Structural abnormalities

Question 1

The most commonly involved organs in pelvic organ prolapse

Answer 1

bladder, vaginal vault, uterus, rectum, and intestines

Question 2

Pelvic organ prolapse can be classified based on severity using

Answer 2

the Baden-Walker system into stages 0–4, with stage 4 the most severe

Question 3

cystocele

Answer 3

the bladder prolapses through the anterior vaginal wall

Question 4

sx cystocele

Answer 4

urinary incontinence or retention and a sensation of pelvic pressure or of the protrusion of tissue through the vagina

Patients often describe feeling as though something is falling out of their vagina

dyspareunia

pressure but not pain

Question 5

dx cystocele

Answer 5

made clinically

Question 6

complications cystocele

Answer 6

urinary retention, urinary tract infections, ulcerations, and vaginal bleeding

Question 7

conservative therapy cystocele

Answer 7

weight loss in patients who are obese, reduction in straining (e.g., heavy weightlifting, chronic coughing, constipation), and Kegel exercises, which strengthen the pelvic floor muscles that provide support to the pelvic organs. Pessaries are another nonsurgical treatment option. They are removable devices that can be inserted into the vagina to provide support to the pelvic organs

Question 8

when is surgical tx considered for cystocele

Answer 8

symptomatic patients who have not improved with conservative treatment or have declined conservative treatment

Question 9

surgical options cystocele

Answer 9

reconstructive vs obliterative

reconstructive - performed more often. There are vaginal and abdominal approaches to pelvic organ prolapse surgery. Two common vaginal-approach repair techniques include uterosacral ligament suspension and sacrospinous ligament suspension. Women undergoing transvaginal apical suspension who require repair of anterior or posterior vaginal wall prolapse should have colporrhaphy performed. Cystoceles require anterior colporrhaphy. Hysterectomy is often performed at the time of apical prolapse repair because it reduces the risk of recurrence

obliterative - removing or closing off at least a portion of the vaginal canal. Patients who wish to have sexual intercourse should not have obliterative pelvic organ prolapse surgery. Obliterative surgeries have a low risk of recurrence or perioperative complications but eliminate the possibility of vaginal intercourse or evaluation of the cervix and uterus, such as during a Pap smear

Question 10

if pts wish to have sexual intercourse after surgery for cystocele, which should they NOT have

Answer 10

obliterative

Question 11

which surgery for cystocele is performed more often

Answer 11

reconstructive

Question 12

What are the risk factors for pelvic organ prolapse?

Answer 12

Increased parity, advancing age, obesity, and increased intra-abdominal pressure

Question 13

cystocele is often due to

Answer 13

pelvic floor injury during childbirth

Question 14

common causes of cystocele

Answer 14

genetic predisposition, prior prolapse surgery, and connective tissue diseases (Ehlers danlos –> joint hyper mobility)

Question 15

RF cystocele

Answer 15

pregnancy, vaginal delivery, advanced age, obesity, multiparity, menopause, and diabetes mellitus

Question 16

in order to void with cystocele, what do pts commonly have to do

Answer 16

Patients usually will push up the bladder in order to void

Question 17

PE cystocele

Answer 17

vaginal bulge, especially when examined in a standing position. Internal examination reveals anterior fullness of the vaginal wall

Question 18

Transabdominal ultrasound cystocele

Answer 18

funnel-shaped bladder

Question 19

Ovarian torsion

Answer 19

complete or partial rotation (twisting) of an ovary on its ligamentous support, which can lead to impaired blood flow to the ovary.

Adnexal torsion refers to the twisting of both the ovary and the fallopian tube

Question 20

is ovarian/adnexal torsion a gynecologic emergency

Answer 20

yes

Question 21

when does ovarian torsion MC occur

Answer 21

reproductive age women

Question 22

the most important risk factor for ovarian torsion

Answer 22

the presence of an ovarian mass, particularly masses larger than 5 cm

Question 23

sx ovarian torsion

Answer 23

acute onset of moderate or severe pelvic pain and the presence of an ovarian mass. Most patients have nausea and vomiting and do not have vaginal bleeding

Question 24

causes ovarian torsion

Answer 24

ovarian cysts, ovarian malignancies, and polycystic ovary syndrome

strenuous exercise or acutely increased abdominal pressure

Question 25

definitive diagnosis of ovarian torsion

Answer 25

direct visualization of a rotated ovary at the time of surgical intervention

Question 26

what must you rule out for ovarian torsion

Answer 26

ectopic or regular pregnancy

Question 27

what may occur due to necrosis of fallopian tube

Answer 27

leukocytosis keep in mind that ovarian torsion rarely if ever causes hemorrhage -- so hemoglobin should be fine

Question 28

what is the best imaging study to assess for ovarian torsion

Answer 28

pelvic US

Question 29

US findings ovarian torsion

Answer 29

affected ovary being enlarged and rounded relative to the unaffected ovary due to edema from vascular and lymphatic engorgement, ovarian masses, and decreased or absent flow within the ovary.

