POP

Question 1

Stage 2 prolapse

Answer 1

-1 to 1 (remember hymen = 0)

Question 2

stage 4

Answer 2

complete procidentia

Question 3

Pessary erosion rate

Answer 3

2-9%
treat with removal of pessary for 2-4 weeks and vaginal estrogen therapy

Question 4

How to prevent vaginal prolapse during hyst?

Answer 4

incorporate ligament pedicles into the vault closure only after shortening these pedicles if uterine prolapse is present

Question 5

how to diagnose enterocele on exam

Answer 5

valsalva, find bulge in cul de sac herniation with bowel on a RECTO-VAGINAL exam

Question 6

Halban culdoplasty - define

Answer 6

serial vertical sutures that obliterate the cul-de-sac
incorporates the uterosacral ligament
- abdominal surgery
- only prevents ENTEROCELE

Question 7

Moskowitz culdoplasty

Answer 7

purse string sutures that incorporate the uterosacral ligaments and obliterate the cul de sac
- abdominal surgery

Question 8

McCall Culdoplasty

Answer 8

plication of uterosacral ligaments in the midline
- vaginal surgery
- usually used as prophylaxis for vault prolapse
- cystoscopy recommended to confirm ureteral integrity
— 11% kink
— 1.8% obstruct

Question 9

vaginal vault prolapse treatments

Answer 9

-abdominal sacrocolpopexy
- sacrospinous ligament fixation
- uterosacral ligament suspension

Question 10

describe abdominal sacrocolpopexy

Answer 10

mesh tags the vaginal/cervical stump to the anterior longitudinal sacral ligament below the sacral promontory
A+ technique

Question 11

SSLF describe

Answer 11

sacrospinous ligament fixation
- usually tagged to the right
- maintains vaginal width and length
- pudendal artery and nerve are immediately posterior and inferior to the ischial spine
- sacrospinous is between the sacrum and the ischial spine
- place sutures 2 cm medial to ischial spine to avoid pudendal nerve injury

Question 12

Uterosacral ligament suspension

Answer 12

• plicate uterosacral ligaments to ipsilateral cuff angle (as high as ischial spine)
• abd or vaginal surgery
• can also be used for prophylaxis
• cysto to confirm ureteral integrity

Question 13

Assess 5 compartments of POP

Answer 13

Uterine prolapse
Anterior vaginal wall
Posterior vaginal wall
Enterocele
Perineal body

Question 14

??% of women develop SUI after POP surgery

Answer 14

40%

Question 15

RF for recurrent prolapse after surgical repair

Answer 15

age > 60
BMI > 26
POP 3-4

Question 16

if there is significant apical prolapse or anterior prolapse, what should you assess for?

Answer 16

occult urinary stress incontinence (SUI when prolapse is reduced)