Vaginal Prolapse

VAGINAL PROLAPSE

Q. 1

A young nulliparous woman has 3rd degree uterovaginal prolapse without any cystocele or rectocele. There is no stress incontinence. Utero­cervical length is 3 inches. All other symptoms are normal. The best treatment plan for her will be :

 A

Observation and reassurance till child bearing is over

 B

Shirodkar’s vaginal repair

 C

Shirodkar’s abdominal sling.

 D

Fothergill’s operation

Q. 1

A young nulliparous woman has 3rd degree uterovaginal prolapse without any cystocele or rectocele. There is no stress incontinence. Utero­cervical length is 3 inches. All other symptoms are normal. The best treatment plan for her will be :

 A

Observation and reassurance till child bearing is over

 B

Shirodkar’s vaginal repair

 C

Shirodkar’s abdominal sling.

 D

Fothergill’s operation

Ans. C

Explanation:

Ans. is c i.e. Shirodkar abdominal sling    

Abdominal sling operations are designed for young women suffering from second or third degree uterovaginal prolapse and who are desirous of retaining their childbearing and menstrual functions.

The objective of these operations is to buttress the weakened supports (Mackenrodt and uterosacral ligaments) of uterus by providing a substitute in the form of Nylone or Dacron tapes, used as slings to support the uterus.

The operations in common practice are :

  • Abdomino-cervicopexy
  • Shirodkar’s abdominal sling operation
  • Khanna’s abdominal sling operation.

Also know :

More about treatment :

  • For young nulliparous women with 2° or 3° uterovaginal prolapse

—  Abdominal sling operation (e.g. Purandare, Shirodkar, Khanna)

  • 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

  • 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.



Q. 2

Young women suffering from 2-1 & 3rd degree uterovaginal prolapse, choice of operation is :

 A

Purandare and Mnatre sling operation

 B

Virkud’s sling operation

 C

Mangeshkar’s Laparoscopic technique

 D

Neeta Warty’s Laparoscopic modification of shirodkar’s operation

Q. 2

Young women suffering from 2-1 & 3rd degree uterovaginal prolapse, choice of operation is :

 A

Purandare and Mnatre sling operation

 B

Virkud’s sling operation

 C

Mangeshkar’s Laparoscopic technique

 D

Neeta Warty’s Laparoscopic modification of shirodkar’s operation

Ans. A

Explanation:

Purandare and Mnatre sling operation


Q. 3

Urinary incontinence in uterovaginal prolapse is mostly is due to :

 A

Detrusor instability

 B

Stress incontience

 C

Urge incontinence

 D

True incontinence

Q. 3

Urinary incontinence in uterovaginal prolapse is mostly is due to :

 A

Detrusor instability

 B

Stress incontience

 C

Urge incontinence

 D

True incontinence

Ans. B

Explanation:

Stress incontience


Q. 4

Treatment of choice in a multiparous female with 2nd degree uterovaginal prolapse is :

 A

Fothergill’s operation

 B

Hysterectomy with pelvic floor repair

 C

Fothergill’s operation with tubal ligation

 D

Hysterectomy only

Q. 4

Treatment of choice in a multiparous female with 2nd degree uterovaginal prolapse is :

 A

Fothergill’s operation

 B

Hysterectomy with pelvic floor repair

 C

Fothergill’s operation with tubal ligation

 D

Hysterectomy only

Ans. C

Explanation:

Fothergill’s operation with tubal ligation


Q. 5

Cystocele is formed by of the bladder :

 A

Base

 B

Superior surface

 C

Trigone

 D

Posterior

Q. 5

Cystocele is formed by of the bladder :

 A

Base

 B

Superior surface

 C

Trigone

 D

Posterior

Ans. A

Explanation:

Base


Q. 6

The most common type of genital prolapse is:

 A

Cystocele

 B

Procidentia

 C

Rectocele

 D

Entrocele

Q. 6

The most common type of genital prolapse is:

 A

Cystocele

 B

Procidentia

 C

Rectocele

 D

Entrocele

Ans. A

Explanation:

Cystocele is the most frequent type of genital prolapse.

Ref: Glenn’s Urologic Surgery, Page 326 ; Shaw’s Textbook of Gynaecology, 11th Edition, Page 358 ; A Comprehensive Textbook of Obstetrics and Gynecology By Sadhana Gupta, 2011, Page 63



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