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Gaby’s Green Top Guidelines > 2015 46 PHVP > Flashcards

2015 46 PHVP Flashcards

1
Q

What are the 4 main aspects of diagnosis & investigation of PHVP?

A
  1. POP-Q classification
  2. MDT assessment
  3. QOL assessment
  4. Not routine urodynamics
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2
Q

** What PHVP preventative techniques are of value at hysterectomy? **

A
  1. McCall culdoplasty (V)
  2. Suturing cardinal & uterosacral ligaments to vaginal cuff (A&V)
  3. Sacrospinous fixation (V)
  4. Not subtotal hysterectomy
  5. Not permanent sutures
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3
Q

** What conservative measures are of value in PHVP? **

A
  1. Pelvic floor muscle training in stage 1 & 2 prolapse
  2. Vaginal pessaries in stage 2-4
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4
Q

What is an acceptable result after surgical Mx of PHVP?

A
  1. Patient-reported success
  2. POP-Q stage 1 or 0 in apical compartment
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5
Q

What are the effective surgical management options for PHVP?

A
  1. Open ASC: abdominal sacrocolpopexy
  2. Vaginal SSF: sacrospinous fixation
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6
Q

What are the advantages of ASC over SSF?

A
  1. Lower rates recurrent vault prolapse
  2. Lower rates dyspareunia
  3. Lower post-op SUI
  4. SSF not possible with short vagina
  5. SSF not good with pre-existing dyspareunia
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7
Q

What are the advantages of SSF over ASC?

A
  1. Earlier recovery
  2. Shorter operation
  3. Less expensive
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8
Q

What outcomes are the same between ASC & SSF?

A
  1. Patient satisfaction
  2. Objective failure
  3. Reoperation rates for SUI
  4. Reoperation rates for prolapse
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9
Q

How does ASC compare to LSC & RSC?

A
  1. LSC & ASC equally effective
  2. Limited evidence on RSC
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10
Q

What are the issues with HUSLS: high uterosacral ligament suspension?

A
  1. Only validated in research
  2. High risk of ureteric injury
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11
Q

** When should colpocleisis be used?**

A

Frail women
Those who don’t want to retain sexual function

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12
Q

When should colposuspension be used?

A
  1. At time of sacrocolpopexy
  2. To reduce occult SUI
  3. Not effective for overt SUI
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13
Q

What is a McCall culdoplasty?

A
  1. Approximating the uterosacral ligaments using continuous sutures
  2. To obliterate peritoneum of POD
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14
Q

What are the potential risks of pessaries for prolapse?

A
  1. Sexual function
  2. Regular pessary changes
  3. Ulceration
  4. Bleeding
  5. Small risk of fistula
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15
Q

What is sacrospinous fixation?

A
  1. Anchoring of vaginal vault to sacrospinous ligament
  2. Can be unilateral or bilateral
  3. Can use absorbable or non-absorbable sutures
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16
Q

What is abdominal sacrocolpopexy?

A
  1. Apical suspension of the vault
  2. With a permanent mesh
  3. To the longitudinal ligament of the sacrum
17
Q

What are the key aspects of POP-Q scoring?

A
  1. 6 points measured wrt hymen
  2. Points above hymen are negative numbers, points below are positive
  3. All measurements except TVL are at maximum valsalva
18
Q

What are the key aspects of POP-Q scoring?

A
  1. 6 points measured wrt hymen
  2. Points above hymen are negative numbers, points below are positive
  3. All measurements except TVL are at maximum valsalva
19
Q

What are the 3 readings across the top of the POP-Q grid?

A

Anterior: Aa, Ba, C

20
Q

What are the 3 readings across the middle row of the POP-Q grid?

A

gh, Pb, tlv

21
Q

What are the 3 readings across the bottom of the POP-Q grid?

A

Ap, Bp, D

22
Q

What are the 6 points measured in POP-Q?

A

Aa: anterior vaginal wall 3cm proximal to hymen
Ba: most distal portion of remaining upper anterior wall
C: most distal edge of Cx or vaginal cuff scar
D: posterior fornix
Ap: posterior vaginal wall 3cm proximal to hymen
No: most distal portion of remaining upper posterior wall

23
Q

What are the additional 3 measurements in POP-Q?

A

gh: genital hiatus, middle of external urethral meatus to posterior midline hymen
pb: perineal body, posterior margin gh to middle of anal opening
tvl: total vaginal length, depth of vagina when C or D reduced to normal position

24
Q

What are the POP-Q staging criteria?

A

0: Aa, Ap, Ba, Bp = -3cm, C or D ≤ -(tvl-2cm)
1: stage 0 criteria not met, leading edge < -1cm
2: leading edge ≥ -1 but ≤ =1cm
3: leading edge >+1cm but < + (tvl-2cm)
4: leading edge ≥ +(tvl-2cm)

Gaby’s Green Top Guidelines (27 decks)

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