Urogenital prolapse

Question 1

What is urogenital prolapse?

Answer 1

· Uterine: Uterus into vagina

· Cystocele: anterior vaginal wall into bladder.

· Rectocele: lower posterior vaginal wall into anterior wall of rectum.

· Enterocele: Upper posterior vaginal wall containing loods of small bowel.

· Vault prolapse: vaginal vault after hysterectomy.

Question 2

What is the aetiology of prolapse?

Answer 2

Weak pelvic floor muscles.

RF: age, parity high especially with vaginal deliveries, pelvic surgery, obesity, menopause, chronic cough, constipation, high impact sports, pelvic mass, FHx, spinal cord injury/muscle atrophy.

Question 3

What is the epidemiology of prolapse?

Answer 3

50% women>50.

Question 4

What is the Hx/ Ex of prolapse?

Answer 4

Heaviness or fescent PV, back pain, recurrent UTI, dyspareunia, urinary symptoms, constipation or fecal incontinence with enterocele.

Abdomen: masses

Speculum: nature and degree of prolapse. 1st: descent into introitus. 2nd: descent past introitus only on straining. 3rd: past introitus. Complete procidentia: third degree uteirne prolapse.

Question 5

What Ix do you do for prolapse?

Answer 5

Urine: MSU, exclude UTI.

Imaging: pelvic USS occasionally required if suspicion of palvic mass

UrodynamicsL may be used ot document detrusor instabilityprior to surgical repair.

Question 6

What is the management for prolapse?

Answer 6

· Uterine: conservative with pelvic floor exercise. Surgical requires hysterectomy.

· Vault: conservative with shelf or ring pessaries. Surgical sacrospinous fixation/sarcolopoplexy.

· Cystocele: conservative a/a, or anterior repair surgically.

· Enterocele/rectocele: conservative a/a, or posterior surgical repair.

Question 7

What are the complications/ prognosis of prolapse?

Answer 7

Ulceration, urinary symptoms, constipation and incontinence, dyspareunia, complications of surgery. Recurrence following surgery 30%.