Genital prolapse (Complete) Flashcards
Define vaginal prolapse
Potrusion of one or more pelvic structures from their normal anatomical position, moving towards or through the vagina
Vaginal prolapse is more common in which demographics of woman?
Post-menopausal
Women who have undergone childbirth
What are the main risk factors for genital prolapse?
Obsteric factors:
Childbirth
Hystorectomy
Hormonal factor:
Menopause
Increasing age
Mechanical stress:
Obesity
Chronic cough
Heavy lifting
Connective tissue disorders:
Marfans syndrome
Ehlers danlos
What are the main types of genital prolapse?
Can be categorised based on organ which has prolapsed and area of vagina affected.
Anterior vaginal wall:
- Cystocele
- Urethrocele
- Cystourethrocele
Posterior vaginal wall:
- Enterocele
- Rectocele
Apical vaginal wall:
- Uterine prolapse
- Vaginal vault prolapse
List examples of types of genital prolapse affecting the anterior vaginal wall
Cystocele: Bladder
Uretrhocele: Ureter
Cystourethrocele: Bladder + Ureter
List examples of types of genital prolapse affecting the posterior vaginal wall
Enterocele: Small intestine
Rectocele: Rectum
List examples of types of genital prolapse affecting the apical vaginal wall
Uterine prolpase
Vaginal vault prolapse
What are the clinical presentations of genital prolapse
Symptoms:
Pelvic discomfort or senation of ‘heaviness’
_Urinary symptoms _: (Especially anterior vaginal wall prolapses)
- Incontinence
- Recurrent UTIs
- Difficulty voiding
Defacatory symptoms: (Posterior wall prolpases)
- Constipation
- Incomplete bowel emptying
Sexual dysfunction
- Dyspareunia
Signs:
Bulging mass felt on vaginal wall
Loss of vaginal wall tone
Visible protrusion of tissue from the vagina
What differentials should be considered alongside genital prolpase?
Gynaecological malignancy
Cervicitis
Urethral diverticulum (Presents wih reccurrent UTIs and palpable anterior vaginal mass)
What investigations should be considered for patients with suspected genital prolapse?
Bedside:
Bimanual examination: Feel for bulging of vaginal wall
Speculum examination: Check for visible protrusion of tissue from vagina
Imaging/Invasive:
MRI: Considered for surgical planning
Urodynamic studies: If urinary symptoms present
What type of speculum is preffered when examining for genital prolapse?
Sim’s speculum
What is the management plan for patients with genital prolapse?
Conservative:
Lifestyle changes
- Weight loss
- Avoid heavy lifting
- Smoking cessation
Pelvic floor exercises
Pessary use (Useful especially for non-surgical candidates)
Surgical: Depends on type of prolapse
Anterior prolapse: Anterior colporrhaphy
Posterior prolapse: Posterior colporrhaphy
Uterine prolapse:
- Vaginal sacrospinous hysteropexy (with sutures)
- Manchester repair
- Vaginal hysterectomy
Vaginal valt prolapse:
- Sacrocolpopexy with mesh
- Vaginal sacrospinous fixation with sutures
What is a pessary?
Device inserted into the vagina to support pelvic organs that have prolapsed
What surgical option is reccomended for anterior vaginal wall prolpase?
Anterior colporrhaphy
AKA anterior vaginal wall repair
What surgical option is reccomended for posterior vaginal wall prolpase?
Posterior colporrhaphy
AKA posterior vaginal wall repair
What surgical options are reccomended for uterine prolpase?
Vaginal sacrospinous hysteropexy (with sutures)
Manchester repair
Vaginal hysterectomy
Vaginal sacrospinous hysteropexy
What surgical options are reccomended for vaginal vault prolpase?
Sacrocolpopexy with mesh
Vaginal sacrospinous fixation with sutures
What complications can occur due to genital prolpase?
Vaginal erosion (if left untreated)
Surgical complications:
Urinary incontinence
Faecal incontinence
Dyspareunia
Reccurrence
