EUROPEAN UROLOGY SUPPLEMENTS 17 (2018) 126–128
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CME Questions for European Urology Supplements Volume 17
(2018) pp. 80–125
CME questions
All CME articles can be read and answered for CME credit
at http://www.eu-acme.org/europeanurology/
1. The following structures provide support to the
pelvic floor, except:
A. Sigmoid colon.
B. Uterosacral ligaments.
C. Levator ani muscles.
D. Vagina wall.
2. Biomechanics is a field of science that applies
classical engineering techniques to understand the
function of biological tissues. Regarding biomechan-
ics which statement is not correct?
A. Biomechanical tools are important to help to compare
and contrast how pelvic floor tissues change as a
function of risk factors and disease states.
B. Active and passive biomechanical tissue
properties can be measured using well character-
ized ex vivo destructive techniques or new in vivo
methods.
C. Only passive biomechanical properties are impor-
tant to understand the behavior of pelvic floor
support tissues.
D. Passive biomechanical properties determine the
ability of the tissue to transmit loads or resist
deformations without generating external forces.
3. Which of the following statements about mechanical
properties is not correct?
A. The mechanical properties of a tissue can be
obtained from the stress-strain curve after perform-
ing an ex vivo uniaxial tensile test.
B. Structural and mechanical properties of a tissue are
always the same.
C. The mechanical properties normalize to
individual specimen dimensions, so they are
sensitive to the location and the size of the tissue
biopsy.
D. To accurately calculate the mechanical properties,
the tissues need to have sufficient aspect ratio
(length/width).
https://doi.org/10.1016/j.eursup.2018.02.003
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4. What information can be obtained by performing a
tensile tissue test?
A. Stress-strain curve.
B. Tissue stretch (l).
C. Stiffness.
D. All of the above.
5. Pelvic floor disorders are characterized by weaken-
ing of the pelvic floor support which is directly
related to the biomechanical properties of the
tissues. Which statement is not correct?
A. Parity does not affect the passive biomechanical
properties any of the pelvic floor supportive tissues.
B. With age the ligaments and the vaginal tissues
become more rigid.
C. Anterior vaginal wall tissues of women with pelvic
organ prolapse are more rigid and stiff than those
from women without prolapse.
D. The anterior vaginal wall mucosa of women with
pelvic organ prolapse is less compliant than in
women without prolapse.
6. To confirm the diagnosis of pelvic organ prolapse a
standardized method to measure the biomechanical
properties of the pelvic floor support tissues can be
used. Which of the following methods can be used?
A. Uniaxial tensile test.
B. The vaginal tactile imaging device.
C. Tripod-mounted computer-controlled linear ser-
voactuator.
D. None of the above.
7. Urodynamics definitions: which statement is
correct?
A. Urodynamics are noninvasive tests and measure-
ments that can be used to study the (dys)functions
of the lower urinary tract.
B. Bladder compliance is defined as the change in
bladder pressure per unit change in volume.
C. Underactive bladder is difficult to define, but
detrusor underactivity is the urodynamic finding
of an impaired bladder contraction, resulting in
prolonged or incomplete bladder emptying.
 EUROPEAN UROLOGY SUPPLEMENTS 17 (2018) 126–128
D. Overactive bladder syndrome is defined as an
increased daytime micturition frequency with or
without nocturia, usually accompanied by urinary
urgency and urgency urinary incontinence.
8. Urodynamics technique: which statement is correct?
A. The intraabdominal pressure is usually measured
with a fully liquid-filled closed balloon catheter in
the rectum.
B. The urodynamic pressure transducers should be
zero’d after closing the circuit (ie, zero’d to the
intravesical pressure).
C. During filling cystometry, the bladder can be filled
with saline, contrast, air, or urine (in ambulatory
urodynamics).
D. In practice, the filling rate during conventional
cystometry is usually in the nonphysiological
range.
9. Urodynamics indications: which statement is correct?
A. In a 23-yr-old woman with unexplained urinary
retention, video-urodynamics are indicated prior to
proceeding to further interventions.
