Genitourinary Prolapse

Question 1

If you have a lack of support of the uterus,rectum or bladder from the top and lack of support from the pelvic floor below, what is this called?

Answer 1

Genitourinary prolapse

Question 2

What is the epidemiology of genitourinary prolapse?

Answer 2

5 in 10 women.

Question 3

What are the common causes of genitourinary prolapse?

Answer 3

1/ Childbirth

2/ Increasing age

3/ Increasing intra-abdo pressure (Coughing, obesity, constipation)

4/ Gyne surgery (hysterectomy)

Question 4

Describe symptoms of Genitourinary prolapse.

Answer 4

1/ Feeling the need to pass urine

2/ Stress incontinence.

3/ Flow of urine starts and stops.

4/ Frequent UTIs

5/Feeling of not emptying.

6/ BOWELS - if rectocele - difficulty passing stools, feeling of blockage, feeling bowels not empyting fully.

Question 5

What examination should you do with someone who has a Genitourinary prolapse?

Answer 5

Examine the patient in both a standing and left lateral position if possible.

Use a Sims’ speculum inserted along the posterior vaginal wall to assess the anterior wall and vaginal vault and vice versa. Ask the patient to strain.

A bivalve speculum can also be used to identify the cervix or vaginal vault. Ask the patient to strain, and slowly remove the speculum. Look for the degree of descent of the vaginal apex.

Determine the parts of the vagina (anterior, posterior or apical) that the prolapse affects. Determine the degree of prolapse.

Ulceration and hypertrophy of the cervix or vaginal mucosa with concomitant bleeding may be seen in women with prolapse that protrudes beyond the hymen.

A rectal examination can be helpful if there are bowel symptoms.

Question 6

Describe the different stages (severity scale) of genitourinary prolapse?

Answer 6

Stage 0: no prolapse.
Stage 1: more than 1 cm above the hymen.
Stage 2: within 1 cm proximal or distal to the plane of the hymen.
Stage 3: more than 1 cm below the plane of the hymen but protrudes no further than 2 cm less than the total length of the vagina.
Stage 4: there is complete eversion of the vagina.

Question 7

What are the treatment options for genitourinary prolapse?

Answer 7

1. Watchful waiting
2. Lifestyle changes
3. Pelvic floor exercises
4. A vaginal pessary
5. Oestrogen cream
6. Surgery

Question 8

Name the different types of prolapse?

Answer 8

1/ Prolapse from the front (anterior)

• Urethrocele – urethra prolapsing into the vagina
• Cystocele – bladder prolapsing into the vagina.
• Cystourethrocele – both. (Most common)

2/ Prolapse from the rear (Posterior)

• Rectocele – rectum prolapsing into the vagina

3/ Prolapse from the middle part

• Uterine (2nd most common)
• Vault Prolapse – sutured up cervix (called “a vault) post hysterectomy.
• Enterocele – prolapse of small bowel through the Pouch of Douglas

Question 9

Name the different types of ring pessary

Answer 9

Question 10

Name the different types of surgical repair for a genitourinary prolapse?

Answer 10

1. Sacrohysteropexy – mesh inserted – one end attached to cervix and the other to the sacrum. Through Abdomen.
2. Sacrocolpopexy – stitched to sacrum and mesh holds vagina in place.
3. Infracoccygeal hysteropexy or colpopexy – mesh inserted through the vagina rather than abdominal wall.
4. Sacrospinous fixation – vagina hitched up and stitched to sacrospinous ligament. Through the vagina.