Urogenital_Prolapse_Flashcards
What is urogenital prolapse?
Descent of one of the pelvic organs resulting in protrusion on the vaginal walls.
How common is urogenital prolapse?
It probably affects around 40% of postmenopausal women.
What are the types of urogenital prolapse?
Cystocele, cystourethrocele, rectocele, uterine prolapse, less common: urethrocele, enterocele (herniation of the pouch of Douglas, including small intestine, into the vagina).
What are the risk factors for urogenital prolapse?
Increasing age, multiparity, vaginal deliveries, obesity, spina bifida.
What are the common presentations of urogenital prolapse?
Sensation of pressure, heaviness, ‘bearing-down’, urinary symptoms: incontinence, frequency, urgency.
What is the management for asymptomatic and mild prolapse?
No treatment needed.
What are the conservative management options for urogenital prolapse?
Weight loss, pelvic floor muscle exercises.
What is a non-surgical option for managing urogenital prolapse?
Ring pessary.
What are the surgical options for cystocele/cystourethrocele?
Anterior colporrhaphy, colposuspension.
What are the surgical options for uterine prolapse?
Hysterectomy, sacrohysteropexy.
What is the surgical option for rectocele?
Posterior colporrhaphy.
summarise urogenital prolapse
Urogenital prolapse
In urogenital prolapse there is descent of one of the pelvic organs resulting in protrusion on the vaginal walls. It probably affects around 40% of postmenopausal women
Types
cystocele, cystourethrocele
rectocele
uterine prolapse
less common: urethrocele, enterocele (herniation of the pouch of Douglas, including small intestine, into the vagina)
Risk factors
increasing age
multiparity, vaginal deliveries
obesity
spina bifida
Presentation
sensation of pressure, heaviness, ‘bearing-down’
urinary symptoms: incontinence, frequency, urgency
Management
if asymptomatic and mild prolapse then no treatment needed
conservative: weight loss, pelvic floor muscle exercises
ring pessary
surgery
Surgical options
cystocele/cystourethrocele: anterior colporrhaphy, colposuspension
uterine prolapse: hysterectomy, sacrohysteropexy
rectocele: posterior colporrhaphy
A 44-year-old woman undergoes a hysterectomy for severe dysmenorrhoea. She had completed her family and pharmacological management had failed. A few months later she suffers from a vaginal vault prolapse and is referred to the gynaecologists.
Which surgical treatment is most suitable?
Anterior colporrhaphy
Vaginoplasty
Vaginal hysterectomy
Bilateral oophorectomy
Sacrocolpopexy
The treatment for vaginal vault prolapse is sacrocolpoplexy
The most suitable surgical option is sacrocolpopexy. This procedure suspends the vaginal apex to the sacral promontory. This support is usually afforded by the uterosacral ligaments.
Anterior colporrhaphy is when the vaginal wall is repaired following a cystocele.
Vaginoplasty is reconstruction of the vagina to make it ‘tighter’ following childbirth, for example.
Vaginal hysterectomy involves the removal of the uterus via the vagina.
Bilateral oophorectomy involves the removal of the ovaries and again would not be appropriate as the ovaries are not involved in the pathology of the underlying disease.
