VAGINAL PROLAPSE

By
Dr Mutevhe
• Mrs ML
• 49 F
• Married
• Kuwadzana
• P 6+o
• C/O Lump in the vagina x 6/12
• Difficulties in completely emptying the bladder
x4/12
• A previously well patient who started feeling a
lump like in the vagina which was made worse by
coughing and straining.
• Lump descends to the introitus when passing urine
or stool
• Painless but feels some discomfort which
disappears on lying down.
• No problems in sexual intercourse but just feels
some discomfort.
• 2/12 later then started noticing that even after
micturation, she had some urine in the bladder and
feels completely empty after pressing the lump.
• This was accompanied by frequency but no
urgency and dysuria.
• No urinary incontinence.
• No history of chronic cough or consipation
• Had no problems in passing stool
• No backache
• No haematuria
• Once treated for the increased frequency
with antibiotics but with no improvement
(pvt GP)
• Had given birth to 6 children the largest she
remembers was 3.8 kg
 GUS
• No pv discharge
• No pv bleeding
• No pelvic pain
• No dysmenorrhea
• No menorrhagia
 GIT
• No bowel habit changes
 RS
• No chronic cough
• No chest pains /SOB
 CVS & CNS
• Nil
 GYNAE HX
• Menarche 14
• 4-5/30
• No dysmenorrhea
• No menorrhagia
• Never treated for STIs
• Never offered pap smear
• No HIV test
 OBS Hx
• 1980 NVD Female mass? epsiotomy
• 1982 NVD Female mass?
• 1985 NVD Female 3,6kg
• 1987 NVD Male 3,8kg epsiotony done.
• 1990 NVD Female 3,7kg
• 1994 NVD Male 3,8kg
• All deliveries no use of forceps or vacuum
• No problems in passing urine after delivery
• No Pueperal complications
 MEDICAL Hx
• No asthma
• No TB
• HPT on HCT 50mg OD and Nefidepine
20mg BD. Diagnosis in 2000.
 SURGICAL Hx
• Once treated for forearm fracture when she
was young.
 DRUG Hx
• No known allergies
• Taking antihypertensive drugs
 FAMILY Hx
• Married housewife stays with husband
• Catholic
• Sober habits (all)
• Husband works as a petrol attendant
 SUMMMARY
– 49 F P6 who feels a lump in the vagina which
descends to the intoitus on straining and has
difficulties in completely emptying her bladder
and increased urinary frequency for 6/12
 O/E
WT 84 kg
• Stable
• Pink
• Apyrexial
• No LN
 CVS
• P 80 BP 140/100
• HS 1- 2- no murmurs
• No cardiomegally
 CHEST
• Clear
 Abd

• Soft nontender
• No organomegally
• No masses
• No suprapubic tenderness
• No renal angle tenderness
 VE
• Normal vulva
• No stress incontinence on coughing / straining
• A bulge in the anteria vaginal wall starting at the
urethrovesical junction upwards = 5cm in diameter
reaching the hymenal ring
• Normal cervix in normal position
• Normal sized uterus
• No Adnexial masses or tenderness
• No PV discharge or blood Pv glove
 Dx
• cystocele
 PLAN
• Pap smear
• Urine MCS
• Nalidixic acid 500g qid
• FBC UXE
• ECG CXR
• Anterior repair
 CYTOCELE
• Occurs when bladder descends centrally through
pubocervical fascia
• Descend can carry the urethrovesical junction and lower
end of the ureter with it.
• This can result in ureteric obstruction or damage
especially during surgery
• A urethrocele occurs due to loss of support by
pubocervical ligament
• + posterior pubouretheral ligaments (Important in
supporting the urethrovesical junction and maintaining
incontinence)
 AETIOLOGY OF VAGINAL
PROLAPSE
• Congenital -Collagen -Race -Anatomy
• Child birth -trauma -denevation
• Raised intraabdominal Pressure -COAD -
smoking -staining and consipation
• Diet -Vit C-Corticosteroids
•
• Menopause -oestrogen deficiency
• Iatrogenic -pelvic surgery esp
sacrospinous fixation or
colposuspension
 PRESENTATION
• Dragging discomfort
• Lump in the vagina
• Stress incontinence
• Voiding diffi0culties
• Urinary frequency
• UT1
• urgency
 DDx
• Gartner’s cyst
• Urethral diverticulum
• Inclusion demoid cyst
 Ix
• Urine m/c/s
• Urodynamic studies
• Fluroscopy
• MR1
 TREATMENT
Medical
• Pessaries
1. During and after pregnancy
2. Still to complete family
3. Medically unfit
4. Relief of symptoms while surgery

• Complications – vaginal ulceration

- incarceration leading to vaginal
discharge and bleeding
 Surgical

• Aims -correct the prolapse

-maintain continence
-preserve coital function
 SURGICAL CT
• Anterior colporrhapy corrects cystocele and
cystourethrocele and stress incontinence less
frequently used for stress incontinence because of
low success rate compared to the urethrovesical
suspension procedure.
• Complications -post operative urinary retension.
-incontinence in someone who was dry.
• Burch colposuspension in correcting cytocele
accompanied by stress incontinence.