4 - prolapse

Question 1

what is prolapse?

Answer 1

descent of 1 or more pelvic structures from normal anatomical position moving towards/through vaginal opening (common in post menopausal women after childbirth)

Question 2

what are anterior vaginal wall prolapses?

Answer 2

• cystocele (bladder prolapse)
• urethrocele (urethral prolapse)

*cystourethrocele = both

Question 3

what are posterior vaginal wall prolapses?

Answer 3

• enterocele (small intestine prolapse)
• rectocele (rectal prolapse)

Question 4

what are apical vaginal wall prolapses?

Answer 4

• uterine prolapse
• vaginal vault prolapse (roof of vagina prolapse after hysterectomy)

Question 5

how does prolapse present?

Answer 5

• sensation of pressure/heaviness/dragging
• visible protrusion of tissue
• urinary symptoms, incontinence, recurrent UTI, difficulty voiding
• defecation symptoms like constipation or incomplete bowel emptying
• sexual dysfunction

Question 6

how investigate prolapse?

Answer 6

pelvic examination, can do MRI to help surgical planning

Question 7

what is grading system for prolapse? whats the more complicated one?

Answer 7

baden walker halfway system:

grade 0 = no prolapse

grade 1 = halfway to hymen

grade 2 = to hymen

grade 3 = halfway past hymen

grade 4 = maximum descent

*POP-Q more complicated one