UROGYNAECOLOGY



Uterovaginal Prolapse

Abnormal descent of the uterus and vagina.

Classification



Cystocele- prolapse of the anterior vaginal wall
Rectocele- prolapse of the posterior vaginal wall
Enterocele- prolapse of the vaginal vault

Epidemiology


Affects 11% women

Risk Factors

Parity and Age
Hysterectomy increases chance of enterocele

Signs and Symptoms


mild/mod/severe

Staging


Grade 1: uterine prolapse as descent of the cervix at rest to above the level of the introitus
Grade 2: descent to the introitus
Grade 3: descent beyond the introitus


Treatment


Surgical/pessaries (foreign body)
  • Ring
  • Synthetic mesh
  • Revision cystocele surgery

Treat UTI with trimethoprim





Incontinence

Classifications



Stress incontinence
Urge incontinence
Mixed incontinence
Neuropathic incotinence- DM, spinal injury

Hx, Ex (cough), Ix urodynamics

Management




PFE pelvic floor exercises
Surgery- conservative (mesh) or reconstructive