Gynaecology

Question 1

What are the 3 main classifications of urogenital prolapse?

Answer 1

1. Anterior compartment
2. Posterior compartment
3. Middle compartment

Question 2

What are the 2 types of anterior compartment prolapse & definitions?

Answer 2

1. Urethrocele - prolapse of urethra into vagina

2. Cystocele - prolapse of bladder into vagina

Question 3

1 type of posterior compartment prolapse ?

Answer 3

1. Rectocele - prolapse of rectum into vagina

Question 4

What can prolapse into the vagina in the middle compartment?

Answer 4

1. Uterus
2. Vaginal vault
3. Pouch of douglas - Enterocele

Question 5

Give 4 key risk factors of urogenital prolapse?

Answer 5

1. Vaginal delivery (biggest)
2. Increased age
3. Parity
4. Obesity

Question 6

Symptoms to ask about if prolapse is suspected & specific Sx for urocele/rectocele?

Answer 6

1. Sensation of pressure/heaviness - dragging sensation
2. (1) is worst at the end of the day and after standing up for a long time
3. Sensation of seeing/feeling bulge or protrusion
4. Coital difficulty
5. LUTs for ?cystocele
6. Bowel symptoms for ?rectocele i.e. having to strain, constipation, incomplete emptying, uregency

Question 7

What investigation is important for women with cystocles?

Answer 7

Urine dip - urine normally becomes stagnent and can get UTI easily

Question 8

Conservative management for urogenital prolapse?

Answer 8

Pelvic floor exercises and weight loss

Question 9

Medical management of urogenital prolapse?

Answer 9

Intravaginal devices i.e pessary +/- estrogen

Device changed every 6 months

Question 10

Complications of using a pessary for urogenital prolapse?

Answer 10

Vaginal irritation, discharge, odour, fistula (rare)

Question 11

Surgical management of urogenital prolapse?

Answer 11

Mesh repair

Hysterectomy (last resort)