Female Urology
Core concepts
Female urology questions cluster around incontinence type, prolapse, and the overactive bladder.
Stress urinary incontinence: leakage with effort, due to sphincteric or support failure. Know the difference between urethral hypermobility and intrinsic sphincter deficiency, and that mid-urethral sling is the commonest surgical option. Trap: operating on urgency-predominant symptoms without urodynamics.
Overactive bladder and detrusor overactivity: urgency, frequency, nocturia, with or without urge incontinence. First-line is behavioural and bladder training; then antimuscarinics or beta-3 agonists; then intravesical botulinum toxin, sacral neuromodulation or augmentation. Trap: confusing OAB with stress incontinence; and forgetting that antimuscarinics can worsen retention.
Pelvic organ prolapse: understand the POP-Q system and that prolapse is staged by the leading edge relative to the hymen. Know that conservative management (pessary, pelvic floor muscle training) precedes surgery, and that mesh use is restricted.
Fistula and urethral diverticulum: vesicovaginal fistula after pelvic surgery or radiotherapy; urethral diverticulum presenting as dribbling, dysuria and a tender anterior vaginal wall swelling.
Recurrent UTI in women: distinguish uncomplicated from complicated, and know when to image.
Worked rule of thumb
A woman with leakage on coughing and no urgency: stress incontinence. If she also has urgency and frequency, treat the OAB component first and reassess - the trap answer is to proceed straight to a sling.
Exam traps
- Operating for stress incontinence when urgency dominates.
- Forgetting POP-Q staging.
- Missing a urethral diverticulum in a woman with post-micturition dribbling.
- Assuming all recurrent UTIs need imaging.