Pelvic Organ Prolapse Flashcards
What is pelvic organ prolapse?
It refers to the descent of pelvic organs into the vagina
What is the general cause of pelvic organ prolapse?
It occurs as the result of muscle and ligament the weakening surrounding the uterus, rectum and bladder
What is urethrocele prolapse?
A urethrocele involves prolapse of the lower anterior vaginal wall involving the urethra
This allows the urethra to descend backwards into the vagina
What is cystocele prolapse?
A cystocele involves prolapse of the upper anterior vaginal wall involving the urinary bladder
This allows the urinary bladder to descend backwards into the vagina
What is an enterocoele prolapse?
An enterocele involves prolapse of the upper posterior vaginal wall involving the small bowel
This allows the small bowel to descend forwards into the vagina
What is a rectocele prolapse?
A rectocele involves prolapse of the lower posterior vaginal wall involving the rectum
This allows the rectum to descend forwards into the vagina
What can occur as a result of rectocele prolapse?
Faecal loading in the part of the rectum that has prolapsed into the vagina
What is another term for uterovaginal prolapse?
Apical prolapse
What is a uterovaginal prolapse?
It involves descent of the uterus, cervix and upper vagina
What is a common subtype of uterovaginal prolapse?
Vault prolapse
What is a vault prolapse?
It involves descent of top of the vagina (vault) into the vagina
In which patients does a vault prolapse occur in?
Hysterectomy
What are the nine risk factors of pelvic organ prolapse?
Multiple Vaginal Deliveries
Instrumental, Prolonged or Traumatic Delivery
Pelvic Surgery
Advanced Age
Menopause
Obesity
Chronic Constipation
Chronic Respiratory Disease
High Impact Exercise
What are the six clinical features of pelvic organ prolapse?
Vaginal Protrusion Sensation
Heavy Pelvis Sensation
Sexual Dysfunction
Urinary Incontinence/Urgency/Retention
Constipation
Bowel Incontinence/Urgency
What investigation is used to diagnose pelvic organ prolapse?
Pelvic examination
What equipment is used during pelvic examination to aid diagnosis of pelvic organ prolapse?
Sim’s speculum
It can be used to support the anterior or posterior vaginal wall while the other vaginal walls are examined
What are the two grading methods used to assess the severity of pelvic organ prolapse?
Pelvic Organ Prolapse Quantification (POP-Q) Score
Baden-Walker-Halfaway Grading
In which three circumstances do we use conservative management for pelvic organ prolapse?
When women are experiencing mild symptoms
When patients have a POP-Q score 1/2
When patients are not suitable for surgery
How do we conservatively manage pelvic organ prolapse?
It involves advising patients on how to conduct pelvic floor exercises, used to strengthen the pelvic muscles and relieve their symptoms
How do we pharmacologically manage pelvic organ prolapse?
It involves the insertion of a vaginal pessary
What are vaginal pessary?
They are silicone structures inserted into the vagina to provide extra support to the pelvic organs
They should be removed and cleaned, or changed periodically – every four months
What are the five types of vaginal pessaries?
Ring
Gellhorn
Cube
Donut
Hodge
What are the two side effects of vaginal pessaries? How do we relieve these?
Vaginal irritation
Vaginal erosion
Oestrogen cream
In which two circumstances is surgical management used for pelvic organ prolapse?
When patients are are experiencing severe symptoms impacting their quality of life
When patients have a POP-Q score 3/4
What is the definitive treatment option for pelvic organ prolapse?
Surgical management - usually relieving symptoms and restoring bladder/bowel function
Describe the surgical management of pelvic organ prolapse
The surgery conducted is directed towards the prolapsing compartment
This means that if the prolapsing compartment is the anterior wall of the vagina, we conduct an anterior vaginal wall repair
What are the three surgeries used to treat apical prolapse?
Hysterectomy
Sacrospinous fixation
Abdominal sacrocolpopexy.
What surgery can be used to treat pelvic organ prolapse in elderly patients who are no longer interested in sexual intercourse?
Colpoclesisis surgery
What is colpoclesis?
A procedure that involves closure of the vagina
