Pelvic Organ Prolapse

Question 1

best position for speculum examination of POP

Answer 1

sims position (excaggerated lateral)+ valsalva maneuvre
or
standing position

Question 2

in POP-Q what is Aa, Ba, Ap, Bp

Answer 2

Aa: point 3 cm from the hymen in the anterior wall
Ba: lowermost point of the anterior wall in prolapse, the same point as Aa if no prolapse

Ap: point 3 cm from the hymen in the posterior wall
Bp: lowermost point of the posterior wall in prolapse, the same point as Ap if no prolapse

Question 3

in POP-Q, what is C, D

Answer 3

C: cervix or cuff (if hysterectomiezed)

D: Posterior fornix (not measured if hysterectomiezed)

Question 4

in case of hysterectomy what measurement of POP-Q score isn’t taken

Answer 4

D

Question 5

in POP-Q score, what is GH, TVL and PB

Answer 5

Genital hiatus: the measurement from mid uretheral orifice to posterior forchette

Prenieal body: from posterior forchette to middle of anal opening

TVL: depth of vagina when points D and C are reduced to normal position

Question 6

prerequisites to measure TVL

Answer 6

the prolapse must be reduced (poit d and C must be at their normal position)

Question 7

Non surgical management of POP

Answer 7

1. Life style modification
2. Topical E2 (UGA)
3. PFMT for 16 w (stage 1,2)
4. Pessaries

Question 8

in ttt POP, when to remove pessary

Answer 8

at least once every 6 months

Question 9

what are the surgical options for anterior and posterior prolapse

Answer 9

1. Anterior: ant. coloporaphy
2. Posteriro: Post. colpoperineoraphy

Question 10

what are the surgical options for uterine prolapse

Answer 10

1. VH+- SSF
2. Vaginal sacrospinous hysteropexy
3. Manchester repair (no wish for children)
4. Sacrohysteropexy with mesh

Question 11

what are the surgical options for vault prolapse

Answer 11

1. SSF
2. SCP with mesh
3. Leforte

Question 12

indications of manchester repair

Answer 12

1. elongation of the Cx
2. 3rd, 4th degree uterine prolapse

Question 13

fo whom we can do leforte repair

Answer 13

Colpocleisis of the vault prolapse, for women who don’t intend to have penetrating sexual intercourse, as it causes obliterated vagina.

Question 14

side effect of sacrospinous fixation

Answer 14

buttock pain when sitting, as it’s done near pudendal nerve nd it may be injured

Question 15

differene between SSF and Sacrohysteropexy SHP

Answer 15

SSF: stitch between vagina, uterus and the sacrospinous lig.

SHP: mesh between uterus, Cx and sacral fascia

Question 16

SSF is CI if

Answer 16

1. Short vagina
2. dysparunia

here we can do SCP

Question 17

how to deal with PHVP

post hysterectomy vaginal vault prolapse

Answer 17

1. Occult: leak at clinic
   * burch (colposusspension)
   * SCP
2. Overt: leak at home
   * SSF
   * Sling

Question 18

Prevention of PHVP in abdominal hysterectomy

Answer 18

Suturing cardinal x uterosacral x vault

prevent PHVP and enterocele formation

Question 19

Prevention of PHVP in vaginal hysterectomy

Answer 19

1. Suturing cardinal x uterosacral x vault
2. McCall Culdoplasty (vault posterior wall x uterosacral lig)
3. SSF (if the vault descends to introitus during closure

Question 21

what type of mesh used in gynecological surgeries

Answer 21

type 1 macroporous and monofilamentous; pores > 75 um