LATEST FEMALE PELVIC MEDICINE &
RECONSTRUCTIVE SURGERY (FPMRS)
CERTIFICATION EXAM OFFERED BY American
Board of Urology / American Board of
Obstetrics & Gynecology style | COMPLETE
EXAM Q&A WITH RATIONALES
1. A 65-year-old female presents with a sensation of
vaginal bulging. On examination, the anterior vaginal
wall extends 2 cm beyond the hymen with Valsalva.
Which stage of pelvic organ prolapse (POP) is this
according to the POP-Q system?
A) Stage I
B) Stage II
C) Stage III
D) Stage IV
Correct answer: B
Rationale: POP-Q Stage II: leading edge of prolapse
between 1 cm above the hymen and 1 cm below the
hymen (≤1 cm beyond hymen).
2. A 72-year-old female with mixed urinary
incontinence (stress and urge) has failed
conservative management. Urodynamics
,demonstrate detrusor overactivity with no stress
leakage. Which is the most appropriate next step?
A) Anticholinergic (oxybutynin) or beta-3 agonist
(mirabegron)
B) Sling procedure (mid-urethral sling)
C) Pelvic floor physical therapy
D) Botulinum toxin (onabotulinumtoxinA) to detrusor
Correct answer: A
Rationale: Mixed incontinence with predominant urge
and detrusor overactivity is treated initially with
anticholinergic or beta-3 agonist.
3. A 55-year-old female with stress urinary
incontinence (SUI) and a positive cough stress test
undergoes urodynamics. Which finding is an
indication for preoperative testing before sling
surgery?
A) Maximum urethral closure pressure (MUCP) 40
cmH2O
B) Valsalva leak point pressure (VLPP) 60 cmH2O
C) Detrusor overactivity
D) Post-void residual (PVR) 50 mL
Correct answer: C
,Rationale: Detrusor overactivity (DO) on urodynamics
may predict worse outcomes or need for combined
treatment.
4. A 68-year-old female with stage III anterior vaginal
prolapse (cystocele) and stress incontinence
undergoes a sacrocolpopexy. Which mesh material is
most commonly used for this procedure?
A) Polypropylene (Type I macroporous)
B) Polytetrafluoroethylene (PTFE, Gore-Tex)
C) Polyester (Dacron)
D) Polyglactin (Vicryl)
Correct answer: A
Rationale: Type I macroporous polypropylene mesh
is the standard for sacrocolpopexy due to low
infection and erosion rates.
5. A 70-year-old female with a history of hysterectomy
presents with a symptomatic apical prolapse (point C
at +3 cm). Which is the most appropriate surgical
procedure?
A) Sacrocolpopexy (abdominal or laparoscopic)
B) Vaginal hysterectomy (no uterus present)
C) Colpocleisis (LeFort)
, D) Anterior colporrhaphy
Correct answer: A
Rationale: Apical prolapse after hysterectomy is best
treated with sacrocolpopexy (mesh) or uterosacral
ligament suspension.
6. A 45-year-old female with urge incontinence and
normal neurologic exam is started on oxybutynin. She
develops dry mouth and constipation. Which is the
most appropriate next step?
A) Switch to mirabegron (beta-3 agonist)
B) Increase oxybutynin dose
C) Add a laxative
D) Discontinue all medications
Correct answer: A
Rationale: Mirabegron has fewer anticholinergic side
effects (dry mouth, constipation, cognitive effects)
than oxybutynin.
7. A 62-year-old female presents with recurrent
urinary tract infections (UTIs) (3 in the past 6
months). She has a large cystocele (stage III) and a
post-void residual (PVR) of 150 mL. Which is the most
appropriate next step?
RECONSTRUCTIVE SURGERY (FPMRS)
CERTIFICATION EXAM OFFERED BY American
Board of Urology / American Board of
Obstetrics & Gynecology style | COMPLETE
EXAM Q&A WITH RATIONALES
1. A 65-year-old female presents with a sensation of
vaginal bulging. On examination, the anterior vaginal
wall extends 2 cm beyond the hymen with Valsalva.
Which stage of pelvic organ prolapse (POP) is this
according to the POP-Q system?
A) Stage I
B) Stage II
C) Stage III
D) Stage IV
Correct answer: B
Rationale: POP-Q Stage II: leading edge of prolapse
between 1 cm above the hymen and 1 cm below the
hymen (≤1 cm beyond hymen).
2. A 72-year-old female with mixed urinary
incontinence (stress and urge) has failed
conservative management. Urodynamics
,demonstrate detrusor overactivity with no stress
leakage. Which is the most appropriate next step?
A) Anticholinergic (oxybutynin) or beta-3 agonist
(mirabegron)
B) Sling procedure (mid-urethral sling)
C) Pelvic floor physical therapy
D) Botulinum toxin (onabotulinumtoxinA) to detrusor
Correct answer: A
Rationale: Mixed incontinence with predominant urge
and detrusor overactivity is treated initially with
anticholinergic or beta-3 agonist.
3. A 55-year-old female with stress urinary
incontinence (SUI) and a positive cough stress test
undergoes urodynamics. Which finding is an
indication for preoperative testing before sling
surgery?
A) Maximum urethral closure pressure (MUCP) 40
cmH2O
B) Valsalva leak point pressure (VLPP) 60 cmH2O
C) Detrusor overactivity
D) Post-void residual (PVR) 50 mL
Correct answer: C
,Rationale: Detrusor overactivity (DO) on urodynamics
may predict worse outcomes or need for combined
treatment.
4. A 68-year-old female with stage III anterior vaginal
prolapse (cystocele) and stress incontinence
undergoes a sacrocolpopexy. Which mesh material is
most commonly used for this procedure?
A) Polypropylene (Type I macroporous)
B) Polytetrafluoroethylene (PTFE, Gore-Tex)
C) Polyester (Dacron)
D) Polyglactin (Vicryl)
Correct answer: A
Rationale: Type I macroporous polypropylene mesh
is the standard for sacrocolpopexy due to low
infection and erosion rates.
5. A 70-year-old female with a history of hysterectomy
presents with a symptomatic apical prolapse (point C
at +3 cm). Which is the most appropriate surgical
procedure?
A) Sacrocolpopexy (abdominal or laparoscopic)
B) Vaginal hysterectomy (no uterus present)
C) Colpocleisis (LeFort)
, D) Anterior colporrhaphy
Correct answer: A
Rationale: Apical prolapse after hysterectomy is best
treated with sacrocolpopexy (mesh) or uterosacral
ligament suspension.
6. A 45-year-old female with urge incontinence and
normal neurologic exam is started on oxybutynin. She
develops dry mouth and constipation. Which is the
most appropriate next step?
A) Switch to mirabegron (beta-3 agonist)
B) Increase oxybutynin dose
C) Add a laxative
D) Discontinue all medications
Correct answer: A
Rationale: Mirabegron has fewer anticholinergic side
effects (dry mouth, constipation, cognitive effects)
than oxybutynin.
7. A 62-year-old female presents with recurrent
urinary tract infections (UTIs) (3 in the past 6
months). She has a large cystocele (stage III) and a
post-void residual (PVR) of 150 mL. Which is the most
appropriate next step?
