POP (Pelvic organ prolapse)

Question 1

T/F: 8 times more women than men suffer from a pelvic organ
dysfunction

Answer 1

T

Question 2

T/F: Pelvic organ disorders - usually under-reported

Answer 2

T

Question 3

Ratio surgery for prolapse vs incontinence:

Answer 3

2:1

Question 4

Prevalence of POP

Answer 4

31% in women aged 29-59 yrs

Question 5

POP is seen in 31% of women aged –

Answer 5

29 -59yrs

Question 6

T/F: 20% of women on gynaecology waiting lists have POP

Answer 6

T

Question 7

% of women with POP on gynaecology waiting lists

Answer 7

20%

Question 8

% lifetime risk of at least one operation in women with POP

Answer 8

11%

Question 9

% of reoperation cases seen in POP

Answer 9

30%

Question 10

Ration of women that will suffer sphincter muscle damage due to
vaginal childbirth

Answer 10

1 out of 3

Question 11

% of women with POP that also have faecal incontinence

Answer 11

20%

Question 12

% of patients with urinary incontinence that also suffer faecal incontinence

Answer 12

30%

Question 13

% of patients with POP that also have urinary incontinence

Answer 13

60%

Question 14

% of patients with urinary incontinence that have some degree of POP

Answer 14

40%

Question 15

T/F: More than 50% of women aged 50 and older suffer one or
more of the problems caused by pelvic floor dysfunction

Answer 15

T

Question 16

% of women by age 80 that will have undergone surgery for prolapse

Answer 16

> 10%

Question 17

Lifetime risk of surgery for POP is

Answer 17

11%

Question 18

Prevalence of POP in parous women

Answer 18

50%

Question 19

% of parous women with symptomatic POP

Answer 19

20%

Question 20

% of postmenopausal women with anterior prolapse

Answer 20

51%

Question 21

% of postmenopausal women with posterior prolapse

Answer 21

27%

Question 22

% of postmenopausal women with uterine/vault prolapse

Answer 22

20%

Question 23

% of TAH in women with prolapse

Answer 23

11.6%

Question 24

% of TAH done for benign conditions

Answer 24

1.8%

Question 25

T/F: Smoking can cause POP

Answer 25

T

Question 26

T/F: Long distance running can prevent prolapse

Answer 26

F Can cause prolapse

Question 27

% of nulliparous women affected by POP

Answer 27

2%

Question 28

3 surgeries for POP

Answer 28

Burch Manchester Hysterectomy

Question 29

T/F: POP is commoner in Caucasians & Hispanics & less so in Afro Caribbeans

Answer 29

T ? cultural differences in reporting

Question 30

How many levels of support does the uterus have

Answer 30

3 Levels 1 to 3

Question 31

Level I support of the uterus:

Answer 31

The cardinal uterosacral ligament complex

Question 32

Level II support of the uterus:

Answer 32

The pubo- cervical and rectovaginal fascia

Question 33

Level III support of the uterus:

Answer 33

The pubo-urethral ligaments anteriorly & the perineal body posteriorly

Question 34

The cardinal uterosacral ligament complex = ? uterine support level

Answer 34

Level I

Question 35

The pubo- cervical and rectovaginal fascia = ? uterine support level

Answer 35

Level II

Question 36

The pubo-urethral ligaments anteriorly & the perineal body posteriorly = ? uterine support level

Answer 36

Level III

Question 37

Pelvic floor muscle training (PFMT) is an effective treatment option for women with -- vaginal prolapse

Answer 37

stage I–II including PHVP

Question 38

Improvement/cure rate of pelvic floor exercises

Answer 38

17 - 79%

Question 39

Dose and duration of pelvic floor exercises

Answer 39

8 contractions 3 times a day Short squeezes (2 secs) and long squeezes (10 secs)

Question 40

T/F: Pelvic floor exercises are more effective if supervised

Answer 40

T

Question 41

T/F: Vaginal pessaries are alternative treatment option for women with stage II–IV PHVP

Answer 41

T

Question 42

T/F: Vaginal pessaries are equally beneficial for both POP or UI

Answer 42

T

Question 43

Satisfaction rate of vaginal pessary use

Answer 43

72-92% ( symptom relief)

Question 44

The commonly used pessary

Answer 44

The ring (with or without knob)

