Evaluation and Management of Recurrent Pelvic Organ Prolapse Flashcards
What are the surgical repair options for POP?
Transvaginal or abdominal approaches using native tissue, biological mesh, or permanent mesh.
What are the risk factors for recurrence after POP repair?
Advanced POP preoperatively, previous pelvic floor surgery, levator avulsion, enlarged genital hiatus, and possibly increased BMI.
What are the conservative management options for recurrent POP?
Observation, pelvic floor physical therapy, vaginal estrogen, weight loss, and pessaries.
What is apical prolapse, and which compartments are involved?
Apical prolapse refers to the descent of the upper (apical) portion of the vagina, including the uterus or vaginal cuff (after hysterectomy). It’s one of three main compartments for prolapse, along with the anterior and posterior compartments.
What is Stage 0 in the POP-Q system?
Stage 0 represents no prolapse; the organs are perfectly supported.
What is Stage 1 in the POP-Q system?
Stage 1 represents minimal prolapse; the most distal portion of the prolapsed organ is more than 1 cm above the level of the hymen.
What is Stage 2 in the POP-Q system?
Stage 2 is marked prolapse; the most distal portion of the prolapse is within 1 cm of the hymen, either 1 cm or less proximal or distal.
What is Stage 3 in the POP-Q system?
Stage 3 is moderate to severe prolapse; the most distal portion of the prolapse is more than 1 cm below the hymen but no further than 2 cm less than the total vaginal length.
What is Stage 4 in the POP-Q system?
Stage 4 is total or complete prolapse; the most distal portion of the prolapse is at least (total vaginal length - 2 cm) below the hymen.
What are the key measurement points in the POP-Q system, and what do they represent?
Aa, Ba: anterior wall; Ap, Bp: posterior wall; C: cervix/vaginal cuff; D: posterior fornix; TVL: total vaginal length.
Which of the following represents the largest risk factor for recurrence after surgical repair of pelvic organ prolapse (POP)?
a. BMI > 30
b. Chronic constipation
c. ≥ Stage 3 POP-Q preoperatively
d. COPD
c. ≥ Stage 3 POP-Q preoperatively
Explanation: Patients with advanced POP (≥ stage 3 POP-Q) preoperatively are at an increased risk of recurrence after primary POP surgery.
What is the recommended management for asymptomatic anatomical recurrence of POP?
a. Immediate surgical repair
b. Observation
c. Pessaries
d. Physical therapy
b. Observation
Explanation: Asymptomatic or minimally symptomatic recurrences can be managed conservatively, and observation is recommended.
Stage 2 of the POP-Q system signifies:
a. No prolapse
b. Prolapse more than 1 cm above the hymen
c. Prolapse within 1 cm of the hymen
d. Complete prolapse
c. Prolapse within 1 cm of the hymen
Explanation: Stage 2 in POP-Q is marked prolapse where the most distal portion of the prolapse is within 1 cm of the hymen.
What is the imaging modality best suited to visualize the placement of synthetic mesh from prior POP repairs?
a. MRI
b. Pelvic US
c. X-ray
d. Computerized tomography scan
b. Pelvic US
Explanation: Pelvic ultrasound (US) can show the relationship of the prolapse to previously inserted mesh and can be an office-based procedure.
Apical prolapse refers to the descent of which part of the female pelvis?
a. Anterior vaginal wall
b. Posterior vaginal wall
c. Uterus or vaginal cuff
d. Bladder
c. Uterus or vaginal cuff
Explanation: Apical prolapse involves the descent of the upper (apical) portion of the vagina, including the uterus or vaginal cuff (after hysterectomy).
