Prolapse

Question 1

Features of cystoceles (3)

Answer 1

upper, anterior wall of vagina and bladder bulge out

urine in cystocele>frequency and dysuria

urethra can prolapse>cystourethrocele>stress incontinence

Question 2

Features of rectoceles (2)

Answer 2

middle, posterior wall attached to rectum prolapses through weak levator ani

may have to reduce hernia w. finger in vagina to defaecate.

Question 3

Features of eneteroceles (2)

Answer 3

bulge from upper posterior vaginal wall

may contain loops of bowel from pouch of douglas

Question 4

Grading uterine prolapse

Answer 4

1st: cervix stays in vagina
2nd: cervix protrudes out of vagina on standing/straining
3rd: fundus lies outside vagina

Question 5

RFs for uterine prolapse (5)

Answer 5

pregnancy/vaginal delivery

congenital factors e.g. EDS

chronic raised intra-abdominal pressure

menopause: oestrogen withdrawal>weakened connective tissue
iatrogenic: pelvic surgery

Question 6

Sx of uterine prolapse (4)

Answer 6

dragging sensation

cystitis

urinary frequency, stress incontinence

constipation

Question 7

Mx of mild prolapse (3)

Answer 7

lose weight, stop smoking, stop straining

insertion of a ring

topical oestrogen if post-menopausal

Question 8

Mx of severe prolapse (6)

Answer 8

uterine prolapse:

• hysterectomy
• hysteropexy: uterus and cervix attached to sacrum via mesh

vault prolapse
-sacrocolpopexy: vaginal vault fixed to sacrum via mesh

urodynamic stress incontinence:

• TVT
• trans-obturator tape
• Burch colposuspension

Question 9

Causes of vesico-vaginal fistulae (2)

Answer 9

in developing world: obstructed labour

in developed world: surgery

Question 10

Ix for vesico-vaginal fistulae

Answer 10

catheter>methylene blue into bladder>speculum to see if it drains into vagina

Question 11

Mx of vesico-vaginal fistulae

Answer 11

surgery