Clin: Pelvic Relaxation, Incontinence - Wootton

Question 1

occurs when the supportive tissue between a woman’s bladder and vaginal wall weakens and stretches, allowing the bladder to bulge into the vagina

Answer 1

anterior vaginal prolapse (cystocele)

Question 2

occurs when the wall of fibrous tissue that separates the rectum from the vagina weakens
- when this happens, tissues or structures just behind the vaginal wall (rectum) can bulge into the vagina

Answer 2

lower posterior vaginal prolapse (rectocele)

Question 3

when the rectum herniates into the vagina

• the uterus drops out of the opening to the vagina
• f the uterus has been removed, the top of the vagina can also drop down.

Answer 3

apical vaginal/uterine prolapse

Question 4

occurs when the upper portion of the vagina loses its normal shape and sags or drops down into the vaginal canal or outside of the vagina
- may occur alone or along with prolapse: cystocele, urethrocele, rectocele, or small bowel (enterocele)

Answer 4

vaginal vault prolapse

Question 5

prolapse of the female urethra into the vagina

• weakening of the tissues that hold the urethra in place may cause it to protrude into the vagina
• often occur with cystoceles

Answer 5

urethrocele

Question 6

what stage:

- no prolapse, anterior and posterior points are all -3cm

Answer 6

stage 0

Question 7

what stage:

- criteria for stage 0 not met, most distal prolapse is more than 1 cm above the level of the hymen

Answer 7

stage 1

Question 8

what stage:

- most distal prolapse is between 1cm above and 1cm below the hymen

Answer 8

stage 2

Question 9

what stage:

- the most distal prolapse is more than 1cm below the hymen but no further than 2cm less than TVL

Answer 9

stage 3

Question 10

what stage:

• complete procedentia or vault eversion
• the most distal prolapse protrudes to at least 2cm

Answer 10

stage 4

Question 11

surgery to correct upper vaginal prolapse

- most commonly used in women with recurrent cystocele, vault, or enterocele

Answer 11

abdominal sacral colpopexy

Question 12

surgery to correct upper vaginal prolapse

- performed at the time of hysterectomy or in pt with post-hysterectomy vaginal vault prolapse

Answer 12

uterosacral ligament suspension

Question 13

surgery to correct upper vaginal prolapse

- performed at the time of hysterectomy or in pt with post-hysterectomy vaginal vault prolapse

Answer 13

sacrospinous fixation

Question 14

surgery to correct anterior wall prolapse
- may be used for tx of prolapse of the bladder or urethra (bladder, urethra, or both, herniates downward into the vagina)

Answer 14

anterior vaginal repair (anterior colporrhapy)

Question 15

surgery to correct posterior wall prolapse

- may be used for tx of rectocele (rectum bulges or herniates forward), defects of perinuem, or both

Answer 15

posterior vaginal repair (posterior colporrhapy)

Question 16

surgery to correct anterior wall prolapse, apical vaginal prolapse, or both

• depending on specific defect, the mesh augmentation can either be anterior, apical, or both
• this repair not routinely recommended

Answer 16

vaginal repair with synthetic mesh or biologic graft augmentation