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PROLAPSE . . . CONT.

Treatment conservative v a g i n a l p e s s a r y e s t r o g e n t h e r a p y s u r g i c a l v a g i n a l v a u l t s u s p e n s i o n ( c a n b e v e r y c o m p l i c a t e d )

CYSTOCELE

prolapse of bladder into the upper anterior vaginal wall

Symptoms frequency, urgency, nocturia stress incontinence incomplete emptying bladder increased incidence of UTIs

Treatment conservative

surgicavlaginal pessary, Kegels exercises • anterior colporrhaphy (“anterior repair”) plication of pubocervical fascia to support bladder and urethra

RECTOCELE

prolapse of large bowel in lower posterior vaginal wall

Symptoms constipation • constant straining may increase rectocele

Treatment conservative

  • laxatives and stool softeners

v a g i n a l p e s s a r y u s u a l l y n o t h e l p f u l s u r g i c a l p o s t e r i o r c o l p o r r h a p h y ( p o s t e r i o r r e p a i r ) p l i c a t i o n o f e n d o p e l v i c f a s c s i a a n d p e r i n e a l m u s c l e s a p p r o x i m a t e d i n m i d l i n e t o s u p p o r t r e c t u m / p e r i n e u m

ENTEROCELE

prolapse of small bowel in upper posterior vaginal wall usually associated with rectocele

Figure 6. Organ Prolapse

Printed with permission from Obstetrics and Gynecology. 2nd ed. Beckman, Charles et al. (eds.) Williams and Wilkins, 1995

MCCQE 2000 Review Notes and Lecture Series

Notes

Gynecology 33

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