100+ Free ABU URPS Practice Questions

Urinary Incontinence (SUI, Urge, Mixed, Overflow)

ICS terminology — SUI (involuntary leakage on effort/exertion/sneezing/coughing), urge UI, mixed UI, continuous, overflow. PRIDE trial (NEJM 2009) — 5-10% weight loss reduces SUI episodes by 47%. Q-tip test for urethral hypermobility (>30° angle change). DIPPERS mnemonic for transient incontinence. Recurrent UTI (E. coli ~75-95%; AUA/CUA/SUFU 2019 Guideline — prophylaxis, vaginal estrogen postmenopausal, methenamine, behavioral). Microhematuria workup (cystoscopy + CT urogram in postmenopausal women).

Pelvic Organ Prolapse Surgery

Sacrocolpopexy (gold standard apical repair — type 1 macroporous polypropylene mesh to sacral promontory S1-S2 anterior longitudinal ligament; lowest exposure ~1-3% with robotic/laparoscopic). OPTIMAL trial (JAMA 2014) — sacrospinous vs uterosacral equivalent at 2 yr. CARE (NEJM 2006) — concurrent Burch reduces postop SUI in continent women undergoing sacrocolpopexy. OPUS (NEJM 2012) — concurrent retropubic TVT during vaginal POP repair reduces SUI but increases adverse events. Anterior/posterior colporrhaphy, McCall culdoplasty, colpocleisis (LeFort) for elderly non-sexually active. Posterior compartment defecography (rectocele, enterocele, intussusception).

Pelvic Organ Prolapse Evaluation & POP-Q

POP-Q points: Aa (3 cm proximal to urethral meatus on anterior wall), Ba (most distal anterior wall), C (cervix/cuff), D (posterior fornix if uterus present), Bp/Ap (posterior wall), TVL, GH, PB. Stages 0-IV (III = >1 cm below hymen but ≤TVL-2; IV = essentially complete eversion). Pessary first-line conservative therapy (~60-75% successful) — ring with support stage I-II; Gellhorn for advanced apical; cube must be removed nightly to prevent erosion. PFMT for stage I-II (POPPY trial). Validated PROMs (PFDI-20, PFIQ-7, PISQ-IR, ICIQ-UI SF, UDI-6, IIQ-7). Procidentia hydronephrosis from ureteral kinking.

Anti-Incontinence Procedures

Retropubic TVT (Ulmsten, integral theory) — gold standard reference; bladder perforation ~5%. Transobturator TOT/TVT-O — groin/thigh pain ~6-12%; equivalent continence (TOMUS trial NEJM 2010). Single-incision mini-slings. Burch colposuspension (periurethral fascia to Cooper's/iliopectineal ligament). Autologous fascial pubovaginal sling (rectus or fascia lata) — SISTEr trial (NEJM 2007) higher cure than Burch but more voiding dysfunction. Urethral bulking (Bulkamid polyacrylamide hydrogel, Durasphere) for ISD without hypermobility, mesh avoidance, frail patients. Intraoperative cystoscopy mandatory.

Neurogenic Bladder & OAB Management

AUA/SUFU OAB Guideline 2024 — first-line behavioral (bladder training, fluid/dietary modification, PFM exercises); second-line antimuscarinics (oxybutynin, tolterodine, solifenacin, fesoterodine, darifenacin, trospium) OR beta-3 agonists (mirabegron, vibegron — preferred in dementia/cognitive impairment); third-line intradetrusor onabotulinumtoxinA 100U idiopathic OAB (CIC ~6%) / 200U NDO, sacral neuromodulation S3 (refractory urge UI, urgency-frequency, non-obstructive retention, fecal incontinence — NOT SUI), PTNS 30 min weekly x 12 weeks. Augmentation cystoplasty (detubularized ileum) — long-term mucus/stones/perforation/B12/adenocarcinoma surveillance starting 10 years.

Urodynamics Interpretation

Detrusor overactivity (involuntary detrusor contraction during filling). DLPP ≥40 cm H2O predicts upper-tract deterioration (McGuire). VLPP <60 cm H2O suggests intrinsic sphincter deficiency (ISD); >90 pure hypermobility. Female BOO criteria (Blaivas-Groutz — Qmax <12, Pdet at Qmax >25). Detrusor underactivity vs BOO (low Pdet/prolonged voiding vs high Pdet/low flow). VALUE trial (NEJM 2012) — UDS not required preoperatively for uncomplicated index SUI per AUA Guideline. Indications for UDS: failed prior surgery, mixed UI predominant urge, neurogenic, prolapse beyond hymen, elevated PVR.

