pelvic organ prolapse

Question 1

classification

1. ant vaginal wall prolapse
2. post vaginal wall prolapse
3. apical vaginal wall prolapse

Answer 1

1.urethrocele:urethral descent
cystocele:bladder descent
cystourethrocele

2. rectocele:rectal descent
   enterocele: small bowel descent
3. uterovaginal:uterine descent with inversion of vaginal apex
   vault: post hysterectomy inversion of vaginal apex

Question 2

prevalence

Answer 2

41-50% over age 40 yo

Question 3

grading

Answer 3

lowest or most dependamt portion of prolapsed is assessed while pt is straining

1st: descent within vagina
2nd: descent to introitus
3rd: descent outside introitus

Question 4

aetiology

-damage to major supports of the vagina;ligaments,fascia and levator ani muscles

Answer 4

1. congenital
2. childbirth and raised intra-abdominal pressure
3. ageing
4. postoperative

Question 5

clinical features

Answer 5

non specific:lump,local discomfort,backache,bleeding/infection if ulcerated,dysparaeunia or apareunia

specific:cystourethrocele-urinary frequency and urgency,voiding difficulty,UTI,stress incontinence
rectocele-incomplete bowel emptying,digitation,splinting,passive anal incontinence

Question 6

ddx

Answer 6

ant wall prolapse:congenital or inclusion dermoid vaginal cyst,urethral diverticulum
uterovaginal prolapse:large uterine polyp

Question 7

tx

Answer 7

depends on pt’s wishes,level of fitness and desire to preserve coital function
ulcerated:7 day topical oestrogen

Question 8

medical

Answer 8

pelvic floor physiotherapy

pessaries

Question 9

indication for pessary tx

Answer 9

pt's wish
as a therapeutic test
childbearing not complete
medically unfit
during and after pregnancy
while awaiting surgery

Question 10

surgery is mainstay tx

Answer 10

uterine preserving surgery:
hysterosacropexy
manchester repair
le fort colpocleisis
total mesh procedure using an introducer device

Question 11

definition

Answer 11

protrusion of an organ or structure beyond its normal confines