Prolapse Flashcards
(19 cards)
Assessing prolapse
- Record POPQ score
- Assess pelvic floor muscles
- Check for vaginal atrophy
- Rule out pelvic mass
Other symptoms to check for
- Urinary symptoms (ant)
- Obstructed defaecation/faecal incont (post)
- Pain/dragging sensation
RF for prolapse
- Age
- Smoking
- Obesity
- Fibroids/enlarged uterus
POP- Q
Add image
Mx of prolapse
- Lifestyle- Wt loss, rx constipation, reduce heavy lifting
- Pelvic floor exercises- min 4/12
- Tropical estrogen
Stage 3/4-
- Pessaries - f/u every 6 months
- Surgery
Risk of surgery for uterine/vault prolapse
- Lack of long term evidence on effectiveness
Surgical options
- Hysterectomy- Vag/Lap +/- sacrospinous fixation
- Manchester repair - keeps uterus in
- CANNOT conceive in future
- Colpoclesis- for older women, cannot have intercourse
- Sacro-hysteropexy with sutures or mesh - Keep uterus
- Ant or post repair wo mesh
When to do SSF
- If vault decends to the introitus during closure
McCall culdoplasty (stage 1 and 2 prolapse)
- Does w hysterectomy to prevent prolapse
- Approx. uterosacral and cardinal ligaments to the vaginal cuff
Sacrospinous fixation (stage 3 and 4)
- Done with hysterectomy
Burch colposuspension
- Used to treat SUI
- Attaches paravaginal fascia to Coopers ligament
Moschowitz culdoplasty
- Placing concentric purse-string sutures around the cul-de-sac ot include the post vag wall
Surgical repair for anterior or apical prolapse
If not incontinent- Explain the risk of developing incontinence post op
F/u post op
- In 6 months
- Perform vaginal exam
- Check symptoms
Mesh complications mx
- Detailed hx and exam
- Refer to mesh specialist centre
- Report to the national registry
Prolapse post hysterectomy- assessment
- Hx
- Examine and classify on POP- Q
- MDT discussion
Do not routinely do urodynamics
Mx of post hyst prolapse
- Refer to specialist
- Offer ASC or SSF
- Colpocleisis if not sexually active
Abdominal sacro-colpopexy vs vag SSF
ASC:
- Lower recurrence of prolapse
- High risk of post op SUI
Vag SSF:
- Quicker recovery
- Buttock pain
- Shortens vaginal length!!!
How to reduce risk of SUI from ASC
- Perform colposuspension at the same time
- Does not reduce pre- exisiting SUI
