Question of the Week # 402

402)  A 68 year old woman with history of Diabetes mellitus is evaluated in your office during routine follow-up visit. She reports that lately she has been experiencing pressure and bulge in her vaginal area and has a sensation of something falling out of her vagina. She denies any fever, burning, frequency or urgency of urination.  She has normal bowel movements and has no problems with defecation. On examination, vitals are stable. Pelvic examination reveals changes consistent with vaginal atrophy and presence of moderate cystocele.   She has marked urinary leakage when she was asked to cough in lithotomy position. Complete blood count, Plasma glucose, Serum electrolytes and Urinalysis are within normal limits. She requests information regarding surgery for vaginal prolapse. Which of the following is the most appropriate statement regarding surgery for her cystocele?

A) Surgery may worsen her Incontinence

B) Surgery may increase urinary obstruction

C) If she were to undergo prolapse surgery, no additional incontinence treatment is needed

D) Surgery may cause defecation problems

E) Surgery is optimal option for her at this time.

11 Responses

  1. B) Surgery may increase urinary obstruction??

  2. c

  3. C

  4. d

  5. c

  6. E.

  7. I think C. ???

  8. a?!!
    pls give d rite answer

  9. a

  10. a

  11. i think the answer is a based on explanation in previous question, a cystocele can compress on urethra and outflow tract therefore reducing urinary incontinence; surgery on prolapse alone with corrective incontinence treatment ie surgery to increase urethral sphincter tone may worse urinary incontinence.

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