Fistula Repair & Urethral Diverticulum

Vesicovaginal fistula — ~75% post-hysterectomy in developed countries; obstetric obstructed labor predominant in low-resource settings. Three-swab/tampon dye test (intravesical methylene blue + oral phenazopyridine) distinguishes vesicovaginal vs ureterovaginal — always image upper tracts (CT urogram). Latzko vaginal vs O'Conor transabdominal/transvesical repair; Martius (labial fat pad — internal/external pudendal blood supply) interposition for complex/recurrent; gracilis for radiation fistula. Catheter 10-21 days postop. Urethral diverticulum 'three Ds' (postcoital dribbling, dysuria, dyspareunia); MRI gold standard. Rectovaginal fistula — obstetric most common in developed countries, Crohn's most common nonobstetric.

Mesh-Related Complications

FDA 2008 Public Health Notification, 2011 Safety Communication, and April 2019 ban on transvaginal mesh for POP repair. Midurethral slings for SUI and abdominal sacrocolpopexy mesh remain available. Mesh exposure (extrusion through vaginal epithelium) ~10% transvaginal, 1-3% sacrocolpopexy with type 1 macroporous polypropylene. Risk factors — smoking, diabetes, postmenopausal status, concomitant total hysterectomy, vaginal incision. Intravesical/intra-urethral mesh erosion presents with recurrent UTI, hematuria, stones — requires excision. Conservative (estrogen + trim <1 cm) vs formal excision. Mandatory preoperative shared decision-making.

Female Pelvic Anatomy

DeLancey three levels — Level I uterosacral-cardinal complex (apical), Level II ATFP paravaginal (lateral, pubic symphysis to ischial spine), Level III perineal body and urogenital diaphragm (distal). Pudendal nerve risk during sacrospinous fixation (place sutures 2 fingerbreadths medial to ischial spine). Ureter at greatest risk near uterine artery in cardinal ligament during hysterectomy ('water under the bridge'). Modified Oxford scale 0-5 for PFM strength; PERFECT scheme. Levator (puborectalis) avulsion — strong recurrence risk factor; 3D/4D translabial ultrasound or MRI confirmatory.

Geriatric Pelvic Floor & Postmenopausal

DIPPERS mnemonic for transient/reversible incontinence in older adults (Delirium, Infection, Pharmaceuticals, Psychological, Excess output, Restricted mobility, Stool impaction). Avoid antimuscarinics in dementia (anticholinergic burden, dementia risk) — beta-3 agonists preferred. GSM/VVA — vaginal estrogen first-line (multidisciplinary in breast cancer); FDA-approved alternatives DHEA prasterone (Intrarosa), oral SERM ospemifene. Nocturia — nocturnal polyuria (>33% 24-hr output at night), OSA-ANP mechanism (CPAP reduces nocturia), evening fluid restriction, treat edema. AUA Microhematuria Guideline (2020/2023) — risk-stratified workup.

Pelvic Pain Syndromes (IC/BPS, Endometriosis, High-Tone PFD)

AUA IC/BPS Guideline — definition (unpleasant bladder sensation >6 weeks without infection/other cause). Hunner-lesion phenotype (5-10%) responds to fulguration/triamcinolone injection. Treatment: First-line behavioral/dietary trigger avoidance (caffeine, alcohol, citrus, tomatoes, spicy, artificial sweeteners); second-line PPS, hydroxyzine, amitriptyline, intravesical DMSO/heparin/lidocaine, manual physical therapy; cyclosporine fifth-line. Endometriosis — chronic pelvic pain, deep dyspareunia, dysmenorrhea, uterosacral nodularity. High-tone pelvic floor dysfunction — pelvic floor PT downtraining (NOT Kegels), diazepam suppositories, trigger-point injections.

Female Sexual Dysfunction

FSFI 19-item validated tool (desire, arousal, lubrication, orgasm, satisfaction, pain). PISQ-IR specific to women with pelvic floor disorders. Vulvodynia multimodal therapy (topical lidocaine, vaginal estrogen, pelvic floor PT with biofeedback, TCAs, gabapentinoids, CBT/sex therapy; vestibulectomy for refractory provoked vestibulodynia). Sexual function generally improved or unchanged after sacrocolpopexy (CARE 7-yr). Dyspareunia from vulvovaginal atrophy — vaginal estrogen, DHEA, ospemifene; vaginal laser (CO2, Er:YAG) NOT FDA-approved for VVA.