Pelvic Organ Prolapse Flashcards
What is prolapsed in an anterior compartment prolapse? Posterior compartment prolapse?
Anterior: bladder (cystocele)
Posterior: Rectum
What is a cystocele? What is it assoc. with?
- the downward displacement of the bladder into the vagina
- associated with:
- childbirth
- Also a/w urethrocele (sagging of urethra)–> cystourethrocele
Sxs of what:
- Pelvic pressure, low back pain
- Sensation of “Sitting on something”
Cystocele
What are aggravating and alleviating factors of a cystocele?
- Aggravating: Sex and incr. in intra-abdominal pressure (sneezing, coughing, etc)
- Alleviating: Lying supine
A patient c/o feeling as though she is “sitting on something” and on physical exam you see the following (pic below). What is the most likely dx?
Cystocele
How do you dx a cystocele?
clinical
+/- IVP/ultrasound
+/- MRI
What are the 3 options for medical management of a cystocele?
- Exercises (i.e. Kegel exercies 10-15min QD)
- Pessary use
- Vaginal weights
*NO estrogen therapy
If you have a cystocele + other prolapses, what is the surgical intervention of choice?
Anterior colporrhaphy
If a patient desires future pregnancy, is she a good surgical candidate for treatment of a cystocele?
No
What is a rectocele?
Rectovaginal herniation b/w the rectum and the vagina
What condition?
- Pt c/o rectal fullness, straining, a vaginal “bulging” and/or low back pain
Rectocele
What is the biggest risk factor of a rectocele?
Chronic constipation
(also pregnancy)
What diagnostic study will help distinguish b/w an enterocele, rectocele and a sigmoidocele?
Dynamic cystoproctography
What are the 3 medical management options for a rectocele in a patient that desires more children and for the asymptomatic patient?
Stool softeners
Kegel exercises
Pessary
What is the surgical management of a Rectocele
Traditional colpoperineorraphy
