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
Vaginal prolapse is common after what
hysterectomy
CPx of what?
- Pelvic pressure
- Sensation of bearing down
- Dyspareunia
- Low back pain
Vaginal prolapse
Patients with a vaginal prolapse may have concomitant what
cystocele
What is the tx for vaginal prolapse if the patient is no longer sexually active?
Colpectomy and colpocleisis
What is the tx for vaginal prolapse if the patient desires sexual activity?
Vaginal suspension
What are the 2 types of pessaries?
- Support pessaries- for mild prolapse
- Space occupying pessaries (more severe prolapse)
When would you recommend a pessary as treatment for pelvic organ prolapse?
Patients that aren’t surgical candidates
