Genital Prolapse and Stress Incontinence

Question 1

What is genital prolapse?

Answer 1

Protrusion of pelvic organs into the vagina due to weakened support structures.

Question 2

Which organs are commonly involved in genital prolapse?

Answer 2

Bladder, uterus, bowel.

Question 3

What supports the uterus anatomically?

Answer 3

Cardinal ligaments, uterosacral ligaments, endopelvic fascia.

Question 4

What structures support the vagina?

Answer 4

Levator ani, triangular ligament, perineal muscles, perineal body.

Question 5

What are the three degrees of uterine prolapse in the traditional system?

Answer 5

1st: cervix inside vagina; 2nd: cervix at introitus; 3rd: uterus outside introitus.

Question 6

What is a cystocele?

Answer 6

Bladder herniating into the anterior vaginal wall.

Question 7

What is the cause of a cystocele?

Answer 7

Weakness of the pubocervical fascia.

Question 8

What are the stages of cystocele?

Answer 8

Stage 1: inside vagina, Stage 2: at introitus, Stage 3: total bladder prolapse.

Question 9

What is a urethrocele?

Answer 9

Urethra is displaced backwards and downwards on straining.

Question 10

What structure is typically damaged in a urethrocele?

Answer 10

Damage to the triangular ligament.

Question 11

What is a rectocele?

Answer 11

Posterior vaginal wall prolapse involving the rectum.

Question 12

What causes rectocele?

Answer 12

Damage to Denonvillier’s fascia.

Question 13

What is an enterocele?

Answer 13

Herniation of small bowel into the upper posterior vaginal wall.

Question 14

What is a vault prolapse?

Answer 14

Prolapse of the vaginal vault post-hysterectomy.

Question 15

What does the POP-Q system measure?

Answer 15

Pelvic Organ Prolapse Quantification – standardised staging.

Question 16

What is stage IV in the POP-Q system?

Answer 16

Complete vaginal eversion (total prolapse).

Question 17

List two congenital causes of genital prolapse.

Answer 17

Spina bifida, short vagina, deep uterosacral pouches.

Question 18

List two acquired causes of genital prolapse.

Answer 18

Difficult labour, forceps delivery, premature bearing down.

Question 19

Name three activating factors for genital prolapse.

Answer 19

Chronic cough, constipation, heavy lifting, abdominal tumours.

Question 20

What are common symptoms of genital prolapse?

Answer 20

Vaginal mass, pelvic pressure, back pain, discharge.

Question 21

What urinary symptoms may occur with prolapse?

Answer 21

Urinary retention, frequency, incontinence.

Question 22

What GI symptom may suggest a rectocele?

Answer 22

Constipation.

Question 23

What complications can occur in severe or neglected prolapse?

Answer 23

Ulceration, keratinisation, bleeding, possible cervical cancer.

Question 24

What positions are used for clinical examination of prolapse?

Answer 24

Sims (left lateral) or dorsal position using speculum exam.

Question 25

What conservative management is recommended early postpartum?

Answer 25

Pelvic floor exercises (Kegel’s), especially in early postpartum.

Question 26

What is the role of pessary treatment?

Answer 26

Symptom relief in non-surgical patients; not curative.

Question 27

List three indications for pessary use.

Answer 27

Pregnancy, unfit for surgery, refuse surgery, trial therapy.

Question 28

What are complications of pessary use?

Answer 28

Ulceration, impaction, carcinoma, incontinence, constipation.

Question 29

What is the role of oestrogen therapy in prolapse?

Answer 29

Improves vaginal mucosa and symptoms in postmenopausal women.

Question 30

Name two common surgical repairs for prolapse.

Answer 30

Anterior/posterior colpoperineorrhaphy, vaginal hysterectomy.

Question 31

What is the Manchester operation?

Answer 31

Surgical uterine suspension with cervical amputation.

Question 32

What is stress incontinence?

Answer 32

Involuntary urine loss when intravesical pressure > urethral pressure.

Question 33

What are risk factors for stress incontinence?

Answer 33

Parity, menopause, collagen disorders, obesity, prolapse.

Question 34

What investigation confirms stress incontinence?

Answer 34

Cystometry or Valsalva with video-urodynamics.

Question 35

What are two main types of surgical treatment for stress incontinence?

Answer 35

Vaginal (e.g. anterior repair) and suprapubic (e.g. Burch colposuspension).