Prolapse Flashcards
1
Q
Assessing prolapse
A
- Record POPQ score
- Assess pelvic floor muscles
- Check for vaginal atrophy
- Rule out pelvic mass
2
Q
Other symptoms to check for
A
- Urinary symptoms (ant)
- Obstructed defaecation/faecal incont (post)
- Pain/dragging sensation
3
Q
RF for prolapse
A
- Age
- Smoking
- Obesity
- Fibroids/enlarged uterus
4
Q
POP- Q
A
Add image
5
Q
Mx of prolapse
A
- 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
6
Q
Risk of surgery for uterine/vault prolapse
A
- Lack of long term evidence on effectiveness
7
Q
Surgical options
A
- 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
8
Q
When to do SSF
A
- If vault decends to the introitus during closure
9
Q
McCall culdoplasty (stage 1 and 2 prolapse)
A
- Does w hysterectomy to prevent prolapse
- Approx. uterosacral and cardinal ligaments to the vaginal cuff
10
Q
Sacrospinous fixation (stage 3 and 4)
A
- Done with hysterectomy
11
Q
Burch colposuspension
A
- Used to treat SUI
- Attaches paravaginal fascia to Coopers ligament
12
Q
Moschowitz culdoplasty
A
- Placing concentric purse-string sutures around the cul-de-sac ot include the post vag wall
13
Q
Surgical repair for anterior or apical prolapse
A
If not incontinent- Explain the risk of developing incontinence post op
14
Q
F/u post op
A
- In 6 months
- Perform vaginal exam
- Check symptoms
15
Q
Mesh complications mx
A
- Detailed hx and exam
- Refer to mesh specialist centre
- Report to the national registry
