Membership of the Royal College of Obstetricians and Gynaecologists (MRCOG) Urogynaecology and Gynaecological Oncology Syllabus

Urogynaecology and Gynaecological Oncology syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Urogynaecology and Gynaecological Oncology in Membership of the Royal College of Obstetricians and Gynaecologists (MRCOG), not a summary of it.

1. 1

   Urinary Incontinence and Bladder Dysfunction

   5 topics

   • Assessment of urinary incontinence
     • History, examination and bladder diaries
     • Urodynamic investigation
   • Stress urinary incontinence management
     • Conservative and surgical options
   • Overactive bladder and urgency incontinence
   • Voiding dysfunction and recurrent urinary infection
   • Bladder pain syndrome and fistulae
2. 2

   Pelvic Organ Prolapse

   3 topics

   • Classification and assessment (POP-Q)
   • Conservative management and pessaries
   • Surgical management of prolapse
     • Vaginal and abdominal approaches
     • Complications and mesh issues
3. 3

   Pre-invasive Disease and Screening

   4 topics

   • Cervical screening programme and HPV testing
   • Cervical intraepithelial neoplasia and colposcopy
   • Vulval and vaginal intraepithelial neoplasia
   • Endometrial hyperplasia
4. 4

   Gynaecological Cancers

   5 topics

   • Cervical cancer
     • Staging, treatment and prognosis
   • Endometrial and uterine cancers
   • Ovarian and fallopian tube cancer
     • Risk assessment, RMI and CA125
     • Surgery and chemotherapy principles
   • Vulval and vaginal cancer
   • Principles of oncology care
     • Multidisciplinary team working and staging systems
     • Palliative and supportive care
5. 5

   Gynaecological Surgery and Procedures

   5 topics

   • Pre-operative assessment and consent
   • Minimal access surgery
     • Laparoscopy: technique and complications
     • Hysteroscopy: diagnostic and operative
   • Open and vaginal gynaecological surgery
   • Surgical complications and their management
   • Enhanced recovery and post-operative care

Urogynaecology and Gynaecological Oncology flashcards for Membership of the Royal College of Obstetricians and Gynaecologists (MRCOG)

21 of 50 cards from the Urogynaecology and Gynaecological Oncology deck — real questions with worked answers.

1. What are the first-line investigations in the assessment of a woman presenting with urinary incontinence?

   History (including symptom severity and impact on quality of life), examination (including cough stress test and assessment for prolapse), a urinalysis/MSU to exclude infection, a bladder diary (frequency-volume chart) for at least 3 days, and assessment of post-void residual volume.

2. When is urodynamic testing (multichannel cystometry) indicated before surgery for urinary incontinence?

   When there is clinical uncertainty about the diagnosis, symptoms of overactive bladder coexisting with stress incontinence (mixed symptoms), voiding dysfunction, previous failed incontinence surgery, or anterior/apical prolapse, before invasive surgical treatment is offered.

3. Define urodynamic stress incontinence.

   The involuntary leakage of urine during increased intra-abdominal pressure (e.g. coughing or exertion) in the absence of a detrusor contraction, demonstrated objectively on urodynamic testing.

4. What is the recommended first-line management for stress urinary incontinence?

   A trial of at least 3 months of supervised pelvic floor muscle training comprising at least 8 contractions performed 3 times per day, along with lifestyle advice (weight loss if BMI > 30, reduce caffeine, manage fluid intake).

5. What is the surgical option of choice for stress urinary incontinence and what are the alternatives?

   Historically the retropubic mid-urethral tape (TVT); however, due to mesh safety concerns, alternatives now offered include colposuspension (open or laparoscopic) and autologous rectus fascial sling. Duloxetine may be offered if surgery is declined.

6. Define overactive bladder (OAB) syndrome.

   Urinary urgency, usually with frequency and nocturia, with or without urgency urinary incontinence, in the absence of urinary tract infection or other obvious pathology.

7. What is the stepwise pharmacological management of overactive bladder?

   First-line is bladder training for at least 6 weeks plus lifestyle advice; second-line is an antimuscarinic (e.g. oxybutynin avoided in frail elderly, or solifenacin/tolterodine) or the beta-3 agonist mirabegron; refractory cases may receive intravesical botulinum toxin A, percutaneous tibial nerve stimulation, or sacral neuromodulation.

