Pelvic organ prolapse Flashcards
1st degree POP
Structure in upper 2⁄3 of vagina;
2nd degree POP
To level of introitus
3rd degree POP
Outside of vagina
4th degree POP
Whole structure outside of vagina
Tool to quantify POP
POP-q can quantify more precisely.
Risk factors for POP
Bigger problem in post-menopausal women 2/2 decreased estrogen, more vaginal deliveries.
Also increased risk with chronic increased abdominal pressure (chronic cough, constipation, repeated heavy lifting, large pelvic tumors).
Physical exam for POP
Do a split-speculum exam. May also need urine cx, cystoscopy, urethroscopy, urinary studies, anoscopy, sigmoidoscopy, defecography depending on presentation.
Anterior POP
Cystocele, urethrocele
Treatment for cystocele
Anterior colporrhapathy (remove excess anterior vaginal mucosa, plicate endopelvic fascia to resuspend bladder)
Posterior POP
Rectocele, enterocele
Treatment for rectocele
Posterior colporrhopathy (similar to above, but rectal fascia plicated posterior, excess posterior vaginal wall removed)
Treatment for enterocele
Vaginal enterocele repair (repair & plicate rectovaginal fascia / posterior vaginal wall)
Apical POP
Uterus
Apical POP treatment
Vaginal hysterectomy + McCall culdoplasty (plicate uterosacral ligaments to reduce risk of future vault prolapse
Vaginal vault prolapse treatment
Sacrospinous ligament suspension: suture endopelvic fascia of (collapsing after
hysterectomy) vaginal apex to sacrospinous ligament (vaginal approach)
Abdominal sacral colpopexy: use mesh, attach vaginal apex to sacrum (abdominal approach)
