Flashcards in Genitourinary Prolapse Deck (82)
What does the choice of surgical procedure for pelvic organ prolapse depend upon?
- If woman is sexually active
- If family is complete
- General fitness
- Whether has had a hysterectomy
- Nature of prolapse
What is a controversial surgery for pelvic organ prolapse?
Why is mesh repair for pelvic organ prolapse a topic of controversy?
Concerns of long-term health problems
What are the long-term complications of mesh repair for pelvic organ prolapse?
- Bladder/bowel dysfunction
What are the surgical options for bladder/urethral prolapse?
- Anterior colporrhaphy
What happens in an anterior colporrhaphy?
Folds the fibromuscular layer of the anterior vaginal wall
What are the intraoperative complications of anterior colporrhaphy?
When can a colposuspension be considered for treatment of pelvic organ prolapse?
For urethral sphincter incontinence associated with cystourethrocele
How is a colposuspension performed?
Paravaginal fascia on either side of the bladder neck and base of the bladder are approximated to pelvic side wall by sutures through ipsilateral iliopectineal ligament
What are the surgical options for a uterine prolapse?
- Sacrospinus fixation
What is a sacrocolpoplexy?
The uterus is attached to the longitudinal ligament over the sacrum
What are the ways a sacrocolpoplexy can be performed?
What is an advantage of a sacrocolpoplexy for uterine prolapse?
Woman can retain her uterus
What is a sacrospinus fixation of uterine prolapse?
Unilateral or bilateral fixation of the uterus to the sacrospinus ligamnet
What are the risks of sacrospinus fixation for uterine prolapse?
Injury to the pudendal nerve and vessels and the sciatic nerve
What are the surgical options for a vault prolapse?
- Sacrospinus fixation
What is the surgical option for a recto/enterocele?
What is obliterative surgery for pelvic organ prolapse?
The prolapse is corrected by moving the pelvic viscera back into the pelvis and closing off the vaginal canal
What are the advantages of obliterative surgery for pelvic organ prolapse?
- Almost 100% effective
- Reduced peri-operative morbidity
- Safe for those who are frail
What is the main disadvantage of obliterative surgery for pelvic organ prolapse?
Vaginal intercourse is no longer possible
What are the potential complications of pelvic organ prolapse?
- Ulceration and infection of prolapsed organs outside introitus
- Urinary tract complications
- Bowel dysfunction