POP

Question 1

What is a physical exam quantification for pelvic organ prolapse? What is reference point?

Answer 1

POP Q

Hymen

Question 2

List the elements of POP Q? Aa, Ap, C, TVL?

Answer 2

Aa: anterior vaginal wall, 3 cm proximal to hymen, Range -3 to +3

Ba: most distal position of upper anterior vaginal wall

Ap: posterior vaginal wall, 3 cm proximal to hymen, Range -3 to +3

Bp: most distal position of upper anterior vaginal wall

C: most distal edge of cervix or vaginal cuff (8)

TVL: total vaginal length

D: posterior fornix (cannot measure with hysterectomy)

pb: perineal body (10)

Question 3

What physical exam is important for leakage after sacrocolpopexy?

Answer 3

Fluid in vaginal vault
Defects at vaginal apex
Leak per meatus (strain/cough)
PVR
Presence/absence of prolapse
Urethral hypermobility

Question 4

Patient s/p sacrocolpopexy with new onset leakage, what is ddx?

Answer 4

Vesicovaginal fistula
Ureterovaginal fistula
SUI
UUI

Question 5

How do you evaluate for vesicovaginal fistula? ureterovaginal fistula?

Answer 5

Vesicovaginal → cystogram

Ureterovaginal → imaging of upper tracts (CTU/RGP)