URPS Qualifying Exam Preparation

Diagnosis and Exam

• Diagnose and differentiate types of lower urinary tract dysfunction
• Perform comprehensive history and physical exam (e.g. POP-Q; myofascial pelvic exam; pelvic muscle tone, strength, and coordination; pelvic muscle spasm and trigger points)
• Select, perform, and interpret results of initial diagnostic testing (e.g. pad test; post-void residual; urinalysis, culture, and sensitivities; cough stress test)
• Perform and interpret results of advanced diagnostic testing (e.g. urodynamics, cystoscopy)
• Obtain and interpret results of voiding diary tests
• Obtain and utilize results of sleep study tests
• Perform interventions to address lower urinary tract dysfunction
• Counsel patients on lower urinary tract dysfunction pathophysiology and diagnostic testing

Counseling on Efficacy, Risks, and Benefits of Non-Surgical Treatments

• Pelvic floor physical therapy
• Pharmacologic therapy
• Urethral bulking
• Onabotulinum toxin A injection
• Neuromodulation (Posterior Tibial Nerve Stimulation, PTNS)
• Pessaries

Non-Surgical Treatments

• Urethral bulking
• Onabotulinum toxin A injection
• Neuromodulation (Posterior Tibial Nerve Stimulation, PTNS)
• Pessaries

Post-Procedural Management of Non-Surgical Treatments

• Monitor therapeutic effects and adjust treatment
• Manage complications or side effects of non-surgical treatment

Counseling on Efficacy, Risks, and Benefits of Surgical Treatments

• Retropubic suspension
• Midurethral sling
• Autologous fascial sling
• Neuromodulation (Sacral Neurostimulation)

Surgical Treatments

• Retropubic suspension
• Midurethral sling
• Autologous fascial sling
• Neuromodulation (Sacral Neurostimulation)
• Manage complications of surgical treatment

Diagnosis of Bladder Injury

• Cystoscopy
• CT urogram
• Retrograde pyelogram
• Voiding cystourethrogram
• Evaluate for complex fistula

Treatment of Bladder Injury

• Cystotomy repair
• Vesicovaginal fistula repair (vaginal)
• Vesicovaginal fistula repair (minimally invasive)
• Vesicovaginal fistula repair (abdominal)
• Treatment of uterovaginal fistula repair
• Treatment of colovesical fistula
• Interpositional graft

Diagnosis of Ureteral Injury

• Cystoscopy
• CT urogram
• Retrograde pyelogram
• Ureterolysis
• Ureteral catheter / stent

Treatment of Ureteral Injury

• Stent
• Ureteroneocystotomy
• Ureterouretostomy
• Percutaneous nephrostomy tube
• Boari flap
• Psoas hitch
• Interpositional graft

Diagnosis of Urethral Injury

• Cystoscopy
• Voiding cystourethrogram

Treatment of Urethral Injury

• Urethrovaginal fistula repair
• Martius flap

Diagnosis and Exam

• Diagnose and differentiate types of pelvic organ prolapse
• Perform and interpret results of post-void residual tests
• Perform and interpret results of urinalysis, culture, and sensitivities tests
• Counsel patients of pathophysiology and indications and results of additional testing

Non-Surgical Treatments

• Counsel patients regarding efficacy, risks, and benefits of pelvic floor physical therapy
• Counsel patients regarding efficacy, risks, and benefits of pessaries
• Perform pessary fitting
• Counsel patient on management of pessary care
• Manage complications or side effects of non-surgical treatment

Counseling on Efficacy, Risks, and Benefits of Surgical Treatments

• Vaginal hysterectomy
• Minimally invasive (laparoscopic) hysterectomy
• Abdominal hysterectomy
• Anterior compartment native tissue repairs
• Posterior compartment native tissue repairs
• Vaginal mesh and graft augmented repairs
• Open abdominal sacrocolpopexy
• Minimally invasive (laparoscopic) sacrocolpopexy
• Vaginal native tissue apical suspensions
• Minimally invasive (laparoscopic) native tissue apical suspensions
• Hysteropexy
• Rectopexy
• Obliterative procedures

Surgical Treatments

• Vaginal hysterectomy
• Minimally invasive (laparoscopic) hysterectomy
• Abdominal hysterectomy
• Anterior compartment native tissue repairs
• Posterior compartment native tissue repairs
• Vaginal mesh or graft augmented repairs
• Open abdominal sacrocolpopexy
• Minimally invasive (laparoscopic) sacrocolpopexy
• Vaginal native tissue apical suspensions
• Minimally invasive (laparoscopic) native tissue apical suspensions
• Hysteropexy
• Rectopexy
• Obliterative procedures

Complications of Surgical Treatments

Augmentation of Surgical Materials

• Counsel patients regarding different types of mesh and graft materials (e.g. allograft, autograft, xenograft, synthetic)
• Identify and manage complications of mesh and graft materials
• Counsel patients regarding alternatives, risks, benefits, and complications associated with mesh and graft materials

Diagnosis and Exam

• Diagnose and differentiate types of fecal incontinence and defecation disorders
• Perform and interpret results of endoanal ultrasound tests
• Perform and interpret results of pelvic floor ultrasound tests
• Perform and interpret results of anorectal manometry tests
• Obtain and interpret results of defecography tests
• Obtain and utilize results of colonoscopy tests
• Obtain and interpret results of motility studies
• Obtain and interpret results of fistulogram tests
• Obtain and interpret results of CT tests
• Counsel patients on pathophysiology and diagnostic testing of fecal incontinence and defecation disorders

