Pelvic organ prolapse

Question 1

Definition

Answer 1

When abdominal organs come through the vagina as there is failure of support of pelvic organs

Question 2

Anterior prolapse

Answer 2

Bladder drops into vagina

Question 3

Middle or apical prolapse

Answer 3

Uterus/vault drops into vagina

Question 4

Posterior prolapse

Answer 4

Rectum drops into vagina

Question 5

Causes

Answer 5

Age
Parity
Previous vaginal deliveries
Obesity

Question 6

Clinical features

Answer 6

Pressure 
Storage symptoms 
- frequency
- urgency 
Incontinence 
Voiding symptoms 
Post micturation symptoms 
- incomplete emptying 
Sexual dysfunction

Question 7

Investigations

Answer 7

US
MRI
Anorectal manometry

Question 8

Quantification system

Answer 8

POP-Q

Question 9

Management for mild-moderate prolapse

Answer 9

Pelvic floor exercises

Vaginal pessary

Question 10

Management for severe prolapse

Answer 10

Surgery

• pelvic floor repair
• sacrospinous fixation

Question 11

What are you potentially at risk of injuring during sacrospinous fixation?

Answer 11

Injury to pudendal nerve and sciatic nerve

Question 12

What is the most common type of prolapse?

Answer 12

Anterior prolapse

Question 13

What is an anterior prolapse called?

Answer 13

Cystocele

Question 14

Cystocele - clinical features

Answer 14

Bladder symptoms 
Bulge
Pressure 
"mass"
Incomplete bladder emptying 
Difficulty inserting tampon 
Dyspareunia 
Urge incontinence

Question 15

Cystocele - management

Answer 15

Pessary

Surgery

Question 16

What is a middle prolapse called?

Answer 16

Uterine prolapse

Question 17

Uterine prolapse - clinical features

Answer 17

Dragging, heavy sensation 
Back pain 
Mass
Difficulty inserting/retaining tampon 
Dyspareunia

Question 18

Uterine prolapse - management

Answer 18

Pessary

Question 19

What is a posterior prolapse called?

Answer 19

Rectocele

Question 20

Rectocele - clinical features

Answer 20

Bulging 
Pressure 
Difficulty defecating 
Incomplete defecation 
Digitation

Question 21

Rectocele - management

Answer 21

Pessary

Question 22

Vaginal vault prolapse happens when

Answer 22

Following hysterectomy

Question 23

Name 3 complications of long term pessary

Answer 23

Vaginal discharge
Ulceration
Formation of fibrous bands (attaching pessary to vagina)

Question 24

How often should pessaries be changed?

Answer 24

Every 6 months

Question 25

POP-Q classification system (stage 1-4)

Answer 25

Stage 1: -1cm
Stage 2: between -1cm and +1cm
Stage 3: +1cm (visible)
Stage 4: complete prolapse