Urogenital prolapse

Question 1

What are the causes, aetiology and RF of urogenital prolapse?

Answer 1

5 types of descent of pelvis organs - due to weakness of pelvis floor muscles

Uterine prolapse- prolapse of uterus in vagina
Cystocele- prolapse of anterior vaginal wall (involving bladder)
Rectocele- prolapse of lower posterior vaginal wall- involve rectum
enterocele- prolapse of upper posterior vaginal wall - bowels
Vault prolapse- prolapse of vaginal vault after hysterctome

RF- Age, parity, menopause, obesity, pelvis surgery, cough (smoking), heavy lifting, sports, consipation, pevlis mass, Fhx
affects 30-50% of women over 50

Question 2

Sx and grading systems of Urogenital prolapse

Answer 2

Feeling of heaviness of descent of PV
reccurent UTI
urinary sx if cystocele
Backpain
dyspareunia
constipation/incontincence if rectocele

grading-
POPq - NICE reccomended -measure anatomical landmarks in relation ot hymen

shaws - most common- 
first degre - descent in introitus
2nd- extends to intoitus but past on strain
3rd- prolapse through introitus
Introitus is vaginal opening

badens walker- like shaws but with hymen as reference

Question 3

Ix of urogenital prolapse

Answer 3

Speculum for grade and severity
Urodynamics for incotinence
MCS for UTIs

Question 4

Mx of urogenital prolapse

Answer 4

1st line - conservative - weight loss, less weight lift, stop smoke etc

2nd line - pelvis exercised (for stress as well)
topical oestrogen
Pessary (rings to put up in vagina)
types - RING (soft, doesnt prevent sex/ Hard (prevenrt sex), Gellhorn (shelf, prevent sex), Gehrung, Cube

3rd line-Depends on what has prolapsed
Uterine -
if doesnt want to preserve uterus - hystectome, sacrospinous hysteropexy
Preserve = hysteropexy with sutures, machester repair, meshes

vault- sacrocolopopexy with mesh

anterior- coloporrhaphy