NBME7......................urinary incontinence - usmlerock99

[ArchivalUser]

43.
A 42-year-old woman comes to the physician because of intermittent loss of small amounts of urine over the past 3 weeks. Her symptoms occur only after voiding; she is otherwise asymptomatic. Pelvic examination shows a 3-cm, midline, cystic, tender mass in the midthird of the vagina. Urinalysis is within normal limits. Her postvoid residual volume is 50 mL. Which of the following is the most likely diagnosis?

A
)
Interstitial cystitis

B
)
Neurogenic bladder

C
)
Stress incontinence

D
)
Urethral diverticulum

E
)
Urethral syndrome

F
)
Urinary tract infection

G
)
Vesicovaginal fistula

[ArchivalUser]

C. Stress Incontinence. I think the patient has a cystocele.

[ArchivalUser]

answer is urethral diverticulum.

[ArchivalUser]

D..............

[ArchivalUser]

Presenting symptoms of urethral diverticula are :postvoid dribbling, dysuria, and dyspareunia (known as the 3 D s).

Irritative voiding symptoms, such as urinary frequency, urgency, and dysuria, are most common.

[ArchivalUser]

Symptoms of urethral diverticulum can often be confused with other disorders such as interstitial cystitis, overactive bladder, and carcinoma in situ. Patients who have irritative voiding symptoms that do not respond to medical therapy should trigger a high index of suspicion for urethral diverticulum.

Interstitial cystitis is a clinical syndrome characterized by daytime and nighttime urinary frequency, urgency, and pelvic pain of unknown etiology.
painful bladder syndrome (suprapubic pain with bladder filling associated with increased daytime and nighttime frequency, in the absence of proven urinary infection or other obvious pathology) and reserves the diagnosis of interstitial cystitis for patients with characteristic cystoscopic and histologic features of the condition

[ArchivalUser]

D for sure

[ArchivalUser]

It is D.
Je suis d'accord.

It is a classical case of Urethral Diverticulum, exactly as depicted in books. And it is also a rare diagnosis. There's a few other threads with wrong answers.