Pelvic Organ Prolapse

Question 0

Cystocele – Defect of? Organ in vagina? Associated finding? Type of pelvic organ prolapse?

Answer 0

Defect in public muscular support of the bladder, allowing bladder to fall into vagina.

Hypermobile urethra

anterior POP defect

Question 1

Types of pelvic organ prolapse based on location?

Answer 1

Anterior – cystocele
Central – enterocele
Posterior – rectocele
Lateral – paravaginal

Question 2

Enterocele – defect of? Organs pushed into the vagina by? Type of prolapse?

Answer 2

Defect of pelvic muscular support of the uterus and cervix or the vaginal cuff (if hysterectomy)

Small bowel or omentum pushes organs into vagina

Central

Question 3

Rectocele – Defect of? Organ in vagina? Associated symptoms? Type of prolapse?

Answer 3

Defect of pelvic muscular support of the rectum

Rectum impinges into the vagina

1. Constipation or difficulty evacuating stool
2. Attenuated/weakened perineal body

Posterior

Question 4

Paravaginal defect – defect of? Leads to? Type of pelvic defect?

Answer 4

Levator ani attachment to the lateral pelvic sidewall

Lack of support of the vagina

Lateral pelvic defect

Question 5

How common is pelvic prolapse? Most common when?

Answer 5

50% of parous women ; After menopause

Question 6

Symptoms of pelvic organ prolapse?

Answer 6

1. Heaviness or pressure sensation in the pelvis
2. Sexual dysfunction or pain with intercourse

Central – bulging mass
Anterior – difficulty voiding or urinary incontinence
Posterior – constipation or needing to push on the vagina to achieve BM

Question 7

Risk factors for pelvic organ prolapse?

Answer 7

1. Multiple vaginal births
2. Valsalva – coughing, lifting
3. Genetics
4. Lack of estrogen
5. Obesity

Question 8

Pelvic diaphragm consists of which muscles?

Answer 8

Pubococcygeus, puborectalis, levator ani

Question 9

Patient with suspected pelvic organ prolapse – positions for examination?

Answer 9

Standing and supine

Question 10

Q-tip test? Interpretation?

Answer 10

Q-tip placed in urethra. Patient then valsalvas

60° angle of excursion or greater indicates hypermobile urethra (Cystocele)

Question 11

Mild versus moderate versus complete prolapse?

Answer 11

Above the hymen versus at the hymen versus beyond the hymen

Question 12

Procidentia?

Answer 12

Entire uterus is prolapsed out the patient’s introitus

Question 13

Women with previous hysterectomy are at risk for what type of prolapse? Why?

Answer 13

Vaginal cuff prolapse; failure to fix the vagina to supporting Cardinal or uterosacral ligaments

Question 14

Treatment for mild prolapse? More significant defects?

Answer 14

Pelvic floor strengthening exercises

Pessary devices (acts as hammock to support pelvic organ) or surgery

Question 15

Surgery for vaginal cuff prolapse?

Answer 15

1. Sacrospinous ligament fixation procedure (fixes vaginal cuff to sacrospinous ligament)
2. Sacrocolopexy – Uses synthetic material to fix vaginal cuff to sacral bone

Question 16

Problem with synthetic meshes in the vagina?

Answer 16

Erosion

Question 17

Posterior colporrhaphy?

Answer 17

Incision of the vaginal mucosa posteriorly, and surgical repair of endopelvic fascia edges that have been separated

For rectoceles

Question 18

Culdoplasty?

Answer 18

Surgical technique to obliterate cul-de-sac region (reduces opportunity for small bowel to push into the vaginal vault and form enterocele)