Pelvic floor disorders - prolapse Flashcards Preview

Y4 Obstetrics and Gynaecology > Pelvic floor disorders - prolapse > Flashcards

Flashcards in Pelvic floor disorders - prolapse Deck (16)
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1
Q

Define what urogenital prolapse is

A

In urogenital prolapse there is descent of one of the pelvic organs resulting in protrusion on the vaginal walls.

2
Q

How common is prolapse ?

A

Very - affects up to 50% of parous women

3
Q

What are the risk factors for developing a prolapse ?

A
  • Pregnancy & birth
  • Obesity
  • Constipation, persistent coughing or prolonged heavy lifting
  • Increasing age
  • Following hysterectomy
  • Family history (genetics)
  • Connective tissue disorders - marfans, ehler danlos syndrome
4
Q

Describe the different types of urogenital prolapse

A
  • Anterior wall prolapse (cystocele) = when the bladder bulges into the front wall of the vagina
  • Posterior wall prolapse (rectocele) = when the rectum bulges into the back wall of the vagina

Middle or apical compartment prolapse causes:

  1. Uterine prolapse = descent of the uterus into the vagina
  2. Vaginal vault prolapse = descent of the vaginal vault post hysterectomy (upper portion of vagina prolapsing into vaginal canal or outside the vagina)
  3. Enterocele = herniation of pouch of douglas into vagina

Note: >1 prolapse type may occur at the same time

5
Q

Describe the typical presentation of a urogenital prolapse

A
  • Sensation of pressure, heaviness, bluging or ‘mass’
  • Urinary symptoms: incontinence, frequency, urgency, incomplete emptying
  • Difficult defacating or incomplete defacation
  • Difficulty inserting tampon
  • Sexual dysfunction - Dysparenuria
6
Q

State the classification of prolapses

A
  • 1st degree (in vagina),
  • 2nd degree (at interiotus),
  • 3rd degree (outside vagina)
  • Procidentia (entirely outside vagina)
7
Q

What should be done on examination of a patient with urogenital prolapse ?

A
  • PR exam
  • Vaginal exam using speculum
  • Urodynamics may be done to exclude OAB & assess voiding
8
Q

How is diagnosis of urogenital prolapse made ?

A

On clinical examination

9
Q

What are the management of urogenital prolapse ?

A

For mild prolapse/ no symptoms:

  • Conservative management (stop smoking, decrease weight, avoid heavy lifting, reduce constipation) + physio pelvic floor exercises
  • If atrophic vaginitis add in topical oestrogens
  • Consider a vaginal pessary for women with symptomatic pelvic organ prolapse, alone or in conjunction with supervised pelvic floor muscle training.

For severe prolapse or prolapse not manged conservatively:

  • Surgery is the best treatment but pessaries may be used if surgery not appropriate
10
Q

What are the indications for pessary use ovary surgery for urogenital prolapse ?

A
  • Women unfit for surgery
  • Relief symptoms whilst awaiting surgery
  • Further pregnancies planned or pregnant
  • As diagnostic test for prolapse/ensure correction of large cystourethrocele not cause SUI
  • Patient request
11
Q

How often do pessaries need to be changed ?

A

Every 6 months (or at least cleaned)

12
Q

What can be given when changing a pessary to help with the pain ?

A

Topical oestrogen

13
Q

What is the surgical treatment of anterior or posterior wall prolapses ?

A

Pelvic floor repair (vaginal repair)

14
Q

What is the surgical treatment of middle/apical prolapses ?

A
  • Marked uterine prolapse is best treated with hysterectomy. There are lots of fixation options - sacrospinous fixation, Sacralcolpopexy, mesh techniques
  • Colpoclesis is done if others have failed & they arent or wont become sexually active (vagina stitched closed)
15
Q

What should be done prior to surgical repair of prolapse and why?

A

Urodyanmic studies to determine if they have any incontinence as may need to repair this at the same time

16
Q

What are the complications of pessaries ?

A
  • Discharge
  • Ulcerations (leading to fistula)
  • FIbrous bands

(hence may need to leave a pessary out for 2-3 weeks after the 6monthly change to allow things to heal before new one inserted)

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