Pelvic Organ prolapse Flashcards

1
Q

What is the defintion of prolapse?

A

Protrusion of an organ or structure beyond its normal anatomical confines

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2
Q

What is the defintion of female pelvic organ prolapse?

A

Refers to the descent of the pelvic organs towards or through the vagina

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3
Q

What is a urethrocele?

A

Prolapse of the lower anterior vaginal wall involving the urethra only

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4
Q

What is a cystocele?

A

Prolapse of the upper anterior vaginal wall involving the bladder

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5
Q

What is a rectocele?

A

Prolapse of the lower posterior wall of the vagina involving the rectum bulging forwards into the vagina

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6
Q

What is an enterocele?

A

Prolapse of the upper posterior wall of the vagina usually containing loops of small bowel

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7
Q

What is a uterovaginal prolapse?

A

This term is used to describe prolapse of the uterus, cervix and upper vagina

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8
Q

What are risk factors for the development of pelvic organ prolapse?

A
  • Pregnancy and labour related issues - Large baby (>4500 gms), Prolonged Second stage, Forceps delivery, Parity
  • Advanced Age
  • Obesity
  • Previous Pelvic Procedures
  • Continence procedures - Burch culposuspension, Hysterectomy
  • Hormonal Factors
  • Quality of Connective Tissue
  • Increased IAP - Constipation, chronic coughing
  • Occupation with Heavy Lifting
  • Exercise - Weight Lifting, High Impact
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9
Q

What are general symptoms of pelvic organ prolapse?

A
  • Dragging sensation/Something coming down
  • Depending on site of prolapse
    • Cystitis
    • Frequency
    • Stress incontinence
    • Difficulty defecating
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10
Q

What are symptoms of vaginal prolapse?

A
  • Sensation of a bulge or protrusion
  • Seeing or feeling a bulge or protrusion
  • Pressure
  • Heaviness
  • Difficulty in inserting tampons
  • Dysparuenia
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11
Q

What are symptoms of a rectocele/Enterocele?

A
  • Incontinence of flatus, or liquid or solid stool
  • Feeling of incomplete emptying/ Straining
  • Urgency
  • Digital evacuation to complete defecation
  • Splinting, or pushing on or around the vagina or perineum, to start or complete defecation
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12
Q

How would you examine someone with symptoms of a prolapse?

A

Left lateral side with Sim’s speculum - ask the patient to bear down

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13
Q

What investigations would you consider doing in a woman with pelvic organ prolapse?

A
  • Bedside - Dipstick
  • Bloods - none
  • Imaging - Bladder scan, IVU/renal USS
  • Other - urodynamics
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14
Q

What is the POPQ scoring system?

A

Pelvic organs prolapse quantification (POP-Q) is a standardised tool for documenting the examination findings

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15
Q

What is stage 0 POPQ prolapse?

A

No prolapse

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16
Q

What is stage 1 POPQ prolapse?

A

Most distal portion of the prolapse is >1cm proximal to the level of the hymen

17
Q

What is stage 2 POPQ prolapse?

A

Most distal portion of the prolapse is < 1cm proximal or distal to the level of the hymen

18
Q

What is stage III POPQ prolapse?

A

Most distal portion of the prolapse is > 1cm beyond the hymen but protrudes no further than total length of the vagina

19
Q

What is stage IV POPQ prolapse?

A

Complete vaginal eversion

20
Q

What measures can be taken to prevent pelvic organ prolapse?

A
  • Avoid constipation
  • Manage chronic chest pathology more effectively
  • Lower parity
  • Improved intrapartum/antenatal care
  • Pelvic floor exercises
21
Q

Why might you do Renal USS scan in someone with a POP?

A

Look for signs of ureteric obstructions

22
Q

What conservative measures could you use to manage POP?

A
  • Preventative measures - alter exercise, reduce weight etc.
  • Physiotherapy - Pelvic floor muscle training
23
Q

What medical interventions can be used to manage pelvic organ prolapse?

A
  • Ring Pessaries
  • Oestrogen cream
24
Q

What is the main purpose of surgical intervention in someone with POP?

A
  • Relieve symptoms
  • Restore bladder/Bowel function
  • Maintian vaginal capacity for sexual function
25
Q

How is marked uterine prolapse managed surgically?

A

Hysterectomy

26
Q

How does a pessarie work?

A

Reduce prolapsed tissue inside the vagina, provide support to related pelvic structures, and relieve pressure on the bladder and bowel in order to avert or delay the need for surgery