Question 45

T/F: The ring pessary is also known as the incontinence ring

Answer 45

T

Question 46

T/F: The ring pessary is recommended in sexually active women

Answer 46

T

Question 47

The ring pessary is useful in which degree of prolapse

Answer 47

first or mild second-degree uterine prolapse associated with a mild cystocele

Question 48

Most commonly used pessary for uterine prolapse

Answer 48

Gellhorn

Question 49

T/F: Gellhorn pessary is helpful in SUI

Answer 49

T

Question 50

Gellhorn pessary provides support in which degree of prolapse

Answer 50

3rd degree uterine prolapse and procidentia

Question 51

T/F: Gellhorn pessary is suitable for rectoceles

Answer 51

F Provides less support for a rectocele since there is less support of the posterior segment.

Question 52

Risk of prolapse recurrence after surgery

Answer 52

10 -20%

Question 53

Surgeries for POP

Answer 53

Anterior colporrhaphy: (Cystocoele & Urethrocoele) Posterior colpoperineorrhaphy (Rectocoele, and defective perineum) Manchester (Fothergill) operation (All the above with amputation of the cervix and, tightening of the cardinal ligaments.) Vaginal Hysterectomy +/- Pelvic floor repair

Question 54

Recurrence rates of anterior repair for cystocele

Answer 54

3 to 20% after 2 to 8 years

Question 55

Midline plication of rectovaginal fascia and perineal body reconstruction:

Answer 55

Posterior repair for rectocele

Question 56

Cure rate for posterior repair for rectocele

Answer 56

72% at 2yrs

Question 57

Surgery for vault prolapse

Answer 57

Sacrocolpopexy/Sacrospinous fixation

Question 58

Surgery for the obliteration of vaginal lumen

Answer 58

Le Forts operation

Question 59

Surgery for uterine prolapse

Answer 59

Hysterectomy Vault suspension procedure & pelvic floor repair

Question 60

Surgery for posthysterectomy vault prolapse

Answer 60

Vault suspension procedure & pelvic floor repair

Question 61

T/F: McCall culdoplasty at the time of vaginal hysterectomy is effective in preventing subsequent PHVP.

Answer 61

T

Question 62

T.F: Subtotal hysterectomy is not recommended for the prevention of PHVP

Answer 62

T

Question 63

T/F: Suturing the cardinal and uterosacral ligaments to the vaginal cuff at the time of hysterectomy is effective in preventing PHVP following both abdominal and vaginal hysterectomies

Answer 63

T

Question 64

4 indications for the abdominal approach in surgery for prolapsed vaginal vault

Answer 64

Failed previous vaginal approach Have fore-shortened vagina Young patients with advanced prolapse With other co-existing conditions

Question 65

4 vaginal surgeries for POP

Answer 65

Sacrospinous ligament fixation High uterosacral ligament suspension with fascial reconstruction Iliococcygeus fascia suspension McCall culdoplasty: Internal and external

Question 66

3 abdominal repairs for POP

Answer 66

Abdominal sacrocolpopexy High uterosacral ligament suspension Laparoscopic approach * Lap sacrocolpopexy * Oxford Sacrohysteropexy

Question 67

The obliterative procedures

Answer 67

Le forte partial colpocleisis Colpectomy and colpocleisis

Question 68

3 advantages of sacrospinous fixation

Answer 68

Less morbid Convenient to perform concurrent vaginal repair procedures Recurrent vault prolapse 3%

Question 69

4 disadvantages of sacrospinous fixation

Answer 69

‘Blind’ Adequate vaginal length needed Cystocele 8 -20% Gluteal pain 3%

Question 70

% of recurrent vault prolapse with sacrospinous fixation

Answer 70

3%

Question 71

% of patients with gluteal pain as a complication of sacrospinous fixation

Answer 71

3%

Question 72

% of cystocele seen after sacrospinous fixation

Answer 72

8 - 20%

Question 73

3 advantages of sacrocolpopexy

Answer 73

Does not rely on patient’s connective tissue Preserves vaginal length and width Recurrent vault prolape 0 – 12%

Question 74

2 disadvantages of sacrocolpopexy

Answer 74

Abdominal procedure Erosion 3%

Question 75

T/F: Sacrocolpopexy is suitable for the following: Young patients, sexually active patients and patients with short vagina

Answer 75

T

Question 76

% of recurrent vault prolapse seen with sacrocolpopexy

Answer 76

0 - 12%

Question 77

% erosion seen in sacrocolpopexy

Answer 77

3%