Female Urology
Core concepts
Female urology centers on urinary incontinence, pelvic organ prolapse, and recurrent urinary tract infection. Distinguish stress incontinence (urethral hypermobility or intrinsic sphincter deficiency), urgency incontinence (detrusor overactivity), and mixed incontinence. Understand the role of urodynamics - not mandatory before every surgery but valuable in complex, mixed, or neurogenic cases. Know the midurethral sling as a standard for stress incontinence and the importance of counseling about mesh-related complications. Pelvic organ prolapse assessment uses the POP-Q system; prolapse can mask or cause incontinence (occult stress incontinence after reduction). Recurrent UTI in women requires culture documentation and evaluation for predisposing factors. Fistula (vesicovaginal) after pelvic surgery presents with continuous leakage.
Traps
Questions test the difference between symptom-based diagnosis and urodynamic confirmation, and when urodynamics change management. Occult stress incontinence unmasked after prolapse reduction is a classic trap. Do not attribute all leakage after hysterectomy to overactive bladder - consider fistula. Antibiotic prophylaxis for recurrent UTI is not the same as treating asymptomatic bacteriuria, which generally should not be treated outside pregnancy or before urologic procedures.
Worked example / rule of thumb
A woman with continuous urinary leakage two weeks after hysterectomy: suspect vesicovaginal fistula; evaluate with examination and imaging, not anticholinergics. Rule of thumb: continuous leakage after pelvic surgery equals fistula until excluded.