Urogynecology: Vaginal Prolapse
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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?

<p>Enterocele</p> Signup and view all the answers

What is the type of posterior vaginal wall prolapse that involves the bulging of the rectum into the vagina?

<p>Rectocele</p> Signup and view all the answers

What is the type of prolapse that occurs when the vaginal vault (the upper part of the vagina) falls into the vaginal canal?

<p>Vaginal Vault Prolapse</p> Signup and view all the answers

What is the congenital factor that may contribute to the development of prolapse?

<p>Congenital shortness of the vagina</p> Signup and view all the answers

What is the racial factor that may contribute to the lower prevalence of prolapse?

<p>Better connective tissue with greater collagen in ligaments</p> Signup and view all the answers

What is the precipitating factor that may reveal prolapse when the supports are already weakened?

<p>Raised intra-abdominal pressure</p> Signup and view all the answers

What is the type of prolapse that occurs when the uterus falls into the vaginal canal?

<p>Uterine Prolapse</p> Signup and view all the answers

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.

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