Uterine Prolapse

Last updated 20.09.12

 

Definition

-  Prolapse of uterus into vagina

 

Features

-  Weakening & stretching of the supporting cardinal & uterosacral ligament complex

-  Decent of uterus into vagina

 

Uterine Prolapse

 

Procidentia

 

 

Stages

-  1 – Descent above the level of the hymen

-  2 – Descent up to the hymen

-  3 – Descent past the hymen

-  4 – Total eversion = procidentia

-  Uterine cavity is not exposed

 

Associated S/S

-  Sense of mass/lump in vagina

-  Urinary obstruction

-  Ulceration of vaginal walls

 

Ix

-  VE

-  POP-Q assessment

-  Speculum exam

-  Cystocoele, rectocoele, enterocoele, procidentia

-  Ulceration

 

Mx

-  Conservative

-  Lifestyle

-  Pelvic floor exercises: Kaegels

-  Vaginal Pessary

-  Topical Oestrogen Replacement

-  Surgical

-  Vaginal approaches unless recurrent or severe

-  10% failure rate, 25% relapse

-  Sacrospinous Fixation

-  25-100% incidence of cystoceole from altered vaginal axis

-  Stress incontinence from bladder neck traction

-  Pudendal neurovascular or sciatic n injury

-  Colposacropexy

-  Mesh fixation

-  Used for recurrent vault prolapse

-  Vaginal hysterectomy w vault suspension

-  Abdominal hysterectomy w vault suspension

 

 

 

References