Question 30

tx ovarian torsion

Answer 30

In premenopausal women, laparoscopy is used to detorse the ovary manually and attempt to conserve it. Ovarian cystectomy is performed if a benign mass is present. However, salpingo-oophorectomy is the recommended treatment in postmenopausal women

Question 31

RF ovarian torsion

Answer 31

pregnancy and reproductive age

Question 32

which ovary is MC affected in ovarian torsion

Answer 32

right

Question 33

PE ovarian torsion

Answer 33

tachycardia or elevated blood pressure associated with severe pain. An abdominal and pelvic exam may be negative for palpable masses may have low grade fever

Question 34

what meds can be helpful in preventing ovarian cyst

Answer 34

high-dose estrogen oral contraceptives

Question 35

Why is the right-sided ovary more likely to torse than the left?

Answer 35

Because the right utero-ovarian ligament is longer than the left and the sigmoid colon is on the left side, so the left ovary has less ability to move and twist

Question 36

Rectocele

Answer 36

herniation of the terminal rectum into the posterior wall of the vagina, resulting in a collapsible pouch-like fullness that passes into the introitus

Question 37

RF rectocele

Answer 37

vaginal birth, advancing age, multiparity, genetic disposition, obesity, elevated intra-abdominal pressure, frequent constipation, and use of laxatives

Question 38

sx rectocele

Answer 38

vaginal fullness, introital bulging with concurrent fecal incontinence, constipation, low back pain, and dyspareunia. Symptoms are exacerbated by standing or the Valsalva maneuver

Question 39

dx rectocele

Answer 39

made clinically by the presence of a bulge in the posterior vaginal wall with concurrent symptoms, such as fecal incontinence in a woman with risk factors for rectocele

Question 40

conservative tx rectocele

Answer 40

high-fiber diet, weight reduction, pessary, Kegel exercises, biofeedback, and electrical stimulation

Question 41

surgical tx rectocele

Answer 41

posterior colporrhaphy and colpocleisis - if no response to conservative measures

Question 42

What is the surgical repair of a cystocele called?

Answer 42

Anterior vaginal colporrhaphy

Question 43

Uterine prolapse

Answer 43

the loss of the normal ligamentous support for the uterus, thereby resulting in the protrusion of the cervix toward or past the introitus prolapse of the vaginal apex

Question 44

MC RF uterine prolapse

Answer 44

childbirth and pregnancy

Question 45

other RF uterine prolapse

Answer 45

aging, chronic cough, constipation, heavy lifting, genetic collagen deficiency, obesity, and previous pelvic surgery vaginal delivery, menopause, obesity, and tobacco use

Question 46

sx uterine prolapse

Answer 46

vaginal fullness or a mass, lower abdominal aching, low back pain, urinary incontinence, and sexual dysfunction Symptoms are often worse after prolonged standing or at the end of the day and are relieved by lying down

Question 47

as uterine prolapse progresses, women may report

Answer 47

sensation of sitting on a ball

Question 48

PE uterine prolapse

Answer 48

soft, reducible mass that may be protruding through the introitus

Question 49

stage 0 uterine prolapse

Answer 49

no prolapse

Question 50

stage 1 uterine prolapse

Answer 50

the most distal portion of the prolapse is > 1 cm above the level of the hymen; prolapse further than 1 cm from the vaginal introitus

Question 51

stage 2 uterine prolapse

Answer 51

the prolapse has descended near the introitus; prolapse ≤ 1 cm to the vaginal introitus

Question 52

stage 3 uterine prolapse

Answer 52

partial protrusion through the introitus; prolapse outside the vaginal introitus but by no more than 1 cm

Question 53

stage 4 uterine prolapse

Answer 53

complete protrusion through the introitus; prolapse ≥ 1 cm outside the vaginal introitus

Question 54

conservative tx uterine prolapse

Answer 54

weight reduction, smoking cessation, Kegel exercises and use of a vaginal pessary

Question 55

surgical tx uterine prolapse

Answer 55

vaginal hysterectomy with sacrospinous ligament suspension, and colpocleisis (An operation in which the vaginal walls are sewn together to fix vaginal vault prolapse in women who are no longer sexually active)

Question 56

What is the name for the type of prolapse that involves the herniation of the anterior, posterior, and apical compartments simultaneously?

Answer 56

Procidentia

Question 57

The rate of recurrence of symptoms or the need for repeat surgery for pelvic organ prolapse

Answer 57

30%

Question 58

uterine prolapse is also known as

Answer 58

uterine procidentia

Question 59

what is the current standard for staging of pelvic organ prolapse

Answer 59

The Pelvic Organ Prolapse Quantification system

Question 60

Which ligaments support the uterus and attach the cervix to the posterior surface of the pubic symphysis?

Answer 60

pubocervical ligaments

Question 61

What is the most commonly encountered form of pelvic organ prolapse?

Answer 61

cystocele