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Reproductive System > Pelvic Organ Prolapse in Women > Flashcards

Pelvic Organ Prolapse in Women Flashcards

1
Q

What is the definition of a prolapse?

A

Protrusion of an organ or structure beyond its anatomical confines

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2
Q

What is a female POP?

A

Descent of the pelvic organs towards or through the vagina

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3
Q

Describe the endo-pelvic fascia

A

Fibromuscular component can stretch
CT does not stretch or attenuate instead it breaks

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4
Q

What is the function of the pubocervical fascia?

A

Provides main support of the anterior vaginal wall
Tends to break at lateral attachments or immediately in front of cervix

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5
Q

Where does the utero-sacral ligament tend to break?

A

Medially - around the cervix

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6
Q

Where does rectovaginal fascia tend to break?

A

Centrally
If upper defect - enterocele
If lower defect - perineal body descent and rectocele

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7
Q

What are the levels of endopelvic support?

A

1 - uterosacral and cardinal ligaments
2 - pubocervical
3 - urogenital diaphragm and perineal body

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8
Q

What are pregnancy and vaginal birth risk factors for POP?

A

Forceps delivery
Large baby >4500gm
Prolonged second stage
Parity is strongest risk factor
Advancing age and obesity

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9
Q

What previous surgeries are a risk factor for POP?

A

Continence procedures
Burch colposuspension (25% of women need prolapse surgery after)
Hysterectomy - vaginal vault prolapse

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10
Q

What are some other risk factors of POP?

A

Hormonal factors
Quality of connective tissue
Constipation
Occupation with heavy lifting
Exercise - weight lifting, high impact aerobics and long distance running

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11
Q

What is a urethrocele?

A

Prolapse of lower anterior vaginal wall involving the urethra only

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12
Q

What is a cystocele?

A

Prolapse of upper anterior vaginal wall involving the bladder

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13
Q

What is a uterovaginal prolapse?

A

Prolapse of uterus, cervix and upper vagina

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14
Q

What is an enterocele and rectocele?

A

Enterocele - prolapse of posterior vaginal wall usually containing loops of small bowel
Rectocele - prolapse of lower posterior vaginal wall where rectum bulges forwards into vagina

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15
Q

What are typical vaginal symptoms for pelvic organ prolapse?

A

Sensation of a bulge or protrusion
Seeing or feeling a bulge or protrusion
Pressure
Heaviness
Difficulty in inserting tampons

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16
Q

What are some urinary symptoms for women with pelvic organ prolapse?

A

Urinary incontinence, frequency/ urgency, weak or prolonged urinary stream/ hesitancy/ incomplete emptying and manual reduction of prolapse to start or complete voiding

17
Q

What are some bowel symptoms for women with pelvic organ prolapse?

A

Incontinence of flatus/ liquid/ solid stool, feeling of incomplete emptying or straining, urgency, digital evacuation, splinting or pushing around vagina to start defecation

18
Q

How is POP assessed?

A

Examination to exclude pelvic mass
Record position - left lateral, lithotomy or standing
QoL
Baden-Walker-Halfawt grading
POPQ score

19
Q

What are the stages of pelvic floor evaluation?

A

Stage 0 - TVL - 2cm
Stage 0-4
Stage 4 - more than TVL -2cm

20
Q

What investigations are used for POP?

A

USS/ MRI - identify fascial defects/ measure levator ani thickness
Urodynamics - concurrent UI
IVU or renal USS

21
Q

What can be done for prevention of POP?

A

Avoid constipation
Effective management chronic chest pathology
Smaller family size
Improvements in antenaral and intrapartum care

22
Q

Describe physiotherapy for POP

A

Pelvic floor muscle training - increase strength and bulk but no role in advanced cases
Perineometer, vaginal cones and electrical stimulation

23
Q

Why is silicone advantageous for pessaries?

A

Long shelf life, resistance to autoclaving + repeated cleaning, non-absorbent, inertness and hypoallergenic nature

24
Q

Describe vaginal pessaries vs surgery

A

After 1 year after successful pessary treatment is as effective as surgery

25
Q

What is the aim of surgical treatment?

A

Relieve symptoms, restore/ maintain bladder and bowel function and vaginal capacity for sexual function

26
Q

What needs to be remembered in surgical treatment?

A

Prophylactic antibiotics, thromboembolic prophylaxis and post-op urinary vs SPC

Reproductive System (33 decks)

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