Prolapse

Question 1

Delancey levels of prolapse

Answer 1

Level 1: upper third, uterus and cervix
Level 2: Middle third, anterior is bladder and posterior is rectum
Level 3: Lower third, Anterior is urethra, lateral is perineal membrane and pubovaginalis and posterior is perineum.

Question 2

What supports have failure if there is a uterine or vault prolapse

Answer 2

Uterosacral Ligament or transverse cardinal ligament

Question 3

Symptoms of a uterine or vault prolapse

Answer 3

Back pain or groin
Feeling heaviness/pressure in pelvis, worse with standing, lifting, worse at the end of the day, Relieved by lying down
Ulceration or bleeding
May have urinary incontinence

Question 4

Treatment of uterine or vault prolapse

Answer 4

Abdominal or laparoscopic sacralcolpopexy
or
Transvaginal sacrospinous fixation
or uterosacral ligament suspension

Question 5

What supports have failure if there is a cystocoele or rectocoele

Answer 5

Paravaginal fasia
or
Arcus tendinous

Question 6

Symptoms of Cystocele

Answer 6

frequency, 
urgency
nocturia
stress incontinence
incomplete bladder emptying may be associated with recurrent infection

Question 7

Symptoms of Rectocele

Answer 7

Digital assistance with passing stools

Constipation

Question 8

Treatment of Cystocele

Answer 8

Nature tissue repair (anterior colporrhaphy)
Mesh repair for anterior wall or vault repair
TVT (tension free vaginal tapefor stress urinary incontinence - gold standard

Question 9

Causes of prolapse

Answer 9

Vaginal childbirth
raging
decreased extrogen e.g. post menopause
following pelvic surgery
Increased intra-abdominal pressure e.g. obesity, chronic cough, constipation, ascites, heavy lifting.
Congenital - rarely
Ethnicity caucasian women greater thenAsian or african
Collagen disorders

Question 10

General treatment for prolapse

Answer 10

Kegel exercises
Local vaginal estrogen therapy
Vaginal pessary (intravaginal suspension disc)

Question 11

Neurological causes of urge incontinence

Answer 11

MS
Herniated disc
DM