Genital Prolapse

Question 1

Prolapse and how to identify

Answer 1

Cystocoele - upper 2/3rd of ant vaginal wall
Urethrocele - lower 1/3 of ant vaginal wall
Entrocoele- prolapse of upper one third of post vaginal wall
Rectocoele - prolapse of lower 2/3rd of post vaginal wall

Question 2

Investigations for prolapse

Answer 2

Urine culture and sensitivity
Cbc and haemogram
Blood urea creatine and sugar
Usg abdomen and pelvis
Biopsy

Question 3

What are the de lancey levels of support?

Answer 3

Level 1- ligaments and condensation of the endocervical fascia
Ant- pubocervical, post- uterosacral ligaments, lateral - mackenrodts ligament

Level 2- pelvic fascia and paracolpos connects vagina laterally to pelvic wall

Level 3- pelvic diaphragm, levator ani muscle, perineal body

Question 4

Classification of prolapse of uterus

Answer 4

Classification of prolapse of uterus
• normal - cervix at the level of ischial spines
•cervix below the ischial spines but above the intoitus
•cervix at the level of introitus
•cervix outside introitus
•uterine fundus outside the introitus

Question 5

POPQ

Answer 5

Pelvic Organ Prolapse Quantification

0- no descent
1-lowest point of descent doesn’t exceed 1cm below the hymen
2- lowest point within 1cm of hymen
3- lowest point>1cm below hymen
4- complete prolapse

Question 6

Causes of prolapse in post menopausal women , parous women

Answer 6

Decrease in oestrogen- causes asthenia and atonicity of supports of uterus

Parous women - frequent childbirth, big baby, instrumental delivery, denervation injury

Question 7

Treatment of decubitus ulcer

Answer 7

Reducing the prolapse relieves congestion and ulcer heals and packing the vagina with pack soaked in betadine help hasten healing

If edematous- use magnesium sulphate dressing

Question 8

Name a palliative care for proplapse

Answer 8

Pessary
Made up of polyvinyl chloride

Question 9

Management of proplapse depends on

Answer 9

Age , degree of prolapse uterus, desire to conceive, associated complications

Question 10

Surgical treatment of prolapse

Answer 10

In older and postmenopausal women- ward mayo’s vaginal hysterectomy with pelvic floor repair

In younger and parous women- Fothergill’s with pfr or manchester operation

Nulliparous - sling operations

Very old unfit for surgery - Leforts surgery

Question 11

What does PFR include?

Answer 11

Includes anterior colporrhaphy and posterior colpoperineorrhapy

For cystocoele- ant colporrhaphy
For entrocoele- obliteration of POD , approximation of uterosacral ligament,mccall cudoplasty
For rectocoele - posterior colpoperineorrhapy

Question 12

Surgery for vault prolapse

Answer 12

Repair of entercoele with PFR
Sacrospinous colpopexy - vaginal approach
Sacrocolpopexy- abdominal approach
Colpocleisis