POP (Pelvic organ prolapse) Flashcards
T/F: 8 times more women than men suffer from a pelvic organ
dysfunction
T
T/F: Pelvic organ disorders - usually under-reported
T
Ratio surgery for prolapse vs incontinence:
2:1
Prevalence of POP
31% in women aged 29-59 yrs
POP is seen in 31% of women aged –
29 -59yrs
T/F: 20% of women on gynaecology waiting lists have POP
T
% of women with POP on gynaecology waiting lists
20%
% lifetime risk of at least one operation in women with POP
11%
% of reoperation cases seen in POP
30%
Ration of women that will suffer sphincter muscle damage due to
vaginal childbirth
1 out of 3
% of women with POP that also have faecal incontinence
20%
% of patients with urinary incontinence that also suffer faecal incontinence
30%
% of patients with POP that also have urinary incontinence
60%
% of patients with urinary incontinence that have some degree of POP
40%
T/F: More than 50% of women aged 50 and older suffer one or
more of the problems caused by pelvic floor dysfunction
T
% of women by age 80 that will have undergone surgery for prolapse
> 10%
Lifetime risk of surgery for POP is
11%
Prevalence of POP in parous women
50%
% of parous women with symptomatic POP
20%
% of postmenopausal women with anterior prolapse
51%
% of postmenopausal women with posterior prolapse
27%
% of postmenopausal women with uterine/vault prolapse
20%
% of TAH in women with prolapse
11.6%
% of TAH done for benign conditions
1.8%
T/F: Smoking can cause POP
T
T/F: Long distance running can prevent prolapse
F
Can cause prolapse
% of nulliparous women affected by POP
2%
3 surgeries for POP
Burch
Manchester
Hysterectomy
T/F: POP is commoner in Caucasians & Hispanics & less so in Afro Caribbeans
T
? cultural differences in reporting
How many levels of support does the uterus have
3
Levels 1 to 3
Level I support of the uterus:
The cardinal uterosacral ligament
complex
Level II support of the uterus:
The pubo- cervical and rectovaginal fascia
Level III support of the uterus:
The pubo-urethral ligaments
anteriorly & the perineal body posteriorly
The cardinal uterosacral ligament
complex = ? uterine support level
Level I
The pubo- cervical and rectovaginal fascia = ? uterine support level
Level II
The pubo-urethral ligaments
anteriorly & the perineal body posteriorly = ? uterine support level
Level III
Pelvic floor muscle training (PFMT) is an effective treatment option for women with – vaginal prolapse
stage I–II
including PHVP
Improvement/cure rate of pelvic floor exercises
17 - 79%
Dose and duration of pelvic floor exercises
8 contractions 3 times a day
Short squeezes (2 secs) and long squeezes (10 secs)
T/F: Pelvic floor exercises are more effective if supervised
T
T/F: Vaginal pessaries are alternative treatment option for women with stage II–IV PHVP
T
T/F: Vaginal pessaries are equally beneficial for both POP or UI
T
Satisfaction rate of vaginal pessary use
72-92% ( symptom relief)
The commonly used pessary
The ring (with or without knob)
T/F: The ring pessary is also known as the incontinence ring
T
T/F: The ring pessary is recommended in sexually active women
T
The ring pessary is useful in which degree of prolapse
first or mild second-degree uterine
prolapse associated with a mild cystocele
Most commonly used pessary for uterine prolapse
Gellhorn
T/F: Gellhorn pessary is helpful in SUI
T
Gellhorn pessary provides support in which degree of prolapse
3rd degree uterine prolapse and procidentia
T/F: Gellhorn pessary is suitable for rectoceles
F
Provides less support for a
rectocele since there is less
support of the posterior segment.
Risk of prolapse recurrence after surgery
10 -20%
Surgeries for POP
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
Recurrence rates of anterior repair for cystocele
3 to 20% after 2 to 8 years
Midline plication of rectovaginal fascia and perineal body reconstruction:
Posterior repair for rectocele
Cure rate for posterior repair for rectocele
72% at 2yrs
Surgery for vault prolapse
Sacrocolpopexy/Sacrospinous fixation
Surgery for the obliteration of vaginal lumen
Le Forts operation
Surgery for uterine prolapse
Hysterectomy
Vault suspension procedure &
pelvic floor repair
Surgery for posthysterectomy vault prolapse
Vault suspension procedure &
pelvic floor repair
T/F: McCall culdoplasty at the time of vaginal hysterectomy is effective in preventing subsequent PHVP.
T
T.F: Subtotal hysterectomy is not recommended for the prevention
of PHVP
T
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
T
4 indications for the abdominal approach in surgery for prolapsed vaginal vault
Failed previous vaginal approach
Have fore-shortened vagina
Young patients with advanced prolapse
With other co-existing conditions
4 vaginal surgeries for POP
Sacrospinous ligament fixation
High uterosacral ligament suspension with fascial reconstruction
Iliococcygeus fascia suspension
McCall culdoplasty: Internal and external
3 abdominal repairs for POP
Abdominal sacrocolpopexy
High uterosacral ligament suspension
Laparoscopic approach
* Lap sacrocolpopexy
* Oxford Sacrohysteropexy
The obliterative procedures
Le forte partial colpocleisis
Colpectomy and colpocleisis
3 advantages of sacrospinous fixation
Less morbid
Convenient to perform concurrent vaginal repair procedures
Recurrent vault
prolapse 3%
4 disadvantages of sacrospinous fixation
‘Blind’
Adequate vaginal
length needed
Cystocele 8 -20%
Gluteal pain 3%
% of recurrent vault prolapse with sacrospinous fixation
3%
% of patients with gluteal pain as a complication of sacrospinous fixation
3%
% of cystocele seen after sacrospinous fixation
8 - 20%
3 advantages of sacrocolpopexy
Does not rely on patient’s connective tissue
Preserves vaginal length
and width
Recurrent vault prolape
0 – 12%
2 disadvantages of sacrocolpopexy
Abdominal procedure
Erosion 3%
T/F: Sacrocolpopexy is suitable for the following: Young patients,
sexually active patients and patients with short vagina
T
% of recurrent vault prolapse seen with sacrocolpopexy
0 - 12%
% erosion seen in sacrocolpopexy
3%
