Prolapse

Question 1

Describe the baden-walker system for evaluation of POP?

Answer 1

Measure the most distal portion of the prolapse.
Grade 0: normal position for each respective site
Grade 1: descent 1/2 way to hymen
Grade 2: descent to hymen
Grade 3: descent 1/2 past hymen
Grade 4: max possible descent for each site

Question 2

Explain the interpretation of POP-Q

Answer 2

0: no prolapse (Aa, Ap, Ba, Bp = -3 cm and C or D ≤ – (tvl – 2) cm)
Stage I: Stage 0 criteria not met and leading edge < -1 cm
Stage II: Leading edge ≥ -1 cm but ≤ +1 cm
Stage III: Leading edge > +1 cm but < + (tvl – 2) cm
Stage IV: Leading edge ≥ + (tvl – 2) cm

Question 3

What are the POP-Q measurements?

Answer 3

Aa: Anterior vaginal wall 3 cm proximal to the hymen (-3 cm to +3 cm)
Ba: Most distal position of the remaining upper anterior vaginal wall (-3 cm to +tv)
C: Most distal edge of cervix/cuff
D: Posterior fornix (N/A if post-hysterectomy)
Ap: Posterior vaginal wall 3 cm proximal to the hymen (-3 cm to +3 cm)
Bp: Most distal position of the remaining upper posterior vaginal wall (-3 cm to + tvl)

Question 4

Extra Pop-q definitions

Answer 4

Genital hiatus (gh)
– Measured from middle of external urethral meatus to posterior midline hymen
Perineal body (pb)
– Measured from posterior margin of gh to middle of anal opening
Total vaginal length (tvl)
– Depth of vagina when point D or C is reduced to normal position

Question 5

Management of prolapse

Answer 5

Pessary
SSLF
Abdominal sacrocolpopexy

Question 6

Describe Delancey’s levels of support

Answer 6

1) Apical suspension
- Upper paracolpium suspends the apex fo the pelvic walls and sacrum
2) Midvaginal lateral attachment
- Vaginal attachment to the arcus tendineus and superior fascia of levator ani muscle
3) Distal perineal fusion
- Fusion to the perineal membrane, perineal body, and levators fix the vagina

Question 7

3 procedures to prevent future enterocele at a hyst?

Answer 7

Moskowitz
McCall’s
Halban

Question 8

4 types of enterocele?

Answer 8

Pulson
Traction (descent of another part of vaginal wall which takes it down)
Congential
Iatrogenic (usually when burch is done)

Question 9

Surgery for complete prolapse with a uterus, not sexually active

Answer 9

Lefort procedure

Question 10

Surgery for complete prolapse without a uterus, not sexually active

Answer 10

Colpocleisis

Question 11

Muscles that make up the levator ani

Answer 11

Pubococcygeus, iliococcygeus, puborectalis