Female Urology and Voiding Dysfunction
What this domain tests
This domain tests the classification of urinary incontinence, overactive bladder, pelvic organ prolapse, and neurogenic bladder, plus the appropriate use and interpretation of urodynamics.
Core rules and concepts
- Stress urinary incontinence is leakage with increased abdominal pressure; urge incontinence is associated with urgency; mixed incontinence has both. Confirm with history, examination, voiding diary, and postvoid residual.
- Pelvic organ prolapse is described with the POP-Q system, which quantifies anterior, posterior, and apical compartment descent relative to the hymen.
- Overactive bladder is urgency, frequency, and nocturia, with or without urgency incontinence, after excluding infection and other causes. First-line care is behavioral therapy plus pelvic floor training; antimuscarinics or beta-3 agonists follow.
- Urodynamics assess detrusor overactivity, compliance, capacity, and pressure-flow. Neurogenic bladder requires attention to high storage pressure and incomplete emptying, which threaten the upper tracts.
- Stress incontinence surgery, including midurethral sling, is considered after conservative therapy and appropriate evaluation.
Worked example
A 55-year-old woman leaks with coughing and sneezing, has no urgency, and empties completely. Reasoning: this is stress urinary incontinence. Start pelvic floor muscle training and weight management; if she fails, a midurethral sling is reasonable after counseling. Urodynamics are not mandatory for uncomplicated cases.
Traps
Do not operate for stress incontinence when the dominant symptom is urgency. Do not ignore elevated postvoid residual. Do not assume prolapse is asymptomatic; assess compartment and function.