8. Why is immediate-release oxybutynin avoided in frail older women?

   Because of its anticholinergic burden, which increases the risk of cognitive impairment, falls, confusion and contributes to total anticholinergic load; mirabegron or alternative agents are preferred.

9. What is the mechanism of action of mirabegron and a key contraindication?

   Mirabegron is a beta-3 adrenoceptor agonist that promotes detrusor relaxation and bladder storage; it is contraindicated in severe uncontrolled hypertension (blood pressure must be monitored).

10. What post-void residual volume suggests significant voiding dysfunction?

    A persistently elevated residual, commonly taken as greater than 100 mL (or > 1/3 of voided volume); chronic retention is often considered when residuals exceed 200-300 mL, warranting investigation for outflow obstruction or detrusor underactivity.

11. How is recurrent urinary tract infection in women defined?

    Two or more proven UTIs in 6 months, or three or more proven UTIs in 12 months.

12. List management strategies for recurrent UTI in women.

    Behavioural/lifestyle advice and adequate hydration; vaginal oestrogen in postmenopausal women; consideration of antibiotic prophylaxis (single nightly dose or post-coital); non-antibiotic options such as D-mannose or methenamine hippurate may be considered.

13. What are the classic clinical features and diagnostic approach for bladder pain syndrome (interstitial cystitis)?

    Chronic suprapubic/bladder pain related to bladder filling, relieved by voiding, with frequency and urgency, in the absence of infection. It is a diagnosis of exclusion; cystoscopy may show Hunner's lesions or glomerulations after hydrodistension.

14. What is the most common cause of vesicovaginal fistula worldwide versus in high-income countries?

    Worldwide the commonest cause is obstructed labour (ischaemic pressure necrosis); in high-income countries it is most often iatrogenic, typically following gynaecological surgery (e.g. hysterectomy) or pelvic radiotherapy/malignancy.

15. In the POP-Q system, what reference point defines the zero plane and how are points anterior/superior versus distal expressed?

    The hymen is the fixed reference point (zero). Points proximal/above the hymen are recorded as negative values (in cm) and points distal/below the hymen as positive values.

16. Name the six measured points and three landmarks in the POP-Q classification.

    Points: Aa and Ba (anterior wall), C (cervix/cuff), D (posterior fornix), Ap and Bp (posterior wall). Landmarks: genital hiatus (gh), perineal body (pb), and total vaginal length (tvl).

17. Describe the POP-Q ordinal staging (Stage 0 to Stage IV).

    Stage 0: no prolapse. Stage I: leading edge more than 1 cm above the hymen. Stage II: leading edge within 1 cm of the hymen (-1 to +1). Stage III: leading edge more than 1 cm below hymen but less than tvl - 2 cm. Stage IV: complete eversion (procidentia).

18. What are the conservative management options for pelvic organ prolapse?

    Lifestyle modification (weight loss, avoid heavy lifting, treat constipation/chronic cough), supervised pelvic floor muscle training (especially for stage I-II), and vaginal pessaries (e.g. ring or shelf/Gellhorn).

19. What ongoing care is required for a woman fitted with a vaginal pessary, and what is a key complication?

    Regular review and pessary changes (typically every 4-6 months), with topical vaginal oestrogen in postmenopausal women to maintain vaginal health. A key complication is vaginal erosion/ulceration; a neglected pessary can rarely cause fistula formation.

20. What is the surgical procedure of choice for uterovaginal/vault prolapse with good anatomical durability, and its main alternative?

    Sacrocolpopexy (abdominal/laparoscopic, using mesh to suspend the vault to the sacral promontory) offers durable apical support; the main vaginal alternative is sacrospinous fixation. For uterine prolapse with completed childbearing, vaginal hysterectomy with apical support is common.

21. In the current NHS Cervical Screening Programme, what is the primary screening test and the screening intervals?

    Primary high-risk HPV (hrHPV) testing is performed first; cytology is used only as reflex triage if hrHPV is positive. Women aged 25-49 are screened every 3 (now moving to 5) years and 50-64 every 5 years, based on negative hrHPV results.

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