2015 46 PHVP Flashcards
What are the 4 main aspects of diagnosis & investigation of PHVP?
- POP-Q classification
- MDT assessment
- QOL assessment
- Not routine urodynamics
** What PHVP preventative techniques are of value at hysterectomy? **
- McCall culdoplasty (V)
- Suturing cardinal & uterosacral ligaments to vaginal cuff (A&V)
- Sacrospinous fixation (V)
- Not subtotal hysterectomy
- Not permanent sutures
** What conservative measures are of value in PHVP? **
- Pelvic floor muscle training in stage 1 & 2 prolapse
- Vaginal pessaries in stage 2-4
What is an acceptable result after surgical Mx of PHVP?
- Patient-reported success
- POP-Q stage 1 or 0 in apical compartment
What are the effective surgical management options for PHVP?
- Open ASC: abdominal sacrocolpopexy
- Vaginal SSF: sacrospinous fixation
What are the advantages of ASC over SSF?
- Lower rates recurrent vault prolapse
- Lower rates dyspareunia
- Lower post-op SUI
- SSF not possible with short vagina
- SSF not good with pre-existing dyspareunia
What are the advantages of SSF over ASC?
- Earlier recovery
- Shorter operation
- Less expensive
What outcomes are the same between ASC & SSF?
- Patient satisfaction
- Objective failure
- Reoperation rates for SUI
- Reoperation rates for prolapse
How does ASC compare to LSC & RSC?
- LSC & ASC equally effective
- Limited evidence on RSC
What are the issues with HUSLS: high uterosacral ligament suspension?
- Only validated in research
- High risk of ureteric injury
** When should colpocleisis be used?**
Frail women
Those who don’t want to retain sexual function
When should colposuspension be used?
- At time of sacrocolpopexy
- To reduce occult SUI
- Not effective for overt SUI
What is a McCall culdoplasty?
- Approximating the uterosacral ligaments using continuous sutures
- To obliterate peritoneum of POD
What are the potential risks of pessaries for prolapse?
- Sexual function
- Regular pessary changes
- Ulceration
- Bleeding
- Small risk of fistula
What is sacrospinous fixation?
- Anchoring of vaginal vault to sacrospinous ligament
- Can be unilateral or bilateral
- Can use absorbable or non-absorbable sutures
What is abdominal sacrocolpopexy?
- Apical suspension of the vault
- With a permanent mesh
- To the longitudinal ligament of the sacrum
What are the key aspects of POP-Q scoring?
- 6 points measured wrt hymen
- Points above hymen are negative numbers, points below are positive
- All measurements except TVL are at maximum valsalva
What are the key aspects of POP-Q scoring?
- 6 points measured wrt hymen
- Points above hymen are negative numbers, points below are positive
- All measurements except TVL are at maximum valsalva
What are the 3 readings across the top of the POP-Q grid?
Anterior: Aa, Ba, C
What are the 3 readings across the middle row of the POP-Q grid?
gh, Pb, tlv
What are the 3 readings across the bottom of the POP-Q grid?
Ap, Bp, D
What are the 6 points measured in POP-Q?
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
What are the additional 3 measurements in POP-Q?
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
What are the POP-Q staging criteria?
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)
