Pelvic organ prolapse

Question 1

define pelvic prolapse

Answer 1

protursion of the uterus and/or vagina beyond normal anatomic confines

Question 2

which organs are often involved in pelvic organ prolapse

Answer 2

always uterus and/or vagina

can also involve bladder, urethra, rectum and bowel

Question 3

risk factors for pelvic organ prolapse 5

Answer 3

increasing age/menopause

vaginal delivery

increased parity

raised intrabomindal pressure

congeital factors

Question 4

how does increasing age/menopause affect risk factor for pelvic organ prolapse 2

Answer 4

loss of oestrogen

connective tissue stregnth

Question 5

how does vaginal delivery affect risk factor for pelvic organ prolapse 3

Answer 5

big babies- prolonged secodnary stage

direct trauma

pudenal nerve damage

Question 6

what causes a raised intraabdominal pressure 3

Answer 6

obesity

chronic cough

chronic constipation

Question 7

what congeital factor can cause an increased risk of pelvic organ prolapse 1

Answer 7

abnromal collagen metabolism

Question 8

vaginal clinical features of pelvic organ prolpase 5

Answer 8

sensation of pressure, fullness, heaviness

sensation of bulge ‘something coming down’
-worse at end of day
-better lying down

bleeding/discharge

backage

dyspareunia

Question 9

urinary syx of pelvic organ prolapse 4

Answer 9

incontinence

frequency

urgency

need to manually reduce prolapse prior to coding

Question 10

bowel syx of pelvic organ prolapse 3

Answer 10

constipation/straining

faecal incontinece or urgency of stool

incomplete evacuation

Question 11

aspects of vaginal exam for pelvic organ prolapse 3

Answer 11

check walls in turn for descent and atrophy

ulceration

ask to cough

Question 12

what to assess for in abdo/bimanual examiantion for pelvic organ prolapse 1

Answer 12

pelvic masses

Question 13

what is used to grade pelvic organ prolapse

Answer 13

pelvic organ prolapse quantification

-recognised grading system for severeity/degree of prolapse

based on position of most distal portion of prolpase during straining

Question 14

regarding pelvic organ prolapse quantification grading system:
-define stage 0

Answer 14

no prolpase [7]

Question 15

regarding pelvic organ prolapse quantification grading system:
-define stage 1

Answer 15

more than 1cm above hymenal ring [7]

Question 16

regarding pelvic organ prolapse quantification grading system:
-define stage 2

Answer 16

prolpase extends from 1cm above to 1cm below hymenal ring [7]

Question 17

regarding pelvic organ prolapse quantification grading system:
-define stage 3

Answer 17

prolpase extends 1cm or more below hymenal ring
-no vaginal eversion [7]

Question 18

regarding pelvic organ prolapse quantification grading system:
-define stage 4

Answer 18

vagina completed everted [7]

Question 19

define the following classification of prolapse
-cystocele

Answer 19

bladder protrudes (anteriorly)

Question 20

define the following classification of prolapse
urethrocele

Answer 20

descent of anterior vaginal wall where the urethra sits

Question 21

define the following classification of prolapse
rectocele

Answer 21

rectum protrudes (posterior)

Question 22

define the following classification of prolapse
enterocele

Answer 22

upper vainga, descent of vagina and peritoneal sac

Question 23

other types of prolapse 2

Answer 23

uterine prolpase

vaginal vault prolapse

Question 24

commonest type of pelvic organ prolapse

Answer 24

cystocele
-prolapse of the upper anterior vaginal wall and bladder

Question 25

second most common type of pelvic organ prolapse

Answer 25

uterine prolpase

Question 26

state the three stages of uterine prolapse

Answer 26

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]

Question 27

when does a vginal vault prolpase occur

Answer 27

follwoing a hysteroectomy

occurs in 15% of women who had hsyterecomty for uterine prolpase

1% for other hysterectomy reasons

Question 28

conservative managemnt of a pelvic organ prolapse 2

Answer 28

lifestyle advice- weight & smoking

pelvic floor exercises supervised by physiotherapy

intravaginal device- pessaries

vaginal oestrogens

Question 29

surgical options for pelvic organ prolapse 2

Answer 29

vaginal

abdominal

Question 30

what factors influence pelvic organ prolpase management 6

Answer 30

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

Question 31

where is a ring pessary fitted

-what is it made of

-how is it fitted

Answer 31

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

Question 32

complications of pessaries 5

Answer 32

may interfere w sex

ulceration

infection

difficulty and discomfort during removal

fistula if neglected

Question 33

when is surgey indicated for pelvic organ prolapses 3

Answer 33

if pessaries have failed

patient wants definitve treatment

prolapse combined w urinary or faecal incontinence

Question 34

what is the surgicla mangment of an anterior compareemnt pelvic organ prolpase

-descirbe it

-complications 4

Answer 34

anterior colporrhapy

-anterior vaginal wall incision
-buutressing sutures placed on fascia
-surplus skin excised

complications
-dyspareunia
-incontience
-fialure
-recurrence (30% in 5yrs)

Question 35

what is the surgicla mangment of a posterior compareemnt pelvic organ prolpase

-descirbe it

-complications 4

Answer 35

posterior colporrhaphy

-incidion made on posterior wall of vagina
-butressing sutures
-reapposition of levator muscles
-removal of excess skin

-dyspareunia

Question 36

describe an enterocele repair

Answer 36

vaignal epithelium dissected from enterocele sac

uterosacral ligaments brought together in midline

Question 37

surgical repair options for uterovaginal prolapse 3

Answer 37

vaginal hysterectomy

manchest repair -cervical amputation

sacrohysteropexy
-open abdo or laparoscopic
-mesh used to attach uterus to anterior longitudinal ligament over the sacrum

Question 38

surgical repair of vaginal vault prolpase 2

Answer 38

sacrospinous ligament fixation
-sutured to sarcospinous ligaments -vaginal approach

sacrocolpopexy
-open/laparoscopic

vault attached to sacrum using mesh

Question 39

pelvic organ prolapse prevention

Answer 39

weight reduction

treat constipation

treat chronic cough & smoking cessation

avoid heavy lifting

encourage life long pelvic floor exercises