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3rd Year - Reproductive Diseases > 8.2. Pelvic Organ Prolapse - Aetiology / Clinical Presentation / Assessment / Management > Flashcards

8.2. Pelvic Organ Prolapse - Aetiology / Clinical Presentation / Assessment / Management Flashcards

1
Q

What are the Risk Factors of Female Pelvic Organ Prolapse?

A
  1. Pregnancy & Vaginal Birth - Foreceps / Large Baby / Prolonged Second Stage
  2. Advancing Age
  3. Obesity / Heavy Lifting (Occupation) / Exercise
  4. Previous Pelvic Surgery - Continence Procedures (Burch Colposuspension) / Hysterectomy
  5. Hormonal Factors
  6. Constipation
  7. Quality of Connective Tissue
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2
Q

What are the Traditional Classifications of Prolapse?

A
  1. Urethrocele
  2. Cystocele
  3. Uterovaginal Prolapse
  4. Enterocele
  5. Rectocele
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3
Q

What is a Urethrocele prolapse?

A

Prolapse of the Lower Anterior Vaginal Wall - involving the Urethra Only

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4
Q

What is a Cystocele prolapse?

A

Prolapse of the Upper Anterior Vaginal Wall - involving the Bladder

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5
Q

What is a Uterovaginal prolapse?

A

Prolapse of the Uterus, Cervix and Upper Vagina

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6
Q

What is a Enterocele prolapse?

A

Prolapse of the Upper Posterior Vaginal Wall (Apical Prolapse) - containing loops of Small Bowel

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7
Q

What is a Rectocele prolapse?

A

Prolapse of the Lower Posterior Vaginal Wall - involving the Rectum Bulging Forwards into the Vagina

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8
Q

What are the Typical Vaginal Symptoms of Women with Pelvic Organ Prolapse?

A
  1. Sensation of Bulge / Protrusion
  2. Seeing / Feeling a Bulge / Protrusion
  3. Pressure
  4. Heaviness
  5. Difficulty inserting Tampons
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9
Q

What are the Typical Urinary Symptoms of Women with Pelvic Organ Prolapse?

A
  1. Urinary Incontinence
  2. Frequency / Urgency
  3. Weak or Prolonged Urinary Stream / Hesitancy / Feeling of Incomplete Emptying
  4. Manual Reduction of Prolapse to Start / Complete Voiding
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10
Q

What are the Typical Bowel Symptoms of Women with Pelvic Organ Prolapse?

A
  1. Incontinence of Flatus / Liquid / Solid Stool
  2. Feeling of Incomplete Emptying / Straining
  3. Urgency
  4. Digital Evacuation to Complete Defecation
  5. Splinting (Pushing on / Around the Vagina / Perineum) to Start / Complete Defecation
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11
Q

How is Female Pelvic Organ Prolapse assessed?

A
  1. Examination - to Exclude Pelvic Mass
  2. Record the Position of Examination (Left Lateral vs Lithotomy vs Standing)
  3. Quality of Life
  4. Objective Assessment
  5. a) Baden-Walker-Halfawy Grading
  6. b) POP Quantification (POPQ) Score - Gold standard
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12
Q

What are the different Stages in a Pelvic Floor Evaluation?

A

Stage 0 - Total Vaginal Length = -2 cm (inside the Hymen)
Stage 1 - Total Vaginal Length = < -1 cm (Inside the Hymen)
Stage 2 - Total Vaginal Length = > -1 cm (Inside the Hymen) to < +1 cm (Outside the Hymen)
Stage 3 - Total Vaginal Length = > +1 cm (Outside the Hymen) to < +2 cm (Outside the Hymen)
Stage 4 - > + 2 cm (Outside the Hymen)

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13
Q

What Investigations are carried out in Pelvic Organ Prolapse?

A
  1. Ultrasound / MRI - Identification of Fascia Defects / Measurement of Levator Ani Thickness
  2. Urodynamics - Concurrent Urinary Infection / Excluse Occult Stress Incontinence
  3. IVU / Renal Ultrasound - If suspicion of Ureteric Obstruction
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14
Q

What is the best Prevention of Pelvic Organ Prolapse?

A
  1. Avoid Constipation
  2. Effective Management of Chronic Chest Pathology
  3. Smaller Family Size
  4. Improvements in Antenatal / Intrapartum Care
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15
Q

What is the treatment of Pelvic Organ Prolapse?

A
  1. Physiotherapy - Pelvic Floor Muscle Training
  2. Silicone (Vaginal) Pessaries
  3. Surgery
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16
Q

How / When is Physiotherapy (Pelvic Floor Muscle Training) used to treat Pelvic Organ Prolapse?

A
  1. Increase the Pelvic Floor Strength and Bulk - Relieve the Tension on the Ligaments
  2. Cases of Mild Prolapse / Younger Women
  3. No role in Advanced Cases - Cannot Treat Fascial Defecits
17
Q

What are the Advantages of the current Silicone Vaginal Pessaries?

A
  1. Long Shelf Life
  2. Resistance to Autoclaving and Repeated Cleaining
  3. Non-Absorbent towards Secretions / Odors
  4. Inertness
  5. Hypoallergenic Nature
18
Q

Which is more effective, Silicone (Vaginal) Pessaries or Surgery?

A

At 1 year follow-up, Successful Pessary treatment is as effective as Surgery

19
Q

What are the aims of Surgical Treatment?

A
  1. Relieve Symptoms
  2. Restore / Maintain Bladder and Bowel Function
  3. Maintain Vaginal Capacity for Sexual Function
    Note - Remember Prophylactic Antibiotics / Anti-Thrombo-Embolics

3rd Year - Reproductive Diseases (41 decks)

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