Pelvic Organ Prolapse Flashcards

1
Q

POP overal ideas

A
  • clinically relevant only if symptomatic (pressure, bulge, sexual dysfunction, abnormal lower urinary or bowel function)
  • usually occurs if reaches 0.5cm above the hymen
  • 13% lifetime risk of surgery
  • 30% risk of repeat surgery
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2
Q

POP staging

A
  • Stage 0: no prolapse
  • 1: higher than 1cm above hymen
  • 2: at 1cm above to below hymen
  • 3: more than 1cm below hymen
  • 4: procidentia (complete prolapse or eversion)
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3
Q

Risk factos POP

A
Parity
vaginal delivery
age
obesity
connective tissue disease
menopause
chronic constipation
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4
Q

w/u POP

A
hx: symptoms, past medical, surgical hx
exam:
- vaginal epithelium looking for atrophy
- do pelvic exam in standing position
- POP-Q eval 
- assessment of muscle tone
labs: 
- UA
- PVR (if prolapsed stage 3 or 4)
- urodynamic testing is stage 2 or worse
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5
Q

POP Treatment: non-surgical options

A
  • high fiber diet
  • osmotic laxatives
  • local estrogen therapy
  • vaginal pessary (change every 3-4 months, or more frequently if wall erosion occurs)
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6
Q

POP surgical treatment options for upper vaginal prolapse

A

Abdominal sacral colpopexy (with mesh)

  • for pt with short vagina, other intra-abdominal pathology ad risk for POP recurrence
  • can be laparoscopically/robotic

USLS

Sacrospinus ligament fixation

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7
Q

POP surgical management: anterior wall prolapse

A

Anterior colporrhaphy

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8
Q

POP surgical management: posterior wall prolapse

A

posterior colporrhaphya

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9
Q

POP surgical management: apical vaginal prolapse and/or anterior wall prolapse

A

repair with synthetic or biological graft

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10
Q

POP surgical management: Uterine prolaps

A

Hysterectomy with USLS and sacrospinous ligament suspension

hysteropexy comprising attachment of the cervix to the sacrospinous ligaments (less invasive and reduced morbidity compared to hysterectomy)

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11
Q

Mesh

A

Mesh with prolapse repair is associated with ~10% risk of erosion (with 10% of those patients needing re-operation)

Effective for anterior wall prolapse (not posterior wall), should only be considered in high risk pt such as those with recurrence or medical co-morbidities

Compared to natural tissue for anterior wall repair, polypropylene mesh provides better anatomic and subjective results, but higher morbidity

special surgical training required

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12
Q

anterior repair or apical compartment prolapse surgery

A

should get a cystoscopy always

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13
Q

Complications from mesh

A
  • Bleeding, infections (especially UTI)
  • Voiding dysfunction (typically transient)
  • Structual anatomic breach (fistula, ureteral injury, diminished vaginal capacity which can cause dyspareunia)
  • mesh erosion
  • symptom recurrence with need for repeat surgery
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