Urogenital prolapse Flashcards
Define urogenital prolapse.
descent of one of the pelvic organs resulting in protrusion on the vaginal walls.
What are 5 risk factors for urogenital prolapse?
Multiparty
Older age
High BMI
Prolonged 2nd stage of labour
Heavy lifting
What is cystocele?
Prolapse of the anterior vaginal wall involving the bladder
What is uterine prolapse?
Prolapse of the uterus, cervix and upper vagina
What is enterocoele?
Prolapse of the upper posterior vaginal wall + loops of bowel
What is Urethrocele?
prolapse of the urethra into the vagina
What is Cystourethrocele?
prolapse of both urethra and bladder.
Most common type of prolapse
What is Rectocele?
Prolapse of lower posterior vaginal wall + rectum
Summarise the epidemiology of urogenital prolapse.
Common ~40% of postmenopausal women
What are 5 signs and symptoms of uterine prolapse?
Vaginal protrusion/ bulge/ something coming down + out the vagina
Sensation of vaginal pressure, heaviness, DRAGGING
Urinary incontinence
Discomfort during sex
Constipation
What is the conservative management of urogenital prolapse?
Pelvic floor exercises: 16w
Lose weight if BMI >30
Avoid heavy lifting
Prevent/ treat constipation
What is the medical management for urogenital prolapse?
Oestrogens: pill, patch, cream or implant for Sx relief + if signs of vaginal atrophy
Vaginal ring Pessary
Changed every 6/12
What are the side effects of vaginal pessaries?
Unpleasant discharge
Irritation
UTI
Interference with sex (not possible with shelf pessary)
What are the surgical management options for urogenital prolapse?
Anterior vaginal wall repair
Hysterectomy +/- vaginal sacrospinus fixation
Vaginal Sacrospinous hysteropexy: cervix stitched to ligament
Sacro-hysteropexy with mesh: mesh used to attach uterus to sacral vertebra
Posterior vaginal wall repair
What are complications of urogenital prolapse? What is the prognosis for urogenital prolapse?
Dyspareunia after posterior repair
Post-repair urinary incontinence
Faecal incontinence after posterior repair
Vaginal erosion
Urinary retention
Post-repair recurrent prolapse
Recurrence is not uncommon