B. In a 33-yr-old woman with overactive bladder
symptoms resistant to conservative interventions
and medical therapy, urodynamics can be limited to
a filling cystometry.
C. In a 43-yr-old woman with stress urinary inconti-
nence and recurrent urinary tract infections, surgi-
cal intervention can safely be planned without
performing urodynamics if conservative interven-
tions fail to improve her symptoms.
D. In a 53-yr-old woman with pelvic organ prolapse
and stress urinary incontinence, urodynamics are
not indicated prior to prolapse surgery.
10. Urodynamics interpretation: which statement is
wrong?
A. Filling cystometry in a spina bifida patient shows a
reduction in bladder compliance with a detrusor
leak point pressure of 15 cmH2O and no vesico-
ureteric reflux. She can therefore be considered safe
from upper tract deterioration.
B. A woman with pure stress urinary incontinence,
urethral hypermobility, a mean urethral closure
pressure of 42 cmH2O and an abdominal leak point
pressure of 97 cmH2O most likely does not suffer
from intrinsic sphincter deficiency.
C. A woman with a low (5 cmH2O) detrusor pressure
during voiding, a normal flow rate (18 ml/s) and a
postvoid residual of 30 ml can be diagnosed with
detrusor underactivity.
D. Detrusor overactivity found on ambulatory urody-
namics in a woman with pure stress urinary
incontinence does not always require treatment.
11. Urodynamics recommendations: which statement is
correct?
A. Every female patient attending an invasive urody-
namic investigation should be provided with
prophylactic antibiotics, as the risk of a symptom-
atic urinary tract infection after the test is close
to 5%.
127
B. Using cut-offs for maximum flow rate and detrusor
pressure at maximum flow rate, and the use of
video-urodynamics, have a good concordance in the
diagnosis of bladder outlet obstruction in women.
C. In women there is a very strong correlation between
symptoms of overactive bladder and detrusor
overactivity.
D. You can safely classify a woman with a
mean urethral closure pressure of 10 cmH2O and
an abdominal leak point pressure of 30 cmH2O to
have very severe stress urinary incontinence. The
success rate of any surgical intervention for her
stress incontinence is therefore very low.
12. Urodynamics overall: which statement is correct?
A. As ambulatory urodynamics are performed with
natural bladder filling and during a patient’s normal
activity, they have better reproducibility and are
easier interpretable than conventional urody-
namics.
B. The mean urethral closure pressure is determined
on urethral pressure profilometry while the patient
is performing a pelvic squeeze to stop urine from
leaking during cough or Valsalva.
C. Abdominal and detrusor leak point pressures can
only be determined if urine leaks during cough or
Valsalva.
D. Several nomograms exist for uroflowmetry: Siroky,
Bristol, and Liverpool. The Liverpool nomogram is
specifically designed to evaluate flow studies in
women.
13. The integral theory of pelvic floor function states
that pelvic organ prolapse, chronic pelvic pain as
well as
A. Pelvic organ prolapse and chronic pelvic pain are
caused by lax suspensory ligaments.
B. Bladder and bowel dysfunction are caused by
increased ligament stiffness.
C. Four oppositely acting forces are responsible for
normal pelvic floor support aned functipon.
D. Replacement of stiff ligaments can cure bladder
dysfunction.
14. Which statement regarding the integral theory is
correct?
A. Application of the integral theory led to the
development of the mid-urethral sling (tension-free
vaginal tape).
B. The application of the integral theory does involve
the use of vaginal mesh repair.
C. Hysterectomy remains a part of the integral theory
approach to prolapse repair.
D. Using tension-free vaginal tape and an anterior
mesh together is an appll,ication of the integral
theory.
15. The integral theory of pelvic floor function views a
ligament-based arch as the anatomical system that
supports the function of the pelvic floor in women.
