ABOG ABOG Urogynecology & Pelvic Floor Disorders 1 — Questions and Answers
Question 1: Which test is the gold standard for diagnosing urodynamic stress urinary incontinence?
- Urinalysis
- Multichannel urodynamic study (Correct answer)
- Post-void residual measurement
- Cystoscopy
Correct answer: Multichannel urodynamic study
Multichannel urodynamic testing, including cystometry and urethral pressure profilometry, is the gold standard for objectively diagnosing stress urinary incontinence and ruling out detrusor overactivity.
Question 2: A 62-year-old woman with symptomatic pelvic organ prolapse has the cervix 3 cm below the hymen. What is her POP-Q stage?
- Stage I
- Stage II
- Stage III (Correct answer)
- Stage IV
Correct answer: Stage III
In the POP-Q system, Stage III prolapse is defined when the leading edge of prolapse extends more than 1 cm beyond the hymen but less than total vaginal length minus 2 cm.
Question 3: First-line therapy for overactive bladder (OAB) without incontinence should begin with which intervention?
- Anticholinergic medication
- Beta-3 agonist (mirabegron)
- Behavioral therapy and bladder training (Correct answer)
- Sacral neuromodulation
Correct answer: Behavioral therapy and bladder training
Behavioral therapy, including bladder training, pelvic floor muscle exercises (Kegel), fluid management, and urgency suppression techniques, is the first-line treatment for overactive bladder.
Question 4: Which surgical procedure for stress urinary incontinence has the highest long-term cure rate in the current evidence base?
- Burch colposuspension
- Mid-urethral sling (retropubic TVT) (Correct answer)
- Urethral bulking agents
- Anterior colporrhaphy
Correct answer: Mid-urethral sling (retropubic TVT)
The retropubic mid-urethral tension-free vaginal tape (TVT) sling has the highest long-term cure rates for stress urinary incontinence, with ~80–90% objective cure at 5–10 years in randomized trials.
Question 5: Which compartment is primarily affected in a patient with cystocele (anterior vaginal wall prolapse)?
- Posterior compartment
- Apical compartment
- Anterior compartment (Correct answer)
- Lateral compartment
Correct answer: Anterior compartment
A cystocele represents anterior compartment prolapse caused by weakening of the pubocervical fascia, allowing the bladder to herniate into the anterior vaginal wall.
Question 6: A patient with recurrent urinary tract infections and urge incontinence has a post-void residual of 250 mL. What condition should be suspected?
- Overactive bladder
- Detrusor underactivity (voiding dysfunction) (Correct answer)
- Stress urinary incontinence
- Vesicovaginal fistula
Correct answer: Detrusor underactivity (voiding dysfunction)
A post-void residual of >200 mL indicates incomplete bladder emptying consistent with detrusor underactivity or bladder outlet obstruction, predisposing to overflow incontinence and recurrent UTIs.
