Urogynaecology and Urinary Incontinence

• Q1.A 32-year lady with uterine fetal death after normal vaginal delivery continues passing of urine from vagina. What is the most probable diagnosis?

  • ABladder rupture
  • BVesicovaginal fistula
  • CUrge incontinence
  • DStress incontinence
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• Q2.In an immediate postoperative hysterectomy, a patient develops leakage of urine. What is the most likely cause?

  • AUrethral injury
  • BBladder injury
  • COverflow incontinence
  • DStress urinary incontinence
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• Q3.A lady underwent vaginal hysterectomy for Carcinoma cervix. Following the surgery after her urethral catheter was removed, she complained of urinary incontinence. On examination she had normal voiding as well as continuous incontinence. Methylene blue dye was instilled in her bladder through her urethra and she was given oral Phenazopyridine dye. After some time her pads were checked and it showed yellow staining at the top most pad, while the middle or bottom pads were unstained. She is likely to have:

  • AVesicovaginal fistula
  • BUreterovaginal fistula
  • CUrethrovaginal fistula
  • DVesicouterine fistula
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• Q4.A 38-years old patient who had a total abdominal hysterectomy presents 2 months postop complaining of leakage of urine from the vagina. On examination, no fistula can be identified. Dilute methylene blue (100mL) is injected into the bladder through a Foley catheter and a tampon is placed in the vagina. The patient is asked to walk for about 15 minutes, after which the patient is found to be wet, but there is no blue stain anywhere on the tampon. Which of the following is true:-

  • A100mL was probably not enough methylene blue, and the test should be repeated with a higher volume
  • BThe patient probably has stress incontinence not a fistula
  • CThe patient probably has a ureterovaginal fistula
  • DThe patient most likely has small apical vesicovaginal fistula that was too small to leak the dye in 15 minutes
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• Q5.While performing Burch operation there was significant bleeding and pooling of blood in the space of Retzius. The source of bleeding cannot be visualized. What is the next step in the management?

  • ACall vascular surgeon
  • BGive a generalized suture in bleeding area
  • CLift endopelvic fascia by putting fingers in vagina
  • DPlacing surgical drain
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• Q6.Most useful test in vesicovaginal fistula?

  • ACystoscopy
  • BThree swab test
  • CUrine culture
  • DIntravenous pyelogram
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• Q7.Bead cystogram is used for the diagnosis of:

  • ACa bladder
  • BStress incontinence
  • CThimble bladder
  • DDiveiculum
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• Q8.Urethral caruncle is best treated by

  • AAdministration of antibiotics
  • BExcision followed by repeated dilatation
  • CResection and end to end anastomosis
  • DChemical uterization
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• Q9.A 50-year old woman complains of leakage of urine. Other than genuine stress urinary incontinence, the most common cause of urinary leakage is ?

  • ADetrusor dyssynergia
  • BUrge incontinence
  • CVesico vaginal fistula
  • DOverflow incontinence
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• Q10.Urge urinary incontinence is

  • AInvoluntary urinary leak with increase in abdominal pressure
  • BInvoluntary urinary leak preceeded by strong imminent need to void
  • CUrinary urgency with increased daytime frequency and nocturia
  • DDetrusor sphincter dyssynergia
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Answer key

Q1: B. Vesicovaginal fistula; Q2: B. Bladder injury; Q3: B. Ureterovaginal fistula; Q4: C. The patient probably has a ureterovaginal fistula; Q5: C. Lift endopelvic fascia by putting fingers in vagina; Q6: A. Cystoscopy; Q7: B. Stress incontinence; Q8: B. Excision followed by repeated dilatation; Q9: B. Urge incontinence; Q10: B. Involuntary urinary leak preceeded by strong imminent need to void.

Other topics in Obstetrics & Gynaecology

• Anatomy of the Female Pelvic Organs
• Physiology of Conception and Fertilisation
• The Maternal Pelvis and Fetal Skull
• The Placenta and Fetal Membranes
• Sexual Development, Puberty and Adolescent Gynaecology
• Maternal Physiological Changes in Pregnancy
• Pregnancy Diagnosis and Antenatal Assessment
• Antenatal Screening and Investigations
• Imaging in Obstetrics
• Normal Labour: Stages and Mechanism
• Abnormal Labour and Dystocia
• Labour Induction and Augmentation
• Malpresentations and Malpositions
• Assisted Vaginal Delivery: Forceps and Vacuum
• Caesarean Delivery and Vaginal Birth After Caesarean (VBAC)
• Puerperium
• Multiple Pregnancy
• Ectopic Pregnancy
• Abortion and Medical Termination of Pregnancy (MTP)
• Antepartum Haemorrhage
• Postpartum Haemorrhage and Its Management
• Preterm Labour and Post-term Pregnancy
• Gestational Trophoblastic Disease
• Fetal Growth Restriction and Fetal Surveillance
• Anaemia in Pregnancy
• Hypertensive Disorders of Pregnancy
• Diabetes Mellitus in Pregnancy
• Thyroid Disorders in Pregnancy
• Cardiac Disease in Pregnancy
• Rhesus Isoimmunisation and Haemolytic Disease
• Liver Disease and Infections in Pregnancy
• Menstrual Disorders and Abnormal Uterine Bleeding
• Prolapse
• Uterine Fibroids
• Adenomyosis and Endometriosis
• Ovarian Disorders
• Contraception and Sterilisation
• Vaginitis and Vaginal Infections
• Infections of the Vulva
• Pelvic Inflammatory Disease (PID)
• Genital Tuberculosis
• Infertility
• Perimenopause, Menopause and Postmenopausal Bleeding
• Ovarian Tumours
• Vulval and Vaginal Malignancies
• Carcinoma of the Cervix
• Carcinoma of the Endometrium
• Obstetric and Gynaecological Instruments