Gynecology Book

http://www.fpnotebook.com/

Uterine Prolapse

Aka: Uterine Prolapse, Genital Prolapse, Uterine Descensus, Pelvic Organ Prolapse, Cystocele, Uterocele, Rectocele
  1. Definition
    1. Pelvic organs (Bladder, Uterus, vagina) protrudes out of vaginal canal
    2. Pelvic Organ Prolapse replaces older terms (Cystocele, Uterocele, Rectocele)
      1. Reflects uncertainty on examination of which organs are actually prolapsing
  2. Pathophysiology
    1. Levator ani muscle
      1. Normally supports the vagina from prolapse in the face of increased intraabdominal pressure
      2. When levator ani loses tone, allows pelvic organs to prolapse
    2. Other factors
      1. Connective tissue weakening
      2. Pudendal nerve injury from child birth
  3. Grading: Braden-Walker System
    1. Evaluate when patient performing valsalva or straining
    2. Grade 0: No prolapse
    3. Grade 1: Descent halfway to hymen
    4. Grade 2: Descent to the hymen
    5. Grade 3: Descent halfway passed the hymen
    6. Grade 4: Maximal possible descent
  4. Grading: Older system
    1. First-degree: On pressing on perineum, Cervix visible
    2. Second-degree: Cervix protrudes via vaginal introitus
    3. Third-degree: Entire Uterus is external to introitus
  5. Symptoms
    1. Peristent pelvic pressure provoked by straining
    2. Patient notes protruding tissue from introitus
    3. Spotting or bleeding per vagina
  6. Signs
    1. Uterine Prolapse on provocative maneuvers
      1. Valsalva
      2. Standing
  7. Risk Factors
    1. Decreased support of pelvic organs
      1. Multiparous women
        1. Vaginal deliveries
        2. Prolonged labor, instrumented delivery, episiotomy
      2. Advanced age (esp. Menopause)
      3. Prior hysterecyomy
    2. Increased intraabdominal pressures
      1. Overweight
      2. Constipation
      3. Heavy lifting
      4. Ascites
    3. Nerve disorders (especially affecting pudendal nerve)
      1. Spina Bifida Occulta
  8. Managment
    1. General Measures
      1. Treat Constipation
      2. Weight loss in Obesity
    2. Mechanical Support
      1. Kegal Exercises
      2. Pessary
    3. Medications
      1. Consider Estrogen Replacement Therapy
    4. Surgery
      1. Hysterectomy
      2. Trasvaginal sacrospinous fixation
      3. Colpocleisis
        1. Obliterative surgery for high risk patients with multiple comorbidity
  9. References
    1. Kuncharapu (2011) Am Fam Physician 81(9): 1111-7
    2. (2007) Obstet Gynecol 110(3): 717-29

Prolapse of female genital organs (C0156349)

Concepts Disease or Syndrome (T047)
ICD9 618
SnomedCT 155995009, 155989008, 198283007, 73998008
English Genital prolapse, NOS, PROLAPSE OF THE FEMALE GENITAL ORGANS, Prolapse of female genital organs, NOS, Genital prolapse NOS, genital prolapse, genital prolapse (diagnosis), 7-73 PROLAPSE OF THE FEMALE GENITAL ORGANS, Genital prolapse NOS (disorder), Genital prolapse (disorder), prolapse genital, Genital prolapse, Prolapse of female genital organs (disorder), genital; prolapse, prolapse; genital, Prolapse of female genital organs
Italian Prolasso genitale, Prolasso genitale NAS
Dutch geslachtsorgaanprolaps NAO, genitaal; prolaps, prolaps; genitaal, genitale prolaps
French Prolapsus génital SAI, Prolapsus génital
German Prolaps der Geschlechtsorgane NNB, Prolaps der Geschlechtsorgane
Portuguese Prolapso genital NE, Prolapso genital
Spanish Prolapso genital NEOM, Genital prolapse, Genital prolapse NOS, prolapso de los órganos genitales femeninos (trastorno), prolapso de los órganos genitales femeninos, prolapso genital, SAI (trastorno), prolapso genital, SAI, prolapso genital, Prolapso genital
Japanese 性器脱, 性器脱ＮＯＳ, ｾｲｷﾀﾞﾂ, ｾｲｷﾀﾞﾂNOS
Czech Prolaps pohlavních orgánů NOS, Prolaps pohlavních orgánů
Hungarian Genitalis prolapsus k.m.n., Genitalis prolapsus
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Navigation Tree