pelvic organ prolapse

Question 1

What is pelvic organ prolapse (POP)?

Answer 1

Descent of endopelvic organs through the urogenital hiatus due to failure of pelvic support structures.

Question 2

Which organs are commonly involved in POP?

Answer 2

Uterus, urinary bladder, rectum, or vaginal vault.

Question 3

Which population is POP more frequent in?

Answer 3

White Caucasian, post-menopausal, multiparous women over 50 years old.

Question 4

What is the lifetime risk of developing POP for women?

Answer 4

0.11

Question 5

According to the WHI study, what was the POP prevalence in women over 60?

Answer 5

41% in those without hysterectomy, 38% with hysterectomy.

Question 6

How is the vaginal position maintained in healthy individuals?

Answer 6

The vagina is pressed against the muscular plane preventing prolapse during increased abdominal pressure.

Question 7

What causes POP when muscular tone is reduced?

Answer 7

Abdominal pressure can cause prolapse and organ exteriorization.

Question 8

List acquired risk factors for POP.

Answer 8

Obesity, childbirth, constipation, chronic bronchitis, menopause, pelvic surgery.

Question 9

List inherited risk factors for POP.

Answer 9

Connective tissue diseases, increased elastase, reduced elastin, altered collagen turnover.

Question 10

What is the role of the pelvic diaphragm?

Answer 10

Supports pelvic organs and maintains lower urinary, reproductive, and digestive system containment.

Question 11

Which muscles form the levator ani?

Answer 11

Pubococcygeus, iliococcygeus, and ischiococcygeus.

Question 12

What stabilizes the urethra anteriorly?

Answer 12

Pubo-urethral ligament.

Question 13

What stabilizes the bladder laterally and inferiorly?

Answer 13

Urethropelvic ligaments and pubo-cervical fascia.

Question 14

Which ligaments support the uterus and vaginal vault?

Answer 14

Cardinal and uterosacral ligaments.

Question 15

What is DeLancey’s Level 1 support?

Answer 15

Uterosacral and cardinal ligaments support uterus and vaginal vault.

Question 16

What is DeLancey’s Level 2 support?

Answer 16

Arcus tendinous and vescicopelvic ligament support the vagina.

Question 17

What is DeLancey’s Level 3 support?

Answer 17

Perineal body, pubo-urethral and urethropelvic ligaments, and perineal muscles.

Question 18

What is a cystocele?

Answer 18

Prolapse of the bladder into the anterior vaginal wall.

Question 19

What is a rectocele?

Answer 19

Prolapse of the rectum into the posterior vaginal wall.

Question 20

What is an enterocele?

Answer 20

Prolapse of the peritoneal cul-de-sac with ileal segments.

Question 21

What is a hysterocele?

Answer 21

Uterine prolapse.

Question 22

Describe Grade 0 in Baden-Walker system.

Answer 22

Normal physiological situation.

Question 23

What is Grade I in POP?

Answer 23

POP reaches halfway to hymeneal ring on straining.

Question 24

What is Grade II POP?

Answer 24

POP reaches the hymeneal ring on straining.

Question 25

What defines Grade III POP?

Answer 25

POP crosses hymeneal ring with straining (reducible).

Question 26

What is Grade IV POP?

Answer 26

POP is outside hymeneal ring at rest (non-reducible).

Question 27

What is a common symptom of POP?

Answer 27

Sensation of weight or foreign body in the perineal area.

Question 28

What urinary symptoms may occur in POP?

Answer 28

Urgency, incomplete voiding, stress urinary incontinence.

Question 29

What are other symptoms of POP?

Answer 29

Bowel habit changes, lumbar pain, sexual discomfort.

Question 30

What does the physical exam evaluate in POP?

Answer 30

Vaginal compartments and pelvic floor musculature at rest and straining.

Question 31

What are instrumental tests for POP?

Answer 31

Pelvic US, MRI, urodynamics, defecography, cystography.

Question 32

What is recommended for Grades I/II POP?

Answer 32

Weight loss, pelvic floor muscle training, biofeedback.

Question 33

When is surgical therapy needed in POP?

Answer 33

Usually in Grades III/IV to restore pelvic support.

Question 34

What are surgical approaches for POP?

Answer 34

Vaginal and transabdominal procedures.

Question 35

What is the benefit of the vaginal approach?

Answer 35

Less morbidity.

Question 36

What is the advantage of transabdominal approach?

Answer 36

Better long-term anatomical outcomes.

Question 37

What is anterior colporrhaphy?

Answer 37

Suturing pubo-cervical fascia via anterior vaginal wall incision.

Question 38

Why use synthetic mesh in POP repair?

Answer 38

To reduce recurrence rates seen with autologous tissue repairs.

Question 39

What types of mesh are used in POP surgery?

Answer 39

Non-resorbable, resorbable synthetic, and biological mesh.

Question 40

What is the success rate of macroporous polypropylene mesh?

Answer 40

93-100%.

Question 41

What is colposacropexy?

Answer 41

Suspension of the vagina to the sacral promontory using synthetic mesh.

Question 42

How is colposacropexy performed today?

Answer 42

Laparoscopic or robot-assisted for reduced morbidity.

Question 43

What are complications of POP surgery?

Answer 43

Bleeding, infections, mesh erosion, neurologic lesions, organ injury.

Question 44

How does surgeon experience affect complications?

Answer 44

Higher volume surgeons have lower complication rates.