Proplapse of the uterus and vagina Flashcards
3 levels of suspension of the pelvic viscera
Level 1- cardinal and uterosacral ligaments- cervix and upper 1/3 vagina attached to the pelvic sidewall and sacrum
Level 2- endopelvic fascia holds midvagina
Level 3- Lower 1/3 vagina supported by levator ani muscles and perineal body
Urethrocele
Lower anterior vaginal wall- urethra only
Cystocele
upper anterior vaginal wall involving bladder. . Frequency and incomplete voiding.
apical prolapse
uterus cervix upper vagina
Enterocele
Upper posterior wall of the vagina
Rectocele
lower posterior wall of the vagina, involving anterior wall of the rectum. difficulty defecating.
Causes of prolapse (5) and reasons why
Vaginal delivery and pregnancy- denervation of pelvic floor
Congenital factors- Ehlers danlos
Menopause- oestrogen withdrawal to collagen
Chronic predisposing factors- intraabdo pressure- obesity, cough, heavy lift
iatrogenic factors- pelvic surgery
Symptoms pf prolapse
Dragging sensation, lump sensation, worse at the end of the day when standing up. Severe- interferes with intercourse, ulcerate cause bleeding or discharge
Investigating a prolapse you…
do a pelvic US,/ urodynamic testing
Management of prolapse
conservative/medical- treat underlying problem
Pessaries- ring/shelf with oestrogen replacement to prevent vaginal ulceration
Surgery depending on pathology
Surgery for Uterine prolapse
Vaginal hysterectomy, Hysteroplexy
Surgery for Vaginal vault prolapse
Sacrocolpopexy, sacrospinous fixation
Surgery for Vaginal wall prolapse
Anterior and posterior repairs
Surgery for Urodynamic stress incontinence
TVT- Tension free vaginal tape
TOT- Transobturator tape procedures
Burch colposuspension