The anatomical cornerstone of this arch is
A. The posterior upper dome of the vagina.
B. The uterus.
128 EUROPEAN UROLOGY SUPPLEMENTS 17 (2018) 126–128

C. The posterior sacral attachment of the rectum. B. Transobturator sling – 4.5%.

D. The pubo-vesical ligamnets in females. C. Retropubic sling – 1.8%.
16. According to the integral theory five main pelvic D. Burch procedure – 4.8%.
ligaments can be repaired. Which of the following is 24. Which statement regarding the cure and compli-
not among those? cation rates of different tape procedures is not
A. Arcus tendinous fascia pelvis. correct?
B. Cardinal ligament. A. The subjective cure rate of the retropubic mid-
C. Uterosacral ligament. urethral sling is not statistically better than that of
D. Sacrospinous ligament. the transobturatoric sling.
17. Which statement about the ‘‘tethered vagina syn- B. The retropubic mid-urethral sling has higher objec-
drome’’ is not correct? tive cure rates than the transobturator sling.
A. Scarring of the bladder neck area of the upper vagina C. With the transobturator approach, the outside-in
leads to increased forward forces that open the technique has fewer vaginal injuries than the inside-
urethra instead of closing them. out technique.
B. It occurs in women after successful repair of D. The retropubic mid-urethral sling has a higher rate
vescovaginal fistula. of bladder injuries than the transobturator sling.
C. Release of the scarred surroundings of the urethra 25. The lifetime risk of a woman needing an operation
can lead to cure. for prolapse by the age of 80 is less than
D. Symptoms are urethral and fecal incontinence. A. 20%.
18. Which is the most important risk factor for B. 30%.
developing pelvic organ prolapse or urinary stress C. 40%.
incontinence in women? D. 50%.
A. BMI > 30. 26. Regarding the statement that the ‘‘use of a polypro-
B. Having undergone pelvic surgery. pylene mesh for anterior compartment prolapse
C. Vaginal delivery. is associated with a significant reduction in
D. Heavy lifting and strenuous activities. objective and subjective prolapse’’, which answer
19. Damage to the levator ani muscle will lead to: is correct?
A. Widening of the levator hiatus. A. The statement is correct.
B. Loss and dysfunction of the arcus tendinous fascia B. The statement is not correct.
pelvis. C. This depends entirely on the case.
C. Fibrotic changes reducing the levator hiatus in size. D. Meshes should no longer be used.
D. Compensatory mechanisms that prevent prolapse 27. What is the average rate of mesh exposure (arrosion)
over time. with polypropylene meshes for anterior prolapse
20. Which investigations should be performed prior to repair?
surgical procedure of treating SUI? A. 2%.
A. History. B. 5%.
B. Micturition diary. C. 11%.
C. Pad test combined with postvoid residual. D. 15%.
D. All of the above. 28. What is roughly the success rate of vaginal oblitera-
21. Which statement regarding the differences between tive procedures or colpocleisis?
the retropubic mid-urethral sling (MUS) and the A. 90–100%.
transobturator tape (TOT) is not correct? B. 80–90%.
A. The subjective and overall cure rates between MUS C. 70–80%.
and TOT show no statistically significant differences. D. 60–70%.
B. Objective cure rates are higher with the MUS in 29. What is the approximate incidence of de novo stress
comparison with those of the TOT. incontinence following prolapse surgery?
C. Retropubic MUS has a higher rate of bladder injuries. A. 10%.
D. Retreatment rates are higher with the retropubic MUS. B. 20%.
22. What is the main reason for developing stress C. 30%.
urinary incontinence? D. 40%.
A. Loss of smooth muscle in the bladder neck. 30. Which if the following procedures in the manage-
B. Hormonal changes of pregnancy. ment of vault prolapse has the best outcomes with
C. Laxity or looseness of connective tissue supporting low rates of recurrence?
the sphincteric mechanism. A. Uterosacral fixation.
D. Vaginal deliveries. B. Sacrospinous fixation.
23. Which statement about the average retreatment C. Sacrocolpopexy.
rates for different types of surgery for stress urinary D. McCall Culdoplasty.
incontinence is not correct?
A. Autologous sling – 2.6%.