Genitourinary Prolapse Flashcards Preview

Gynaecology > Genitourinary Prolapse > Flashcards

Flashcards in Genitourinary Prolapse Deck (82)
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31

How do mild pelvic organ prolapses present?

Many are asymptomatic and are incidental findings

32

How severe can the symptoms of pelvic organ prolapse be?

Severe enough to affect quality of life

33

What are the symptoms of pelvic organ prolapse related to?

Site and type of prolapse

34

What are the vaginal/general symptoms of pelvic organ prolapse?

- Sensation of pressure/fullness/heaviness
- Sensation of bulge or 'something coming down'
- Seeing/feeling a bulge/protrusion
- Difficulty retaining tampons
- Spotting

35

What can cause spotting in a pelvic organ prolapse?

Ulceration of the prolapse

36

What are the potential urinary symptoms of pelvic organ prolapse?

- Incontinence
- Frequency
- Urgency
- Feeling of incomplete bladder emptying
- Weak or prolonged urinary stream
- Need to reduce prolapse manually before voiding
- Need to change position to start voiding

37

What are the symptoms of coital difficulty that may present in pelvic organ prolapse?

- Dyspareunia
- Loss of vaginal sensation
- Vaginal flatus
- Loss of arousal

38

What are the potential bowel symptoms in pelvic organ prolapse?

- Constipation/straining
- Urgency of stool
- Incontinence of flatus or stool
- Incomplete evacuation
- Need to apply digital pressure to perineum or posterior vaginal wall to enable defecation
- Digital evacuation necessary

39

In what positions should patients presenting with pelvic organ prolapse be examined?

- Standing
- Left lateral position

40

What should the patient be asked to do whilst examining for prolapse?

Strain

41

How should the vagina be examined when assessing pelvic organ prolapse?

With a speculum

42

What may be noticed on pelvic organ prolapse examination?

- Ulceration
- Hypertrophy
- Bleeding

43

When are abnormalities of the mucosa likely to occur in pelvic organ prolapse?

When the prolapse protrudes beyond the hymen level

44

How is pelvic organ prolapse usually diagnosed?

Based on history and examination

45

What tests should be considered if urinary symptoms are present in pelvic organ prolapse?

- Urinalysis/MSU
- Post-void residual urine volume testing using catheter or bladder USS
- Urodynamic investigations
- Urea and creatinine
- Renal USS

46

What tests can be considered if bowel symptoms are present in pelvic organ prolapse?

- Anal manometry
- Defecography
- Endo-anal USS

47

When is treatment of a prolapse not necessary?

In mild and/or asymptomatic prolapse

48

What are the broad management options for pelvic organ prolapse?

- Conservative
- Vaginal pessary
- Surgery

49

Who is conservative management of pelvic organ prolapse particularly helpful for?

- Mild prolapse
- Want further pregnancies
- Frail or elderly
- High anaesthetic risk
- Don't want surgery

50

What are the approaches to conservative management of pelvic organ prolapse?

- Watchful waiting
- Lifestyle modification
- Pelvic floor muscle exercises
- Vaginal oestrogen creams

51

When may further treatment be required for pelvic organ prolapse following watchful waiting?

If symptoms become troublesome or complications develop

52

What lifestyle modifications can conservatively treat pelvic organ prolapse?

- Weight loss
- Minimising heavy lifting
- Preventing or treating constipation

53

Who can vaginal oestrogen creams be useful for treating pelvic organ prolapse in?

Women with signs of vaginal atrophy

54

What is the function of a vaginal pessary in pelvic organ prolapse?

It is inserted in the vagina to reduce the prolapse and provide support and relieve pressure on the bladder and bowel

55

What can vaginal pessaries be used in combination with to treat pelvic organ prolapse?

Pelvic floor muscle exercises

56

How long can vaginal pessaries for prolapse be used for?

- Short-term prior to surgery
- Long-term if surgery is not an option

57

What should patients wanting vaginal pessary for prolapse be made aware of?

- More than one fitting may be necessary
- May affect sexual intercourse
- Should be changed every 6 months
- Complications

58

What are the potential complications of a vaginal pessary for pelvic organ prolapse?

- Bleeding
- Discharge
- Difficulty removing pessary
- Expulsion
- Vesicovaginal and rectovaginal fistulas
- Faecal impaction
- Hydronephrosis
- Urosepsis

59

What are the indications for surgical intervention for pelvic organ prolapse?

- Failure of conservative management
- Presence of voiding problems or obstructed defecation
- Recurrence of prolapse
- Ulceration
- Irreducible prolapse
- Woman prefers surgery

60

What are the goals of surgical intervention for pelvic organ prolapse?

- Restore anatomy
- Improve symptoms
- Return bladder, bowel and sexual function