Structural Abnormalities Flashcards
What is cystocele?
bladder prolapse (cystocele) is a bulge of the bladder into the vagina
What are the characteristics of cystocele?
anterior vaginal prolapse of the posterior bladder wall into the vagina, emerging from the introitus
What can a cystocele result from?
childbirth, constipation, violent coughing, heavy lifting, or other pelvic muscle strain
What are the symptoms of cystocele?
include feeling pressure in the pelvis and vagina, discomfort when straining, and feeling that the bladder hasn’t fully emptied after urinating
- feels like “sitting on a ball” or “something is falling out”
- worse with Valsalva and better with redundancy
- concurrent urinary incontinence
How is a cystocele dx?
diagnose with POP-Q (pelvic organ prolapse quantification): quantifies the extend and location of defects, ultrasound, or MRI
-additional testing: Q-tip test, voiding cystourethrogram (VCUG), cystometrogram
What is the tx of cystocele?
includes a flexible ring pessary to support the bladder or surgical repair with mesh augmentation
- prophylaxis with Kegel exercises: strengthen levator ani and perineal muscles
- estrogen therapy after menopause maintains tone and vitality of the tissue
What is a rectocele?
herniation of the rectum into the posterior wall of the vagina
What can lead to a rectocele?
childbirth and other processes that put pressure on the tissue wall can lead to a rectocele
What does a rectocele result in?
pelvic pressure + bowel symptoms
What are the symptoms of a rectocele?
include a soft bulge of tissue in the vagina that may or may not protrude through the vaginal opening
- defecatory dysfunction (constipation, straining, incomplete emptying)
- perceived or discovered bulge into the vagina, low back pain
How is a rectocele dx?
POP-Q (pelvic organ prolapse quantification): quantifies the extent and location of defects
-get a colonoscopy to rule out cancer and rectal studies if indicated
What is the tx of rectocele?
kegel exercises, pelvic floor retraining, behavioral changes, bowel regimen, pessary, surgical repair or repair with mesh augmentation
What is ovarian torsion?
refers to the rotation of the ovary at its pedicle to such a degree as to occlude the ovarian artery and/or vein
How do patients with ovarian torsion?
present with sudden onset of sharp and usually unilateral lower abdominal pain, in 70% of cases accompanied by nausea and vomiting
How is ovarian torsion dx?
abdominal ultrasound with doppler flow is the diagnostic test of choice
-doppler flow is not always absent in torsion-the gold standard for the diagnosis of ovarian torsion is laparoscopy
What is the tx of ovarian torsion?
the mainstay of treatment of ovarian torsion includes laparoscopic surgery to uncoil the ovary
What is uterine prolapse?
when the uterus descends toward or into the vagina
- it happens when the pelvic floor muscles and ligaments become weak and there are no longer able to support the uterus
- in some cases, the uterus can protrude from the vaginal opening
What are the signs and symptoms of uterine prolapse?
- caucasian women, after labor/delivery, chronic cough
- vaginal fullness, abdominal pain worse late in the day, after prolonged standing
- relieved by lying down
How are uterine prolapse graded?
prolapse of the uterus into the vaginal canal - graded by uterine descent
What is 0 degree uterine prolapse?
no descent
What is 1st degree uterine prolapse?
to the upper vagina/between ischial spines and hymen
What is 2nd degree uterine prolapse?
to the Introits/between ischial spines and hymen
What is 3rd degree uterine prolapse?
cervix is outside the introitus/within hymen
What is 4th degree uterine prolapse?
(sometimes referred to as providentia); uterus and cervix entirely outside the introitus/through the hymen
How is uterine prolapse dx?
diagnosis is confirmed by a speculum or bimanual pelvic examination
- vaginal ulcers are biopsied to exclude cancer
- simultaneous urinary incontinence requires evaluation
What is the tx of uterine prolapse?
asymptomatic 1st or 2nd degree prolapse can be treated with a pessary if the perineum can structurally support a pessary
- severe or persistent symptoms and 3rd or 4th degree prolapse require surgery
- usually hysterectomy with surgical repair of the pelvic support structures (colporrhaphy) and suspension of the top of the vagina (suturing of the upper vagina to a stable structure nearby)
