uterine prolapse**, which requires direct mechanical support. - It does not address the underlying anatomical displacement and would not sustainedly reduce the prolapse. *Sling surgery* - **Sling surgery** is a surgical procedure typically indicated for severe, symptomatic uterine prolapse in non-pregnant individuals or after childbirth, not during pregnancy. - Performing surgery during the **second trimester** carries significant risks to both the mother and the fetus, including potential for miscarriage or preterm labor.

Q: In anterior colporrhaphy, the best method of suture apposing the vaginal flaps is:

Interrupted. ***Interrupted*** - **Interrupted sutures** are preferred in anterior colporrhaphy to allow for drainage and prevent hematoma formation, which can impair healing. - They also distribute tension more evenly across the surgical wound, reducing the risk of wound dehiscence. *Continuous* - **Continuous sutures** are generally avoided in colporrhaphy as they can create a closed space that traps fluid, increasing the risk of infection and hematoma. - If a single point of the suture breaks, the entire closure can unravel, compromising wound integrity. *Interrupted mattress* - While **interrupted mattress sutures** offer strong apposition, they are often more complex and time-consuming to place compared to simple interrupted sutures. - The added bulk and multiple passes through tissue may also increase the risk of tissue ischemia if tied too tightly. *Interlocking* - **Interlocking sutures** are primarily used for hemostasis and are less suitable for mucosal apposition in colporrhaphy. - They tend to create a tighter, more constricting closure that can impede wound drainage and increase tissue tension.

Q: A 52 year old lady presents with constant leakage of urine and dysuria two weeks after a complicated total abdominal hysterectomy. A diagnosis of Vesicovaginal fistula is suspected. The most important test for the diagnosis is:

Triple Swab Test. ***Triple Swab Test*** - The **Triple Swab Test** (also known as the **dye test** or **tampon test**) is the **gold standard diagnostic test** for confirming vesicovaginal fistula. - **Methylene blue** or indigo carmine dye is instilled into the bladder via a catheter, and tampons are placed in the vagina. - If the tampon stains blue, it **confirms the diagnosis** of vesicovaginal fistula by demonstrating direct communication between bladder and vagina. - This is a **simple, non-invasive, and definitive diagnostic test** that directly proves the presence of a fistula. *Cystoscopy* - **Cystoscopy** is important for **evaluation and surgical planning** rather than initial diagnosis. - It allows direct visualization of the **fistula site, size, and proximity to ureteral orifices**, which is crucial for planning repair. - While it can identify the fistula, it is an **invasive procedure** and is typically performed after diagnosis is confirmed, to characterize the fistula before surgical intervention. *Urine culture* - A **urine culture** identifies bacterial infections and guides antibiotic treatment for urinary tract infections. - While UTIs commonly accompany vesicovaginal fistula and cause dysuria, urine culture **does not diagnose the fistula itself**. - It is useful for managing concurrent infection but not for confirming the anatomical defect. *IVP* - **Intravenous Pyelogram (IVP)** is primarily used to assess **upper urinary tract pathology** and ureteral integrity. - It may show contrast leakage but is **not specific for vesicovaginal fistula** and does not provide direct confirmation. - IVP is more useful for ruling out ureteral injury or ureterovaginal fistula rather than diagnosing vesicovaginal fistula.

Q: The disadvantage of Marshall-Marchetti-Krantz procedure compared with other surgical alternatives for treatment of stress urinary incontinence includes

Osteitis pubis. ***Osteitis pubis*** - **Osteitis pubis** is a known, though rare, complication specifically associated with the Marshall-Marchetti-Krantz (MMK) procedure due to the sutures placed in the periosteum of the pubic symphysis, leading to inflammation. - This complication presents as **groin pain** and tenderness over the symphysis pubis, and it is less common with modern sling procedures or colposuspension techniques. *Increased incidence of urinary tract infections* - While **urinary tract infections (UTIs)** can occur after any pelvic surgery, there is no evidence to suggest that the MMK procedure specifically carries a higher incidence compared to other stress urinary incontinence (SUI) surgeries. - Post-surgical catheterization and manipulation can increase UTI risk universally regardless of the specific surgical approach. *Urinary retention* - **Urinary retention** is a potential complication of many SUI surgeries, including MMK, due to over-correction or urethral obstruction. - However, newer procedures like mid-urethral slings have also been associated with significant rates of transient or persistent urinary retention, suggesting it's not a unique disadvantage of MMK. *High failure rate* - The **failure rate** of MMK, while debated and variable across studies, is generally comparable to or sometimes better than some older SUI procedures. - Modern tension-free vaginal tape (TVT) and other sling procedures have often superseded MMK due to less invasiveness or similar efficacy, not necessarily a universally higher failure rate of MMK.

Question 1

True about Latzko technique of genitourinary fistula repair is

Accepted Answer

Partial colpocleisis.

Answer

Lengthens upper vagina.

Answer

Excision of fistulous tract completely.

Answer

Weakens surrounding tissues.

Question 2

Which surgical procedure has the highest incidence of ureteric injury?

Accepted Answer

Radical hysterectomy

Answer

Vaginal hysterectomy

Answer

Anterior colporraphy

Answer

Abdominal hysterectomy

Question 3

In Procidentia which of the following is true?

Accepted Answer

Both uterus and vagina outside the introitus

Answer

Uterus in vagina cervix outside the introitus

Answer

Uterus and cervix in vagina

Answer

None of the options

Question 4

Cause of decubitus ulcer in uterine prolapse is :

Accepted Answer

Friction

Answer

Trauma

Answer

Intercourse

Answer

Venous congestion

Question 5

Which of the following cannot be treated by laparoscopy?

Accepted Answer

Genital prolapse

Answer

Non descent of uterus

Answer

Ectopic pregnancy

Answer

Sterilization

Question 6

Bonney's test is done for:

Accepted Answer

Stress incontinence

Answer

Urinary retention

Answer

Urge incontinence

Answer

Urinary fistula

Question 7

Fourteen weeks pregnancy with third degree prolapse. Best management will be:

Accepted Answer

Ring pessary

Answer

No treatment

Answer

Foot end elevation

Answer

Sling surgery

Question 8

In anterior colporrhaphy, the best method of suture apposing the vaginal flaps is:

Accepted Answer

Interrupted

Answer

Continuous

Answer

Interrupted mattress

Answer

Interlocking

Question 9

A 52 year old lady presents with constant leakage of urine and dysuria two weeks after a complicated total abdominal hysterectomy. A diagnosis of Vesicovaginal fistula is suspected. The most important test for the diagnosis is:

Accepted Answer

Triple Swab Test

Answer

Urine culture

Answer

Cystoscopy

Answer

IVP

Question 10

The disadvantage of Marshall-Marchetti-Krantz procedure compared with other surgical alternatives for treatment of stress urinary incontinence includes

Accepted Answer

Osteitis pubis

Answer

Increased incidence of urinary tract infections

Answer

Urinary retention

Answer

High failure rate

Urogynecology — MCQs

Urogynecology — MCQs

On this page

Practice by Chapter

Want unlimited practice?