Pelvic organ prolapse Flashcards
define pelvic prolapse
protursion of the uterus and/or vagina beyond normal anatomic confines
which organs are often involved in pelvic organ prolapse
always uterus and/or vagina
can also involve bladder, urethra, rectum and bowel
risk factors for pelvic organ prolapse 5
increasing age/menopause
vaginal delivery
increased parity
raised intrabomindal pressure
congeital factors
how does increasing age/menopause affect risk factor for pelvic organ prolapse 2
loss of oestrogen
connective tissue stregnth
how does vaginal delivery affect risk factor for pelvic organ prolapse 3
big babies- prolonged secodnary stage
direct trauma
pudenal nerve damage
what causes a raised intraabdominal pressure 3
obesity
chronic cough
chronic constipation
what congeital factor can cause an increased risk of pelvic organ prolapse 1
abnromal collagen metabolism
vaginal clinical features of pelvic organ prolpase 5
sensation of pressure, fullness, heaviness
sensation of bulge ‘something coming down’
-worse at end of day
-better lying down
bleeding/discharge
backage
dyspareunia
urinary syx of pelvic organ prolapse 4
incontinence
frequency
urgency
need to manually reduce prolapse prior to coding
bowel syx of pelvic organ prolapse 3
constipation/straining
faecal incontinece or urgency of stool
incomplete evacuation
aspects of vaginal exam for pelvic organ prolapse 3
check walls in turn for descent and atrophy
ulceration
ask to cough
what to assess for in abdo/bimanual examiantion for pelvic organ prolapse 1
pelvic masses
what is used to grade pelvic organ prolapse
pelvic organ prolapse quantification
-recognised grading system for severeity/degree of prolapse
based on position of most distal portion of prolpase during straining
regarding pelvic organ prolapse quantification grading system:
-define stage 0
no prolpase [7]
regarding pelvic organ prolapse quantification grading system:
-define stage 1
more than 1cm above hymenal ring [7]
regarding pelvic organ prolapse quantification grading system:
-define stage 2
prolpase extends from 1cm above to 1cm below hymenal ring [7]
regarding pelvic organ prolapse quantification grading system:
-define stage 3
prolpase extends 1cm or more below hymenal ring
-no vaginal eversion [7]
regarding pelvic organ prolapse quantification grading system:
-define stage 4
vagina completed everted [7]
define the following classification of prolapse
-cystocele
bladder protrudes (anteriorly)
define the following classification of prolapse
urethrocele
descent of anterior vaginal wall where the urethra sits
define the following classification of prolapse
rectocele
rectum protrudes (posterior)
define the following classification of prolapse
enterocele
upper vainga, descent of vagina and peritoneal sac
other types of prolapse 2
uterine prolpase
vaginal vault prolapse
commonest type of pelvic organ prolapse
cystocele
-prolapse of the upper anterior vaginal wall and bladder
second most common type of pelvic organ prolapse
uterine prolpase
state the three stages of uterine prolapse
1- cervix decensds within viagna but does not pass outside the introoitus
2- cervic proturds beyond introitus
3total prolapse of uterus outside vaginal introitus [8]
when does a vginal vault prolpase occur
follwoing a hysteroectomy
occurs in 15% of women who had hsyterecomty for uterine prolpase
1% for other hysterectomy reasons
conservative managemnt of a pelvic organ prolapse 2
lifestyle advice- weight & smoking
pelvic floor exercises supervised by physiotherapy
intravaginal device- pessaries
vaginal oestrogens
surgical options for pelvic organ prolapse 2
vaginal
abdominal
what factors influence pelvic organ prolpase management 6
severity of syx - effect on QoL
age, parity and wish for further pregnancies
patients sexual activity
presence of aggravating factors- smoking/obesity
urinary syx
additional gynae problems
where is a ring pessary fitted
-what is it made of
-how is it fitted
placed between posterior aspect of symphysis pubis and posterior fornix of the vaigna [9]
-made of pliable plastic
-compressed into oval shape forinsertion and regains circular shape in vagina
complications of pessaries 5
may interfere w sex
ulceration
infection
difficulty and discomfort during removal
fistula if neglected
when is surgey indicated for pelvic organ prolapses 3
if pessaries have failed
patient wants definitve treatment
prolapse combined w urinary or faecal incontinence
what is the surgicla mangment of an anterior compareemnt pelvic organ prolpase
-descirbe it
-complications 4
anterior colporrhapy
-anterior vaginal wall incision
-buutressing sutures placed on fascia
-surplus skin excised
complications
-dyspareunia
-incontience
-fialure
-recurrence (30% in 5yrs)
what is the surgicla mangment of a posterior compareemnt pelvic organ prolpase
-descirbe it
-complications 4
posterior colporrhaphy
-incidion made on posterior wall of vagina
-butressing sutures
-reapposition of levator muscles
-removal of excess skin
-dyspareunia
describe an enterocele repair
vaignal epithelium dissected from enterocele sac
uterosacral ligaments brought together in midline
surgical repair options for uterovaginal prolapse 3
vaginal hysterectomy
manchest repair -cervical amputation
sacrohysteropexy
-open abdo or laparoscopic
-mesh used to attach uterus to anterior longitudinal ligament over the sacrum
surgical repair of vaginal vault prolpase 2
sacrospinous ligament fixation
-sutured to sarcospinous ligaments -vaginal approach
sacrocolpopexy
-open/laparoscopic
vault attached to sacrum using mesh
pelvic organ prolapse prevention
weight reduction
treat constipation
treat chronic cough & smoking cessation
avoid heavy lifting
encourage life long pelvic floor exercises
