Prolapse Flashcards
What is an Urethrocoele
Prolapse of lower anterior vaginal wall involving the urethra only
http://www.mdguidelines.com/images/Illustrations/urethroc.jpg
What is a Cystocoele?
Prolapse of upper anterior vaginal wall involving the bladder
Often also involving urethra, ie cystourethrocoele
What is an Apical Prolapse
Prolapse of uterus, cervix and upper vagina
aka Uterine prolapse
What is an Enterocoele?
Small bowel prolapses into upper posterior vaginal wall
What is a Rectocoele?
Rectum prolapses into lower posterior vaginal wall
How do you grade a prolapse?
Pelvic Organ Prolapse (POP) scoring system of International Continence Society (ICS);
When straining
- No descent
- >1cm above Hymenal ring
- <1cm above Hymenal ring & <1cm below Hymenal ring
- >1cm below Hymenal ring
- Vagina completely everted
What is a complete Procidentia?
Grade 4 prolapse accordinint to ICS POP system.
Vagina completely everted
Draw a picture of the major pelvic ligaments and muscles
Outline the Epidemiology of Prolapse
Half of all parous women have some degree of prolapse
10-20% seek medical attention
Outline the Aetioloy of prolapse
Increase intra-abdominal pressure;
- Pregnancy
- Obesity
- Chronic cough
- Constipation
- Heavt lifting
- Pelvic mass
Weakened pelvic floor;
- Congenital factors (collagen metabolism [eg Ehlers-Danlos syndrome])
- Menopause (deterioration of collagenous connective tissue following oestrogen withdrawal)
- Vaginal delivery (damage to pelvic floor)
-
Iatrogenic (surgery predisposing)
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Outline the clinical presentation of prolapse
- Asymptomatic
-
Dragging/ lump sensation
- Worse at end of the day or when standing
- Back pain usual
- Severe prolapse;
- Interferes with intercourse
- May ulcerate
- Bleeding/ discharge
- Cystourethrocoele; freq/ urgency/ incontinence/ retention
- Rectocoele; problems defaecating
- O/E
- Bear down to produce prolapse
- Rectocoele can be confirmed by PR finger (compared to enterocoele)
Outline the investigations for Prolapse
- Cause?
- USS is pelvic mass suspected
- Urodynamic testing if urinary incontinence is principle complaint
How can you prevent Prevention?
- Recognition of obstructed labour
- Avoidance of long second stage
- Pelvic floor exercises
Outline the conservatory (non-surgical) treatment for Prolapses
-
Lifestyle
- Weight reduction
- Stop smoking
- Physio & pelvic floor muscles
-
Pessaries (unwilling/ unfit for surgery)
- Artificial pelvic floor
- Types include Ring (most common) & Shelf (for severe)
- Changed every 6-9 months
- Ulceration: Post-menopausal women may require oestrogen replacement (topical/ HRT)
Outline the Surgical treatments for Uterine Prolapse
-
Vaginal hysterectomy
- Traditional treatment
- Often re-presents with Vault prolapse..
- **Hysteropexy **[o/lap]
- Uterus & cervix attahed to Sacrum using bifurcated non-absorbable mesh
- Effective
