Prolapse Flashcards
What is the epidemiology of prolapse?
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How do you grade utero-vaginal prolapse?
1st degree/mild - slight protrusion of cervix and inferior uterus into upper vaginal cavity
2nd degree/moderate - greater protrusion visible externally but not protruding
3rd degree/severe - protruding outside the vaginal opening but retractable
4th degree/complete procidentia - vaginal wall and uterus predominantly outside body
How would a utero-vaginal prolapse present?
‘something coming down’
Pain/discomfort - on sex or sitting
Incontinence
How do you investigate a possible prolapse?
Mostly a clinical diagnosis
Examination:
Getting women to cough on inspection and on speculum examination will show excessive bulging of vaginal walls in response to pressure increase (usually should barely move)
Sims speculum: used to look at anterior and posterior vaginal wall to see where prolapse is coming from/is most significant
Sometimes urodynamics or MRI done but infrequently
How do you mange prolapse?
Reassurance
Manage any sexual or urinary symptoms
Pessary
Surgery
What types of pessary are there? What are their features and indications?
Ring - most common - sits over cervix and supports uterus from dipping into vagina; can teach patients to change by themselves; used in women who have had no previous surgery and who are sexually active
Shelf and Gellhorn - used in women who have had hysterectomies and aren’t sexually active as have pointy bits on their inferior sides, cannot be changed by patients
Last for 4-6 months at a time then replaced; granulation tissue can form - sometimes bleed - if significant can be left out for one month before replacing
Can be given with Estradiol cream to help keep things clean and healthy
What are the indications for surgery in prolapse?
Symptomatic:
Dyspareunia
Discomfort
Obstruction
Severe:
4th degree
Ulcerated
Failure of conservative measures
What is the surgery for prolapse?
Posterior repair
Sacro Spinous fixation
Mesh
