Pelvic Organ Prolapse Flashcards

1
Q

What is a prolapse?

A

The protrusion of an organ or structure beyond its normal anatomical confines (in females this is the descent of the pelvic organs towards or through the vagina)

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2
Q

Name the three layers of the pelvic floor

A
  • Endo-pelvic fascia: connective tissue
  • Pelvic diaphragm: levator ani and coccygeus
  • Urogenital diaphragm: superficial and deep transverse perineal muscles + fascia
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3
Q

Describe the location of the utero-sacral complex

A
  • Medial to the uterus, cervix, lateral vaginal fornices and pubocervical + rectovaginal fascia
  • Lateral to the sacrum and the fascia overlying the Piriformis muscle
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4
Q

Describe the borders of the pubocervical fascia

A
  • Central: merges with the base of the cardinal ligaments and cervix
  • Laterally: arcus tendineus fascia pelvis
  • Distally: urogenital diaphagm
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5
Q

Describe the borders of the rectovaginal fascia

A
  • Centrally: merges with the base of the uterosacral ligaments and peritoneum
  • Laterally: fuses with fascia over the levatator ani
  • Distally: firmly attached to the perineal body
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6
Q

Name the three levels of endopelvic support

A
  • Level 1: utero-sacral and cardinal ligaments
  • Level 2: para-vagina to arcus tendineus fascia and rectovaginal fascia
  • Level 3: urogenital diaphragm and perineal body
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7
Q

What are the risk factors for POP?

A
  • Pregnancy and vaginal birth
  • Advancing age
  • Obesity
  • Previous pelvic surgery
  • Hormonal factors
  • Quality of connective tissue
  • Constipation
  • Occupation with heavy lifting
  • Exercise
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8
Q

What is an urethrocele?

A

Prolapse of the lower anterior vaginal wall involving the urethra only

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9
Q

What is a cystocele?

A

Prolapse of the upper anterior vaginal wall involving the bladder

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10
Q

What is an uterovaginal prolapse?

A

-Prolapse of the uterus, cervix and upper vagina

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11
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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12
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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13
Q

What are the typical symptoms of pelvic organ prolapse?

A
  • Sensation/seeing/feeling a bulge or protrusion
  • Pressure
  • Heavinesss
  • Difficulty in inserting tampons
  • Urinary incontinence
  • Frequency/urgency
  • Weak or prolonged urinary stream
  • Hesitancy
  • Feeling of incomplete emptying
  • Manual reduction of prolapse to start or complete voiding
  • Incontinence
  • Incomplete bowel 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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14
Q

How can POP be assessed?

A
  • Examination
  • Quality of life
  • Baden Walker Halfawy grading
  • POPQ score
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15
Q

How can POP be investigated?

A
  • USS/MRI
  • Urodynamics
  • IVU or renal USS
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16
Q

How can POP be prevented?

A
  • Avoid constipation
  • Effective management of chronic chest pathology
  • Smaller family size
  • Antenatal and post-natal pelvic floor muscle training (evidence not yet conclusive)
17
Q

How can POP be treated?

A
  • Pelvic floor muscle training
  • Education about pelvic floor exercises
  • Pessaries
  • Surgery