Uterine Prolapse

Question 1

The definition of prolapse is a downward movement of pelvic structures secondary to weak connective tissues. What % of women >50 y/o are expected to have some symptoms of pelvic floor prolapse?

1 - 5%
2 - 15%
3 - 50%
4 - 80%

Answer 1

3 - 50%

Question 2

The definition of prolapse is a downward movement of pelvic structures secondary to weak connective tissues. What % of women with uterine prolapse will need corrective surgery at some point?

1 - 2%
2 - 5%
3 - 20%
4 - 60%

Answer 2

3 - 20%

Question 3

What age does uterine prolapse typically peak?

1 - 30
2 - 45
3 - 55
4 - 70

Answer 3

4 - 70
- can occur earlier depending on risk factors

Question 4

In a prolapse, which organs can be effected?

1 - uterus
2 - bladder
3 - urethra
4 - rectum
5 - vaginal vault
6 - all of the above

Answer 4

6 - all of the above
all protrude out of the vagina

Question 5

Which of the following is NOT a risk factor for developing uterine prolapse?

1 - Childbearing and vaginal delivery
2 - Age
3 - Obesity
4 - Chronic cough
5 - Abdominal mass (eg fibroids)
6 - Pelvic surgery
7 - Connective tissue disorders

Answer 5

2 - Age

Question 6

Women with uterine prolapse can present with a variety of symptoms which typically get worse as the day progresses. Which of the following is NOT a common symptom of uterine prolapse?

1 - increased pelvis pressure
2 - urinary incontinence
3 - dysuria
4 - difficulty emptying the bladder or bowel
5 - dyspareunia
6 - general back/pelvic pain

Answer 6

3 - dysuria
- pain/stinging when urinating

• patients can also be asymptomatic

Question 7

The pelvic floor support structures help hold the rectum and vagina entry in place. Which of the following ligaments holds in place the rectum and vagina posteriorly?

1 - utero sacral ligaments
2 - cardinal ligaments
3 - white line of fascia (arcus tendineus fascia pelvis)
4 - pubo cervical fascia

Answer 7

1 - utero sacral ligaments
- attaches from cervix to sacrum

Question 8

The pelvic floor support structures help hold the rectum and vagina entry in place. Which of the following ligaments holds in place the rectum and vagina laterally?

1 - utero sacral ligaments
2 - cardinal ligaments
3 - white line of fascia (arcus tendineus fascia pelvis)
4 - pubo cervical fascia

Answer 8

2 - cardinal ligaments
- attaches from cervix to greater sciatic foramen before

Question 9

The pelvic floor support structures help hold the rectum and vagina entry in place. Which of the following ligaments holds in place the rectum and vagina anteriorally?

1 - utero sacral ligaments
2 - cardinal ligaments
3 - white line of fascia (arcus tendineus fascia pelvis)
4 - pubo cervical fascia

Answer 9

4 - pubo cervical fascia
- attaches from cervix to symphysis

Question 10

The prolapse can be categorised based on which compartment of the pelvis is affected. What is the name given if the anterior compartment is affected?

1 - rectal prolapse
2 - cystocele prolapse
3 - uterine prolapse
4 - rectocele prolapse

Answer 10

2 - prolapse
- causes bulging at the front of the vagina

• can also be a urethrocele

urethrocele = urethral
cystocele = bladder

Question 11

The prolapse can be categorised based on which compartment of the pelvis is affected. What is the name given if the posterior compartment is affected?

1 - rectal prolapse
2 - cystocele prolapse
3 - uterine prolapse
4 - rectocele prolapse

Answer 11

4 - rectocele prolapse
- causes bulging at the back of the vagina

• can also be called a enterocele

rectocele = rectal
enterocele = small bowel herniation)

Question 12

The prolapse can be categorised based on which compartment of the pelvis is affected. What is the name given if the uterus is affected?

1 - rectal prolapse
2 - cystocele prolapse
3 - uterine prolapse
4 - rectocele prolapse

Answer 12

3 - uterine prolapse

Question 13

In a patient with a suspected prolapse, what should be the 1st line investigation?

1 - urinalysis
2 - PR examination
3 - bimanual pelvic examination
4 - ultrasound

Answer 13

3 - bimanual pelvic examination
- speculum will tell you exactly where the bulge is coming from

• valsalva manoeuvre can be performed to elicit the prolapse by increasing intra abdominal pressure
• can also assess for pelvic masses, tenderness, or cervical motion tenderness.

Question 14

Are all prolapses the same severity?

Answer 14

• no, different stages
• stage 4 and 5 are the worse

Question 15

What is a procidentia in terms of a prolapse?

1 - bowel protrudes into bladder
2 - pelvic organs protrude outside the vaginal
3 - uterus folds in on itself
4 - bladder moves into abdominal cavity

Answer 15

2 - pelvic organs protrude outside the vaginal

Question 16

Typically what is the first line treatment for a patient with a prolapse?

1 - Physiotherapy
2 - Pessary treatment
3 - Surgery
4 - botox injections

Answer 16

1 - Physiotherapy
- ineffective in advanced cases, but useful in less severe cases

Question 17

How can a pessary help treat a prolapse?

1 - provides structural support
2 - provides electrical current to strength pelvic muscles
3 - contains estrogen which is effective at strengthening the pelvic muscles
4 - all of the above

Answer 17

1 - provides structural support
- positioned behind pubic bone and posterior fornix

• should be no pain or discomfort

Question 18

If a vaginal pessary is proving helpful for a patient with a prolapse, how often should they be checked and changed?

1 - every week
2 - every month
3 - every 6 months
4 - every year

Answer 18

3 - every 6 months

• can increase discharge and cause ulceration and damage to vaginal wall

Question 19

Surgery for prolapse is common place. Which of the following is NOT a benefit of surgery for prolapse?

1 - Very effective initially
2 - Mostly conducted vaginally rather than abdominally
3 - Low recurrence rates
4 - Amenable to spinal anaesthesia

Answer 19

3 - Low recurrence rates
- there is a high recurrence rate

Question 20

Surgery for prolapse is common place. Which of the following is NOT a negative of surgery for prolapse?

1 - High recurrence rate
2 - Complications of surgery in often elderly patients
3 - Straightening of urethra in prolapse correction may lead to de-novo stress incontinence
4 - small intestine perforation

Answer 20

4 - small intestine perforation