Genitourinary Prolapse Flashcards Preview

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Flashcards in Genitourinary Prolapse Deck (82)
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How do mild pelvic organ prolapses present?

Many are asymptomatic and are incidental findings


How severe can the symptoms of pelvic organ prolapse be?

Severe enough to affect quality of life


What are the symptoms of pelvic organ prolapse related to?

Site and type of prolapse


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


What can cause spotting in a pelvic organ prolapse?

Ulceration of the prolapse


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


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

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


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


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

- Standing
- Left lateral position


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



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

With a speculum


What may be noticed on pelvic organ prolapse examination?

- Ulceration
- Hypertrophy
- Bleeding


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

When the prolapse protrudes beyond the hymen level


How is pelvic organ prolapse usually diagnosed?

Based on history and examination


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


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

- Anal manometry
- Defecography
- Endo-anal USS


When is treatment of a prolapse not necessary?

In mild and/or asymptomatic prolapse


What are the broad management options for pelvic organ prolapse?

- Conservative
- Vaginal pessary
- Surgery


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


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

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


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

If symptoms become troublesome or complications develop


What lifestyle modifications can conservatively treat pelvic organ prolapse?

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


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

Women with signs of vaginal atrophy


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


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

Pelvic floor muscle exercises


How long can vaginal pessaries for prolapse be used for?

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


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


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


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


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

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