Urogynecology and Pelvic Reconstructive Surgery
Core concepts
Urogynecology covers pelvic floor disorders: urinary incontinence (stress, urgency, mixed), pelvic organ prolapse, fecal incontinence, and overactive bladder. Understand the anatomy of the pelvic floor and continence mechanism, the evaluation of incontinence (history, exam, urinalysis, postvoid residual, urodynamics when indicated), and conservative versus surgical management. Know the types of prolapse (anterior, posterior, apical, uterine), the POP-Q system conceptually, and the role of pessaries, pelvic floor muscle training, and reconstructive surgery.
Traps
- Stress vs. urgency incontinence: stress is leakage with increased intra-abdominal pressure; urgency is associated with a sudden urge. Mixed incontinence requires treating the dominant component first.
- Postvoid residual: elevated PVR suggests retention or obstruction and changes management.
- Prolapse staging: POP-Q uses defined points; questions often test that apical prolapse is common and must be addressed in repair.
- Mesh complications: synthetic mesh has specific indications and risks; transvaginal mesh for prolapse has restricted use.
- Fecal incontinence: evaluate for sphincter injury, especially after obstetric anal sphincter tears.
Worked example / rule of thumb
A patient leaks with coughing and sneezing. Rule of thumb: stress incontinence is diagnosed clinically and first-line management is pelvic floor muscle training; urodynamics are reserved for complex or surgical candidates.
Study strategy
Create a symptom-based algorithm for incontinence and a diagram-based review of prolapse compartments.