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Questions and Answers
What is the most common type of anterior vaginal wall prolapse?
Cystocele
What is the medical term for the bulging of the urethra in the lower 1/4 of the anterior vaginal wall?
Urethrocele
What is the term for the total or complete anterior vaginal wall prolapse?
Cysto-urethrocele
What is the type of posterior vaginal wall prolapse that involves the bulging of the small intestine into the vagina?
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What is the type of posterior vaginal wall prolapse that involves the bulging of the rectum into the vagina?
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What is the type of prolapse that occurs when the vaginal vault (the upper part of the vagina) falls into the vaginal canal?
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What is the congenital factor that may contribute to the development of prolapse?
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What is the racial factor that may contribute to the lower prevalence of prolapse?
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What is the precipitating factor that may reveal prolapse when the supports are already weakened?
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What is the type of prolapse that occurs when the uterus falls into the vaginal canal?
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Study Notes
Types of Prolapse
- Posterior vaginal wall prolapse can be divided into two types: Enterocele and Rectocele
- Enterocele is the descent of the upper part of the posterior vaginal wall, lined by peritoneum of Douglas pouch, containing intestine
- Rectocele is the descent of the lower part of the posterior vaginal wall, usually occurring with perineal tears
Vaginal Vault Prolapse
- This type of prolapse occurs when the vault of the vagina is displaced downward, usually after hysterectomy
- Increased intra-abdominal pressure directed against the top of an inadequately supported vagina can cause vaginal vault prolapse
- Etiology: usually following hysterectomy, more common in subtotal hysterectomy, and neglected enterocele
- Lack of surgical prophylaxis can also contribute to vaginal vault prolapse
Uterine Prolapse
- Uterine prolapse can be classified into four degrees:
- First degree: The cervix is within the vagina above the level of the introitus but below the level of the ischial spine
- Second degree: The cervix is out of the vagina, but the body of the uterus is inside
- Third degree & Fourth degree: A variable extent of the body of the uterus is out of the vagina, either partially or complete (procidentia)
Clinical Picture
- Symptoms and examination are crucial in diagnosing prolapse
- Local examination (pelvic examination) involves two separate evaluations: first with the patient at rest, and then under conditions of maximal straining (Valsalva maneuver)
Predisposing Factors
- Menopausal factors: estrogen deficiency leads to decreased vascularity and degeneration of ligaments
- Congenital factors: congenital bony lesions, collagen disease, anatomical anomalies, and congenital weakness of connective tissues
- Race: black women may have a lower prevalence of prolapse due to better connective tissue with greater collagen in ligaments, or lumbar lordosis
Precipitating Factors
- Raised intra-abdominal pressure: chronic obstructive airways disease, smoking, straining at stools with constipation, heavy physical work, and abdominal mass or ascites
- Factors causing traction on the uterus: cervical polyp, fibroid
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Description
This quiz covers the types of vaginal prolapse, including enterocele, rectocele, and vaginal vault prolapse, as well as their symptoms and causes.
