Prolapse Flashcards Preview

Gynaecology > Prolapse > Flashcards

Flashcards in Prolapse Deck (17)
Loading flashcards...
1
Q

What is an Urethrocoele

A

Prolapse of lower anterior vaginal wall involving the urethra only

http://www.mdguidelines.com/images/Illustrations/urethroc.jpg

2
Q

What is a Cystocoele?

A

Prolapse of upper anterior vaginal wall involving the bladder

Often also involving urethra, ie cystourethrocoele

3
Q

What is an Apical Prolapse

A

Prolapse of uterus, cervix and upper vagina

aka Uterine prolapse

4
Q

What is an Enterocoele?

A

Small bowel prolapses into upper posterior vaginal wall

5
Q

What is a Rectocoele?

A

Rectum prolapses into lower posterior vaginal wall

6
Q

How do you grade a prolapse?

A

Pelvic Organ Prolapse (POP) scoring system of International Continence Society (ICS);

When straining

  1. No descent
  2. >1cm above Hymenal ring
  3. <1cm above Hymenal ring & <1cm below Hymenal ring
  4. >1cm below Hymenal ring
  5. Vagina completely everted
7
Q

What is a complete Procidentia?

A

Grade 4 prolapse accordinint to ICS POP system.

Vagina completely everted

8
Q

Draw a picture of the major pelvic ligaments and muscles

A
9
Q

Outline the Epidemiology of Prolapse

A

Half of all parous women have some degree of prolapse

10-20% seek medical attention

10
Q

Outline the Aetioloy of prolapse

A

Increase intra-abdominal pressure;

  • Pregnancy
  • Obesity
  • Chronic cough
  • Constipation
  • Heavt lifting
  • Pelvic mass

Weakened pelvic floor;

  • Congenital factors (collagen metabolism [eg Ehlers-Danlos syndrome])
  • Menopause (deterioration of collagenous connective tissue following oestrogen withdrawal)
  • Vaginal delivery (damage to pelvic floor)
  • Iatrogenic (surgery predisposing)
    *
11
Q

Outline the clinical presentation of prolapse

A
  • Asymptomatic
  • Dragging/ lump sensation
    • Worse at end of the day or when standing
  • Back pain usual
  • Severe prolapse;
    • Interferes with intercourse
    • May ulcerate
    • Bleeding/ discharge
  • Cystourethrocoele; freq/ urgency/ incontinence/ retention
  • Rectocoele; problems defaecating
  • O/E
    • Bear down to produce prolapse
    • Rectocoele can be confirmed by PR finger (compared to enterocoele)
12
Q

Outline the investigations for Prolapse

A
  • Cause?
    • USS is pelvic mass suspected
    • Urodynamic testing if urinary incontinence is principle complaint
13
Q

How can you prevent Prevention?

A
  • Recognition of obstructed labour
  • Avoidance of long second stage
  • Pelvic floor exercises
14
Q

Outline the conservatory (non-surgical) treatment for Prolapses

A
  • Lifestyle
    • Weight reduction
    • Stop smoking
    • Physio & pelvic floor muscles
  • Pessaries (unwilling/ unfit for surgery)
    • Artificial pelvic floor
    • Types include Ring (most common) & Shelf (for severe)
    • Changed every 6-9 months
    • Ulceration: Post-menopausal women may require oestrogen replacement (topical/ HRT)
15
Q

Outline the Surgical treatments for Uterine Prolapse

A
  • Vaginal hysterectomy
    • Traditional treatment
    • Often re-presents with Vault prolapse..
  • **Hysteropexy **[o/lap]
    • Uterus & cervix attahed to Sacrum using bifurcated non-absorbable mesh
    • Effective
16
Q

Outline the Surgical treatments for Vaginal Vault Prolapse

A
  • **Sacrocolpopexy **[o/lap]
    • Fixed vault to sacrum using mech
    • Complications: Mesh erosion & haemorrhage
  • Sacrospinous fixation [pv]
    • Suspends vault to sacrospinous ligament
    • Complications: nerve/ vessel injury, infection, buttock pain
17
Q

Outline the Surgical treatments for Vaginal Wall Prolapse

A
  • Anterior and Posterior ‘repairs’ for relevent prolapse