EXAM #1: PELVIC RELAXATION

Question 1

What structure anatomically is in very close proximity to the uterus that must be accounted for during surgery?

Answer 1

Ureter

Question 2

What are the signs/symptoms of pelvic floor prolapse?

Answer 2

1) Pelvic pain/pressure
2) Bulging from the vagina
3) Dysparenuia
4) Difficulty voiding/evacuating bowels

Question 3

What are Delancye’s three levels of vaginal support?

Answer 3

I= connective tissue support to upper vagina
II= fascial arcus in mid vagina
III=
- Anterior fusion of anterior vagina/ urethra
- Posterior fusion between vagina and perineum

Question 4

What is anterior compartment prolapse?

Answer 4

Bladder and urethra prolapse

Question 5

What is posterior compartment prolapse?

Answer 5

Rectal prolapse

Question 6

What is apical vaginal prolapse?

Answer 6

Vaginal vault prolapse

• S/p hysterectomy
• Top of vagina normally attached to uterosacral ligaments
• Vault pulls free from uterosacral ligaments

*This term is only used if there is no uterus; if there is a uterus, then this is a uterine prolapse

Question 7

What is the most important support to the upper vagina?

Answer 7

Level I i.e. connective tissue to the upper vagina

Question 8

Weakness of the connective tissue to the upper vagina will result in what kind of prolapse?

Answer 8

• Uterine prolapse

- Vaginal vault prolapse

Question 9

What does failure of the fascial arus of the mid vagina result in?

Answer 9

Bladder prolapse and rectal prolapse into the vaginal vault

*This is a Level II loss of support

Question 10

What does loss of the anterior fusion of the vagina result in?

Answer 10

Hypermobile urethra

Question 11

What does loss of the posterior fusion of the vagina result in?

Answer 11

Perinocele or perineal prolapse

Question 12

How is a hypermobile urethra diagnosed?

Answer 12

• Urethra should be parallel to exam table on exam
• Insert Q-tip; it will be at an angle greater than 30 degrees
• Also, will move with coughing

Question 13

Why don’t women with grade III or IV prolapse have urinary incontinence?

Answer 13

Functional obstruction from prolapse

Question 14

What is stress incontinence?

Answer 14

Involuntary loss of urine during exertion

Question 15

Is stress incontinence more common in men or women?

Answer 15

Women

*Urge incontinence is more common in men

Question 16

What are the two main categories of stress incontinence?

Answer 16

1) Hypermobility

2) Intrinsic Sphincter Deficiency

Question 17

What is hypermobility incontinence?

Answer 17

Loss of urine related to movement of the bladder neck and urethra

Question 18

What is urge incontinence?

Answer 18

Incontinence with the “OMG I need to get to the bathroom” feeling

Question 19

What is mixed incontinence?

Answer 19

Mix of stress and urge incontinence

Question 20

What is overflow incontinence?

Answer 20

Involuntary loss of urine associated with bladder overdistension

Question 21

What is functional incontinence?

Answer 21

Loss of urine from dementia, decreased mobility, fistula

Question 22

How is pelvic organ prolapse evaluated?

Answer 22

1) Determine extent/stage of prolapse
2) Assess pelvic muscle function on PE
3) Evaluating resting tone and voluntary contraction of anal sphincters

Question 23

What testing is indicated in a women with pelvic organ prolapse?

Answer 23

1) Screen for UTI
2) Measure post-void residual urine volume
3) Determine presence/absence of bladder sensation

Question 24

What is Grade I Baden-Walker?

Answer 24

Prolapsed tissue descends halfway to the hymen

Question 25

What is Grade II Baden-Walker?

Answer 25

Prolapsed tissue descends to the hymen

Question 26

What is Grade III Baden-Walker?

Answer 26

Prolapse extends beyond the hymen with straining

Question 27

What is Grade IV Baden-Walker?

Answer 27

Prolapse extends beyond the hymen at rest/ without straining

Question 28

What are the non-surgical options for POP?

Answer 28

1) Kegels

2) Pessary

Question 29

What ligament can be used to anchor pelvic structures in surgical management of POP?

Answer 29

Sacrospinous ligament

Question 30

What three mechanisms are part of the surgical support of the vagina?

Answer 30

1) Closure of the introitus
2) Vertical suspension of the vagina
3) Flap effect of near horizontal vagina