Structural abnormalities Flashcards
The most commonly involved organs in pelvic organ prolapse
bladder, vaginal vault, uterus, rectum, and intestines
Pelvic organ prolapse can be classified based on severity using
the Baden-Walker system into stages 0–4, with stage 4 the most severe
cystocele
the bladder prolapses through the anterior vaginal wall
sx cystocele
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
dx cystocele
made clinically
complications cystocele
urinary retention, urinary tract infections, ulcerations, and vaginal bleeding
conservative therapy cystocele
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
when is surgical tx considered for cystocele
symptomatic patients who have not improved with conservative treatment or have declined conservative treatment
surgical options cystocele
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
if pts wish to have sexual intercourse after surgery for cystocele, which should they NOT have
obliterative
which surgery for cystocele is performed more often
reconstructive
What are the risk factors for pelvic organ prolapse?
Increased parity, advancing age, obesity, and increased intra-abdominal pressure
cystocele is often due to
pelvic floor injury during childbirth
common causes of cystocele
genetic predisposition, prior prolapse surgery, and connective tissue diseases (Ehlers danlos –> joint hyper mobility)
RF cystocele
pregnancy, vaginal delivery, advanced age, obesity, multiparity, menopause, and diabetes mellitus
in order to void with cystocele, what do pts commonly have to do
Patients usually will push up the bladder in order to void
PE cystocele
vaginal bulge, especially when examined in a standing position. Internal examination reveals anterior fullness of the vaginal wall
Transabdominal ultrasound cystocele
funnel-shaped bladder
Ovarian torsion
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
is ovarian/adnexal torsion a gynecologic emergency
yes
when does ovarian torsion MC occur
reproductive age women
the most important risk factor for ovarian torsion
the presence of an ovarian mass, particularly masses larger than 5 cm
sx ovarian torsion
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
causes ovarian torsion
ovarian cysts, ovarian malignancies, and polycystic ovary syndrome
strenuous exercise or acutely increased abdominal pressure
