Podcast
Questions and Answers
What is splinting used to improve?
What is splinting used to improve?
Why may surgery be necessary in cases of obstructed defecation?
Why may surgery be necessary in cases of obstructed defecation?
What is the primary purpose of taking a comprehensive history in patients with POP?
What is the primary purpose of taking a comprehensive history in patients with POP?
Why is it essential to evaluate the patient's symptoms thoroughly?
Why is it essential to evaluate the patient's symptoms thoroughly?
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What is the common consequence of treating prolapse in isolation?
What is the common consequence of treating prolapse in isolation?
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What percentage of women undergoing routine gynecological care will show loss of vaginal or uterine support on examination?
What percentage of women undergoing routine gynecological care will show loss of vaginal or uterine support on examination?
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Why is it important to evaluate patients with POP thoroughly?
Why is it important to evaluate patients with POP thoroughly?
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What symptoms are often misattributed to POP?
What symptoms are often misattributed to POP?
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Which type of prolapse is the least common?
Which type of prolapse is the least common?
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What is the ideal position for the patient during the pelvic examination?
What is the ideal position for the patient during the pelvic examination?
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What is the approximate number of women undergoing surgery for pelvic organ prolapse in the USA each year?
What is the approximate number of women undergoing surgery for pelvic organ prolapse in the USA each year?
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What percentage of women in the UK report symptoms of pelvic organ prolapse?
What percentage of women in the UK report symptoms of pelvic organ prolapse?
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What is the lifetime risk of surgery for pelvic organ prolapse?
What is the lifetime risk of surgery for pelvic organ prolapse?
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What is the most common type of prolapse?
What is the most common type of prolapse?
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What is the most common cause of avulsion injury to the levator ani during childbirth?
What is the most common cause of avulsion injury to the levator ani during childbirth?
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What is the term for the prolapse of the vaginal vault after the removal of the uterus?
What is the term for the prolapse of the vaginal vault after the removal of the uterus?
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What is the most significant contributor to the development of prolapse?
What is the most significant contributor to the development of prolapse?
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What is the term for the prolapse of the anterior vaginal compartment wall?
What is the term for the prolapse of the anterior vaginal compartment wall?
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What is the term for the prolapse of the posterior vaginal compartment wall?
What is the term for the prolapse of the posterior vaginal compartment wall?
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What is the effect of instrumental delivery on the risk of developing prolapse?
What is the effect of instrumental delivery on the risk of developing prolapse?
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What is the term for the prolapse of the uterus?
What is the term for the prolapse of the uterus?
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What is the condition that may contribute to the development of prolapse besides vaginal childbirth and age?
What is the condition that may contribute to the development of prolapse besides vaginal childbirth and age?
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What is the more common approach for performing sacrocolpopexy nowadays?
What is the more common approach for performing sacrocolpopexy nowadays?
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What is the main advantage of abdominal supporting procedures over vaginal procedures?
What is the main advantage of abdominal supporting procedures over vaginal procedures?
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What is the primary concern when evaluating apical support in anterior compartment prolapse?
What is the primary concern when evaluating apical support in anterior compartment prolapse?
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What is the main reason for reserving abdominal procedures for younger, fitter patients?
What is the main reason for reserving abdominal procedures for younger, fitter patients?
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What is a common complication associated with uterosacral colpopexy?
What is a common complication associated with uterosacral colpopexy?
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What is the typical approach for sacrospinous fixation?
What is the typical approach for sacrospinous fixation?
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What is the primary reason for performing a detailed examination under anaesthesia?
What is the primary reason for performing a detailed examination under anaesthesia?
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What is a common feature of anterior compartment prolapse?
What is a common feature of anterior compartment prolapse?
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What is the primary goal of adding apical support procedures to anterior repair?
What is the primary goal of adding apical support procedures to anterior repair?
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What is the typical success rate of posterior repair?
What is the typical success rate of posterior repair?
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What is the primary indication for obliterative surgical procedures?
What is the primary indication for obliterative surgical procedures?
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What is the name of the most common obliterative procedure?
What is the name of the most common obliterative procedure?
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What is the role of mesh in posterior repair?
What is the role of mesh in posterior repair?
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What is the primary advantage of performing anterior repair concurrently with apical support repair?
What is the primary advantage of performing anterior repair concurrently with apical support repair?
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What is the typical outcome of anterior colporrhaphy in terms of bowel symptoms?
What is the typical outcome of anterior colporrhaphy in terms of bowel symptoms?
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What is the primary reason for performing lateral wall defect correction in anterior repair?
What is the primary reason for performing lateral wall defect correction in anterior repair?
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Study Notes
Pelvic Organ Prolapse (POP)
- Defined as the downward displacement of pelvic organs from their original position into or beyond the vagina
- Affects a substantial number of women, with a lifetime risk of surgery of 12-19% and approximately 300,000 women undergoing surgery annually in the USA
- Symptoms can have a major impact on quality of life, but skillful assessment and management are required to ensure appropriate treatment and improved outcomes
Incidence and Epidemiology
- 8% of women in the UK report symptoms of prolapse
- 30-70% of women who present for routine gynecological care have loss of vaginal or uterine support
- Only 3-6% of these women have descent beyond the hymenal margin and are symptomatic
Types of Prolapse
- Anterior vaginal wall prolapse (cystocele): most common form
- Posterior vaginal wall prolapse (rectocele): less frequent
- Apical prolapse (descent of the uterus or vaginal vault): least common
Aetiology
- Poorly understood, but predisposing risk factors include:
- Vaginal childbirth
- Obesity
- Previous hysterectomy
- Age (incidence doubles with every decade of life)
Evaluation
- Comprehensive history taking, including urinary, bowel, and sexual history
- Patients presenting with primary bladder or bowel dysfunction may be referred for management of prolapse due to mistaken belief that their symptoms are the result of the prolapse
Treatment
- Surgery: laparoscopic sacrocolpopexy, robotically assisted sacrocolpopexy, or transvaginal apical support with sacrospinous fixation
- Abdominal supporting procedures reserved for younger, fitter, and more active patients
- Vaginal procedures reserved for older and frailer patients
Surgery for Anterior Compartment Prolapse
- Rarely occurs in isolation, often accompanied by descent of the vaginal apex or posterior wall
- Apical support must be carefully evaluated
- Anterior repair involves midline plication of the vaginal fascia, excision of redundant vaginal wall epithelium, and suture of the epithelium
- Success rates in the range of 40-60%
Surgery for Posterior Compartment Prolapse
- Associated with higher rates of anatomical success (80-95%)
- Operation involves midline plication of the rectovaginal fascia, excision of redundant epithelium, and reconstruction of the epithelium
- Improvement in bowel symptoms demonstrated in the majority of women after posterior colporrhaphy
Obliterative Surgical Procedures
- Reserved for women who have failed conservative therapy, have significant comorbidities, and are not candidates for extensive surgery
- Most common procedure: colpocleisis, which can be done in women who have had a hysterectomy and those who have not
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Description
This quiz covers the definition, impact, assessment, and management of pelvic organ prolapse (POP) in women, a benign condition affecting quality of life.
