(gynae) Pelvic Organ Prolapse

Question 1

What’s the term for a prolapsed bladder, urethra, rectum , small bowel, rectum&small bowel

Answer 1

Bladder: cystocoele 
Urethra: urethrocoele
Rectum: rectocoele
Small bowel: enterocoele
Small bowel&rectum: enterorectocoele

Question 2

Predisposing factors for pelvic organ prolapse

Answer 2

Age- post menopause women there is both muscular and ligamentous deficiency in support of the uterus

Multiple vaginal deliveries and/or traumatic births (greatest risk factor)
-macrosomic Babies have greatest risk factor

Low estrogen levels (e.g., during menopause)

Increased intraabdominal pressure (e.g., obesity, cough related to chronic lung disease and/or smoking, ascites, pelvic tumors, constipation)

Previous pelvic surgery (e.g., hysterectomy)

Congenital connective tissue disorders

Diabetes mellitus

Question 3

Clinical features of a patient presenting with pelvic organ prolapse

Answer 3

Sensation of fullness within vagina or feeling like something coming down or like sitting on a ball

Lower back pain due to stretching of uterosacral ligaments

May have features of urinary incontinence, sexual dysfunction, constipation and fecal incontinence

Cystocoele: more urinary symptoms ie hesitancy incomplete voiding urinary infections

Rectocoele: constipation and alternating diarrhea, incontinence of feces and flatus

Enterocoele: just the fullness

Question 4

Describe the 4 grades of uterine prolapse

Answer 4

Grade 0: no descent of cervix
Grade 1: descent of cervix into vagina
Grade 2: descent of cervix to introitus
Grade 3: descent of cervix outside of the vagina (procidentia)

Question 5

Sx management of pelvic organ prolapse

Answer 5

Obliterative surgery: colpocleisis in which the vagina is closed off or narrowed to provide more support for pelvic organs.
Reconstructive surgery (abdominal or vaginal approach): to restore the original position of the descended pelvic organs
Sacrocolpopexy (with vaginal vault suspension and hysterectomy): fixation of the vaginal apex to the sacrum for the repair of apical or vaginal vault prolapse, with suspension and hysterectomy
Suspension techniques: prolapsed organ is fixated or suspended using native tissues such as the endopelvic fascia, iliococcygeus muscle, uterosacral ligament, or sacrospinous ligaments.
Colporrhaphy: reinforcement of the anterior or posterior vaginal wall for the repair of cystocele or rectocele
Sacrohysteropexy: fixation of the cervix to the sacrum for the repair of uterine prolapse