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vaginal prolapse

Etiology: - rectocele - cystocele - enterocele - uterine prolapse Pathology: - child-bearing & other causes of increased intra-abdominal pressure weaken muscles & connective tissue supporting the perineum Clinical manifestations: - the uterus, rectum, bladder, urethra, small bowel, & vagina may begin to prolapse through the vaginal orifice - symptoms may be present even with mild prolapse - pelvic pressure - back pain - urinary incontinence - fecal incontinence Management: - if asymptomatic, not treatment is necessary - the degree of prolapse & organs involved determine therapy - mild cases - topical estrogen may be of benefit - pelvic muscle exercises may be of benefit - symptomatic prolapse - pessary - transvaginal colpopexy - perioperative behavioral therapy with pelvic floor muscle training (Kegel exercises) of little value [5] - retropubic midurethral sling [4] - sacrospinous ligament fixation (SSLF) - uterosacral ligament suspension (ULS) - equivalent outcomes for SSLF vs ULS [5]

General

vaginal disorder

References

  1. Lazarou G emedicinehealth: Vaginal Prolapse http://www.emedicinehealth.com/vaginal_prolapse/article_em.htm
  2. WebMD: Women's Health: Vaginal Prolapse http://women.webmd.com/vaginal-prolapse
  3. Geriatrics at your Fingertips, 13th edition, 2011 Reuben DB et al (eds) American Geriatric Society
  4. Wei JT et al A Midurethral Sling to Reduce Incontinence after Vaginal Prolapse Repair N Engl J Med 2012; 366:2358-2367June 21, 2012 PMID: 22716974 http://www.nejm.org/doi/full/10.1056/NEJMoa1111967 - Iglesia CB Vaginal Prolapse Repair - Place Midurethral Sling Now or Later? N Engl J Med 2012; 366:2422-2424June 21, 2012 PMID: 22716981 http://www.nejm.org/doi/full/10.1056/NEJMe1204042 - FDA News Release: July 13, 2011 Surgical placement of mesh to repair pelvic organ prolapse poses risks [press release]. Rockville, MD: Food and Drug Administration (FDA). July 13 , 2011. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm262752.htm
  5. Barber MD et al Comparison of 2 Transvaginal Surgical Approaches and Perioperative Behavioral Therapy for Apical Vaginal Prolapse. The OPTIMAL Randomized Trial. JAMA. 2014;311(10):1023-1034 PMID: 24618964 https://jama.jamanetwork.com/article.aspx?articleid=1840237