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1. How is prolapse defined?
Descent of the uterus and/or vaginal walls wtihin the vagina as a result of weakness in supporting structures
2. Laxity in which ligaments allows uterine prolapse?
Transverse cervical (cardinal) and uterosacral ligaments.
3. How is uterine prolapse graded?
1 - 3 depending on how much prolapse
4. If the anterior vaginal wall prolapses, what occurs?
Cystocoele (bladder prolapse. This sometimes includes urethra (urethrocoele)
5. If the posterior vaginal wall prolapses, what occurs?
Rectum prolapses (rectocele). A enterocele is if the pouch of Douglas (with perineum) prolapses.
6. What is the main risk factor for prolapse?
vaginal delivery - prolonged, with forceps delivery, with poor suturing. Also can be iatrogenic (post-hysterectomy)
7. What are the 4 contributing factors to prolapse?
Childbirth + oestrogen deficiency, obesity + chronic cough, pelvic masses, congenital
8. What symptoms may accompany prolapse?
dragging, lump. With cystocoele: frequency and incontinence. With rectocoele: constipation (occasionally)
9. What examination would you perform for a prolapse?
chest, abdo. Bimanual (exclude pelvic masses), sims' speculum (for anterior and posterior walls), rectal examination for rectocoele.
10. What investigations would you want for a prolapse?
pelvic ultrasound (endometrial mass). Biopsy if any post-menstrual bleeding. Cystometry if incontinence. Assess fitness for surgery if appropriate (ECG, CXR, FBC, U+E in age >50)
11. how do you manage prolapse?
lifestyle: weight reduction, discourage smoking, physiotherap. Medical: HRT. Pessary + oestrogen cream.
12. How do you manage a ring pessary?
Change every 4-6 months. Can fall out or cause pain or infection.
13. How is a prolapse managed surgically?
Manchester repair. Consider colposuspension if severe genuine stress incontinence with cystocoele.
What would you like to do?
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