ABOG ABOG Urogynecology & Pelvic Floor Disorders 2 — Questions and Answers
Question 1: Sacral neuromodulation (InterStim) is FDA-approved for which condition(s)?
- Stress urinary incontinence only
- Pelvic organ prolapse
- Urgency urinary incontinence, urinary retention, and fecal incontinence (Correct answer)
- Interstitial cystitis only
Correct answer: Urgency urinary incontinence, urinary retention, and fecal incontinence
Sacral neuromodulation is FDA-approved for refractory urgency urinary incontinence, urinary frequency/urgency, non-obstructive urinary retention, and fecal incontinence.
Question 2: Which anatomic structure is the primary support for the uterus and upper vagina at the apical compartment?
- Pubocervical fascia
- Rectovaginal fascia
- Uterosacral and cardinal ligament complex (Correct answer)
- Arcus tendineus fascia pelvis
Correct answer: Uterosacral and cardinal ligament complex
The uterosacral-cardinal ligament complex provides level I (apical) support to the uterus and upper vagina, and its failure leads to uterine or vaginal vault prolapse.
Question 3: Which pharmaceutical class is contraindicated in patients with narrow-angle glaucoma who present with overactive bladder?
- Beta-3 adrenergic agonists (mirabegron)
- Anticholinergic/antimuscarinic agents (Correct answer)
- Alpha-adrenergic blockers
- Topical estrogen
Correct answer: Anticholinergic/antimuscarinic agents
Anticholinergic agents (e.g., oxybutynin, tolterodine) are contraindicated in narrow-angle glaucoma because they can precipitate acute angle-closure by blocking the iris sphincter muscle.
Question 4: During sacrocolpopexy, which graft material is associated with the best long-term success and lowest recurrence rates?
- Biological porcine dermis
- Cadaveric fascia lata
- Synthetic polypropylene mesh (Correct answer)
- Absorbable polyglycolic acid mesh
Correct answer: Synthetic polypropylene mesh
Permanent synthetic polypropylene mesh used in abdominal/laparoscopic sacrocolpopexy has the highest long-term success rates for apical compartment prolapse repair compared to biologic grafts.
Question 5: A patient with interstitial cystitis/bladder pain syndrome typically presents with which characteristic cystoscopic finding?
- Papillary lesions
- Glomerulations and Hunner lesions after hydrodistension (Correct answer)
- Trabeculation only
- Normal findings
Correct answer: Glomerulations and Hunner lesions after hydrodistension
Classic interstitial cystitis is identified on cystoscopy with hydrodistension by the presence of Hunner lesions (ulcers) or petechial hemorrhages (glomerulations) in the bladder wall.
Question 6: Pelvic floor muscle training (PFMT) reduces stress urinary incontinence episodes by approximately what percentage?
- 10–20%
- 25–35%
- 50–75% (Correct answer)
- 90–100%
Correct answer: 50–75%
Supervised pelvic floor muscle training (Kegel exercises) reduces stress urinary incontinence episodes by 50–75% in motivated patients who are adherent to a structured program.
ABOG ABOG Urogynecology & Pelvic Floor Disorders 2
Sacral neuromodulation (InterStim) is FDA-approved for which condition(s)?