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gynecology_pelvic organ prolapse (physical examination (lithotomy position…
gynecology_pelvic organ prolapse
investigations
urodynamic study
history
prolapse kink urethra, occult urinary stress incontinence
compartment
posterior compartment
pain, digital assistance, anal incontinence
middle/apical compartment
anterior compartment
hesitency, poor stream, intermittent
protrusion, dragging sensation, dysparaunia
physical examination
general
abdominal
lithotomy position
prolapse
ulcer/laceration/discharge
cough (stress incontinence)
Sim speculum
lie on left, right hip knee up
retract ant/post
compartment
bimanual examination
uterus
adnexal mass
distance between pubic symphysis and posterior fornix
POP-Q pelvic organ prolapse quantification system
(normal) stage 0
(1 cm above hymen) stage 1
(1 cm above/below hymen) stage 2
(1 cm below hymen) stage 3
(at least total vaginal length - 2 cm OR less than 2 cm) stage 4
pelvic floor exercise
surgery
uterine prolapse
vaginal hysterectomy
anterior compartment
anterior colporrhaphy
anterior vaginal mesh
old, unfit, need surgery
colpoclesis
middle/apical compartment
sacrocolpopexy (young patient)
sacrospinous ligament fixation SSLF (stage 3, 4)
hystercolposacaropexy (conserve uterus)
posterior compartment
posterior colporrhaphy
vaginal ring pessary
indications
mild
x complete family
unfit for surgery
waiting for surgery
advantages: v help x surgery disadvantages: fall out, infection, ulcer/bleed
change every 6 months
behavioral
weight reduction
cough
voiding habit (x heavy strainging)
prolapse
protrusion of an organ beyond its normal anatomical confines
posterior compartment
rectocele, enterocele
middle/apical compartment
uterine prolapse, vault prolapse
anterior compartment
cystocele, urethrocele
causes
pelvic floor muscles
trauma e.g. 3/4 degree perineal tear
lack estrogen e.g .ageing
intra-abdominal pressure