Vaginal Prolapse

Neelam Maurya

8 years ago

INTRODUCTION:

The network of muscles, ligaments, and skin in and around a woman’s vagina acts as a complex support structure that holds pelvic organs, and tissues in place.
This support network includes the skin and muscles of the vaginal walls (a network of tissues called the fascia).
Various parts of this support system may eventually weaken or break, causing a common condition called vaginal prolapse.

RISK FACTORS:

TYPES:

Anterior vaginal wall prolapse: Urethrocele, Cystocele(base of bladder), Cystourethrocele
Posterior vaginal wall prolapse:Rectocele, Enterocele
Apical vaginal prolapse: Uterovaginal , Vaginal prolapse

SYMPTOMS:

The most common type of genital prolapse is Cystocele
The symptoms that result from vaginal prolapse commonly affect sexual function as well as bodily functions such as urination and defecation.
Pelvic pressure and discomfort are also common symptoms.
Pressure in the vagina or pelvis
Painful intercourse (dyspareunia)
A mass at the opening of the vagina
A decrease in pain or pressure when the woman lies down
Recurrent urinary tract infections
Difficulty emptying bowel
Difficulty emptying bladder
Constipation
Urinary stress incontinence
Pain that increases during long periods of standing
Protrusion of tissue at the back wall of the vagina
Protrusion of tissue at the front wall of the vagina
Enlarged, wide, and gaping vaginal opening

INVESTIGATION:

Q-tip test:Predictive factor of success of anti-incontinence surgery.
Bladder function test:This tests the ability of the bladder to store and evacuate urine (i.e. urinate) and to dispose of it.
Pelvic floor strength:assesses the strength of the muscles and ligaments that support the vaginal walls, uterus, rectum, urethra, and bladder.

Imaging technique:

TREATMENT:

Nonsurgical options:

Most appropriate for women who are not sexually active, cannot undergo surgery because of medical reasons, or experience few or no symptoms associated with the condition.
Estrogen replacement therapy

Surgical repair:

For young nulliparous women with 2° or 3° uterovaginal prolapse
Abdominal sling operation (e.g. Purandare, Shirodkar, Khanna and Mnatre sling operation)
For a parous women in early weeks of pregnancy.
Ring pessary in the first trimester of pregnancy.
For a parous women in pregnancy with 2° or 3° prolapse at 28 weeks.
Ring pessary till child birth and few weeks after and then Fothergill’s repair.
For < 40years multipara, desirous of retaining menstrual function and reproductive function with 2° or 3° prolapse.
Fothergill’s repair with tubal ligation
For women > 40 years completed family size
Mayoward’s vaginal hysterectomy (with ant. Colporrhaphy and posterior colpoperineorrhaphy) with pelvic floor repair.

For elderly menopause patient with advanced prolapse

Lefort’s repair
For enterocele
Moscowitz repair
For vault prolapse
Right transvaginal sacrospinous colpopexy (in obese and elderly, not fit for abdominal surgery).
Transabdominal sacral colpopexy using Mersilene mesh extraperitoneally (in patient fit for abdominal surgery).
Congenital prolapse of uterus / Nulliparous prolapse without cystocele :
Purandare’s cervicopexy.
Fothergill’s repair(treatment of choice uterovaginal prolapse)

Other therapy:

Exam Question

Shirodkar’s abdominal sling is the treament of choice for nulliparous woman who has 3rd degree uterovaginal prolapse without any cystocele or rectocele.
Urinary incontinence in uterovaginal prolapse is mostly is due to Stress incontience
Treatment of choice in a multiparous female with 2nd degree uterovaginal prolapse is Fothergill’s operation with tubal ligation
Cystocele is formed by base of the bladder
The most common type of genital prolapse is Cystocele

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