Pelvic Organ Prolapse

Question 1

Partial prolapse

Answer 1

Partially out side vaginal opening

Question 2

Total pop

Answer 2

Located out side the vaginal wall

Question 3

Ssx of pop

Answer 3

Vaginal and rectal fullness
Constipation
Incomplete rectal emptying
Vaginal discharge

Question 4

Uterine precidente

Answer 4

Protrusion if all vaginal wall or cervix beyond vagina

Question 5

Vaginal vault prolapse

Answer 5

descent of the apex of the vagina
Apical compartment prolapse: herniated uterus, cervix, or vaginal vault

Question 6

Risk factor for pop

Answer 6

Low estrogen
Collagen vascular disease
DM
Prior pelvic surgery

Question 7

Stages of pop

Answer 7

Stage 0: no prolapse

Stage 1: The most distal portion of prolapse is more than 1 cm above the level of the hymen.

Stage 2: The most distal portion of prolapse is 1 cm or less proximal or distal to the hymenal plane.

Stage 3: The most distal portion of prolapse is more than 1 cm from the hymenal plane but no more than 2 cm less than the vaginal length.

Stage 4: The vagina is completely everted or uterine procidentia has occurred.

Question 8

Ddx for pop

Answer 8

Pelvic floor dysfunction
Urethral dysfunction

Question 9

Skene duct cyst

Answer 9

A retention cyst that results from obstruction, accumulation of fluid, and cystic dilation of the ducts that drain the paraurethral glands.

Pelvic examination typically shows masses located just lateral to the external urethral meatus.

Question 10

Conservative mgt of pop

Answer 10

Vaginal pessary

A silicone or latex device that is inserted into the vagina
Provides support for pelvic organs

Kegel exercises: pelvic floor muscle training (also as a preventive measure)

Question 11

Surgical mgt of pop

Answer 11

Obliterative surgery: colpocleisis, a procedure that involves sewing the walls of the vagina together to provide support for pelvic organs.

Reconstructive surgery (abdominal or vaginal approach): to restore the original position of the descended pelvic organs

Sacrocolpopexy (with vaginal vault suspension and hysterectomy): repair of apical or vaginal vault prolapse by hysterectomy and fixation of the vaginal apex to the sacrum

Suspension techniques: fixation or suspension of the prolapsed organ by using native tissues such as endopelvic fascia, iliococcygeus muscle, uterosacral ligament, or sacrospinous ligaments

Colporrhaphy: reinforcement of the anterior or posterior vaginal wall for the repair of cystocele or rectocele
Sacrohysteropexy: fixation of the cervix to the sacrum for the repair of uterine prolapse

Question 12

Complications of pop

Answer 12

Fecal incontinence
Sexual dysfunction
Pressure ulcer
Recurrence

Question 13

Posterior vaginal wall prolapse

Answer 13

enterocele (upper 1/3rd of the posterior vaginal wall) or rectocele (middle 1/3rd of the posterior vaginal wall). Both can occur concurrently.

Question 14

Bartholin gland cyst

Answer 14

Although a large Bartholin gland cyst can cause pelvic pain which worsens on walking, a pelvic examination would show a unilateral, soft, fluctuant mass in the lower vestibular area.

A Bartholin gland cyst can result in mild dyspareunia and a palpable, tender mass on pelvic examination. However, these cysts are not typically associated with urinary incontinence or dysuria. Moreover, they develop at the posterior vaginal introitus, not the anterior vaginal wall

Question 15

Cystocele

Answer 15

pink structure at the vaginal introitus that protrudes from the anterior vaginal wall when the patient is asked to cough

Question 16

Urethral diverticulum

Answer 16

triad of urinary incontinence (in particular, postvoid dripping), dysuria, and dyspareunia. Urethral diverticula can sometimes be identified on pelvic examination as a usually tender anterior vaginal wall mass