POP Flashcards
What is a physical exam quantification for pelvic organ prolapse? What is reference point?
POP Q
Hymen
List the elements of POP Q? Aa, Ap, C, TVL?
Aa: anterior vaginal wall, 3 cm proximal to hymen, Range -3 to +3
Ba: most distal position of upper anterior vaginal wall
Ap: posterior vaginal wall, 3 cm proximal to hymen, Range -3 to +3
Bp: most distal position of upper anterior vaginal wall
C: most distal edge of cervix or vaginal cuff (8)
TVL: total vaginal length
D: posterior fornix (cannot measure with hysterectomy)
pb: perineal body (10)
What physical exam is important for leakage after sacrocolpopexy?
Fluid in vaginal vault
Defects at vaginal apex
Leak per meatus (strain/cough)
PVR
Presence/absence of prolapse
Urethral hypermobility
Patient s/p sacrocolpopexy with new onset leakage, what is ddx?
Vesicovaginal fistula
Ureterovaginal fistula
SUI
UUI
How do you evaluate for vesicovaginal fistula? ureterovaginal fistula?
Vesicovaginal → cystogram
Ureterovaginal → imaging of upper tracts (CTU/RGP)