Counseling on Efficacy, Risks, and Benefits of Non-Surgical Treatments

• Pelvic floor physical therapy
• Pharmacologic therapy
• Bulking
• Neuromodulation (Posterior Tibial Nerve Stimulation, PTNS)
• Pessaries

Non-Surgical Treatments

• Bulking
• Neuromodulation (Posterior Tibial Nerve Stimulation, PTNS)
• Pessary fitting and placement

Post-Procedural Management of Non-Surgical Treatments

• Monitor therapeutic effects and adjust treatment
• Manage complications or side effects of non-surgical treatment

Surgical Treatments

• Counsel patients regarding efficacy, risks, and benefits of the surgical treatment: Neuromodulation (Sacral neurostimulation)
• Counsel patients regarding efficacy, risks, and benefits of the surgical treatment: Rectovaginal fistula repair
• Counsel patients regarding efficacy, risks, and benefits of the surgical treatment: Anal sphincteroplasty
• Perform neuromodulation (Sacral neurostimulation)
• Perform rectovaginal fistula repair
• Perform anal sphincteroplasty
• Manage complications or adverse effects of surgical treatment

Diagnosis and Exam

• Diagnose and differentiate types of congenital anomalies
• Obtain and interpret results of diagnostic testing (e.g. ultrasound, MRI, karyotype, hormone testing, hysteroscopy)
• Counsel patients on urogenital anomalies including pathosphysiology and diagnostic testing

Non-Surgical Treatments

• Counsel patients regarding timing, efficacy, risks, and benefits of non-surgical treatments (e.g. expectant management, vaginal dilation)

Counseling on Timing, Efficacy, Risks, and Benefits of Neovagina Surgical Procedures

• McIndoe
• Laparoscopic Vacchietti
• Laparoscopic Davydov
• Resection of septum

Neovagina Surgical Procedures

• McIndoe
• Laparoscopic Vacchietti
• Laparoscopic Davydov
• Resection of septum

Complications or Adverse Effects of Neovagina Surgical Procedures

• Manage complications or adverse effects of neovagina surgical procedures

Diagnosis and Exam for Urethral Mass

• Diagnose and differentiate types of urethral masses
• Perform and interpret results of pelvic floor ultrasound
• Perform and interpret results of cystoscopy diagnostic testing
• Obtain and interpret MRI results
• Counsel patients on urethral mass pathophysiology and diagnostic testing
• Manage complications or adverse effects of treatment

Counseling on Efficacy, Risks, and Benefits on Treatment Options for Urethral Mass

• Observation
• Drainage
• Excision
• Urethral reconstruction
• Concomitant anti-incontinence procedure

Treatment Options for Urethral Mass

• Observation
• Drainage
• Excision
• Urethral reconstruction
• Concomitant anti-incontinence procedure

Urinary Tract Infection (UTI)

• Evaluate and diagnose UTIs
• Manage acute, chronic, and complicated UTIs
• Diagnose and treat urogenital atrophy

Hematuria

• Obtain and interpret results of initial diagnostic testing (e.g. post-void residual; urinalysis, culture, and sensitivities; cystoscopy and biopsy)
• Obtain and interpret results of advanced diagnostic testing (e.g. CT urogram/IVP, urine cytology, renal ultrasound)
• Counsel patients on hematuria pathophysiology and diagnostic testing

• Describe and apply knowledge of anatomy to safely perform surgery and avoid complications (e.g. vascular and nerve supply, bladder, urethra, anatomic supports, ureter, anal sphincter, rectum, small bowel, large bowel)
• Describe and apply knowledge of central and peripheral nervous system anatomy as it applies to the etiology and treatment of pelvic floor disorders (urinary tract dysfunction, fecal incontinence)

• Identify and perform preoperative testing depending on patient comorbidities (e.g. immunosuppression, diabetes, cardiovascular disease)
• Identify and perform preoperative testing depending on patient population (e.g. geriatric)
• Manage perioperative anticoagulation (e.g. prevention of VTE, chronic anticoagulation)
• Position patient to decrease adverse outcomes
• Utilize intraoperative techniques to minimize vascular, visceral, and urinary tract injuries
• Manage intraoperative injuries (e.g. vascular, bowel, urinary tract, and nerve)
• Manage postoperative medical and surgical complications
• Manage prolonged urinary catheterization

Ethics and Professionalism

• Systematically engage in practice review to identify health disparities
• When engaged in shared clinical decision making, incorporate patient, family, and cultural considerations in making treatment recommendations
• When providing care for patients, considers psychological, sexual, and social implications of various treatment options

Patient Safety

• Systematically analyze the practice for safety improvements (e.g. root cause analysis)
• Systematically engage in practice reviews for safety improvements (e.g. root cause analysis)
• Incorporate the standard use of procedural briefings, "time outs", and debriefings in clinical practice
• Participate in the review of sentinel events, reportable events, and near misses
• Implement universal protocols (e.g. bundles, checklists) to help ensure patient safety

Interpersonal Communication Skills

• Communicate to patient and family regarding adverse outcomes and medical errors
• Demonstrate sensitivity and responsiveness when communicating with a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation
• Provide comprehensive information when referring patients to other professionals

Systems-Based Practice

• Incorporate considerations of cost awareness and risk-benefit analysis in patient care
• Provide care with multidisciplinary teams to promote safety and optimize patient outcomes

Patient-Based Learning and Improvement

• Design or participate in practice or hospital quality improvement activities

Evidence-Based Medicine

• Incorporate evidence-based practices and national guidelines to improve practice patterns and outcomes
• Implement evidence-based protocols to enhance recovery after surgery (ERAS)