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Practice exam 3: Answers
Published in Euan Kevelighan, Jeremy Gasson, Makiya Ashraf, Get Through MRCOG Part 2: Short Answer Questions, 2020
Euan Kevelighan, Jeremy Gasson, Makiya Ashraf
An examination should be performed using standard quantifying tools, such as the Pelvic Organ Prolapse Quantification (POPQ). The presence of anterior and posterior defects should be noted, as these may need to be dealt with at the same time as any vault surgery (2).
Incontinence Pessaries
Published in Teresa Tam, Matthew F. Davies, Vaginal Pessaries, 2019
Pessaries used for the treatment of incontinence are most commonly support pessaries. They are thought to restore continence by stabilizing the proximal urethra and urethrovesical junction. Incontinence pessaries act as a backstop for the urethra during times of increased abdominal pressure. According to the most recent Cooper Surgical, Inc. (Trumball, Connecticut) pessary guide, there are approximately 11 different incontinence pessaries available, ranging in size from 1¾ to 5 inches, depending on the pessary (Table 3.1).6 Each style of incontinence pessary is designed to serve specific functions and patient needs. This allows the treatment of multiple pelvic floor disorders concomitantly in women with variations in pelvic anatomy. For example, incontinence dishes and rings are most commonly used in the straightforward patient with SUI only (Figure 3.1). If the patient also has pelvic organ prolapse quantification (POPQ) stage 1 anterior vaginal wall prolapse, an incontinence dish with support may be more appropriate (Figure 3.2). The patient with a narrow vaginal introitus may be most comfortable with a Hodge pessary with or without support or a knob, while the presence of a POPQ stage 1 posterior wall prolapse may prove the Gehrung pessary with knob to be the most effective (Figure 3.3).
Urogenital prolapse
Published in David M. Luesley, Mark D. Kilby, Obstetrics & Gynaecology, 2016
Sushma Srikrishna, Dudley Robinson
Recently, the International Continence Society produced a standardisation document in order to assess urogenital prolapse more objectively.2 The ICS Prolapse Scoring System (POPQ) allows the measurement of fixed points on the anterior and posterior vaginal walls, cervix and perineal body against a fixed reference point, the genital hiatus (Fig. 98.1). Measurements are performed in the left lateral position at rest and at maximal valsalva, thus providing an accurate and reproducible method of quantifying urogenital prolapse.
Ultralight type I transvaginal mesh: an alternative for recurrent severe posterior vaginal prolapse
Published in Climacteric, 2022
W. Tian, Y. Dai, P. Feng, Y. Ye, Q. Gao, J. Guo, Z. Zhang, Q. Yu, J. Chen, L. Zhu
The primary outcome was the composite surgical success rate at the last follow-up. Composite success was defined as including all of the following: symptomatic success (no vaginal bulge symptoms as indicated by a score of 0 for Question 3 of the PFDI-20: ‘Do you usually have something falling out that you can feel or see in your vaginal area?’); anatomic success (no POP-Q point at or beyond the hymen); and no re-treatment (pessary or surgery) for POP. The secondary outcomes included anatomic outcome (POP-Q score), symptomatic relief (including improvement in bowel and urinary symptoms, assessed using validated instruments) and complications. Recurrence was defined as a POP-Q point at or beyond the hymen accompanied by bulge symptoms. Patients’ satisfaction was defined as ‘very much better’ or ‘much better’ based on PGI-I scores.
Laparoscopic sacrocolpopexy versus pelvic organ prolapse suspension for surgical management of pelvic organ prolapse: a retrospective study
Published in Journal of Obstetrics and Gynaecology, 2022
Valeria Tagliaferri, Chiara Taccaliti, Federico Romano, Marco D’Asta, Bruno Martulli, Cosimo Gentile, Francesco Legge, Stefania Ruggieri, Maurizio Guido
Data are reported as mean ± standard deviation or percentage for categorical variables. To compare continuous data, we used the Student's t-test or the Mann-Whitney U test. Associations between categorical variables were evaluated by using Chi-squared test or Fisher test as appropriate. Longitudinal changes were compared with analysis of variance ANOVA for repeated measurements with the aim of assessing an effect between treatments during follow-up and whether an interaction exists (difference among groups at specific time point). Mean values were displayed with 95% confidence interval. A p value of .05 or less was considered statistically significant. All analyses were conducted using STATA software, version 16 (Stata-Corp LP, College Station, TX, USA). Prolapse stage evaluation with POP-Q is presented as median and range.
Ten-year surgical complications and mesh erosion of transvaginal Elevate™ mesh for management of pelvic organ prolapse
Published in Journal of Obstetrics and Gynaecology, 2022
Wong Daniel, To Valerie, Lam Alan
Placement of the meshes and other concomitant procedures were performed by the senior gynaecological surgeon (Alan Lam). If there are concomitant procedures, the sequence of operation would be hysterectomy first, followed by mesh placement, then native tissue repair and finally mid-urethral tape if needed. Prophylactic intravenous antibiotic was administered at the induction of anaesthesia. Operative time, intra-operative blood loss, peri-operative complications as well as postoperative adverse events were recorded. A course of post-operative oral antibiotic was prescribed. All patients underwent the same study protocol and had the same postoperative assessment on mesh complications according to a standardised datasheet. Postoperative follow-up by the same gynaecological surgeon was scheduled at 6 weeks, 1 year and annually up to 5 years, or any adhoc time for unexpected concerns. Each follow-up visit evaluation included reassessment of prolapsed related symptoms, and symptoms of mesh exposure, filling in Prolapse Quality of Life (P-QOL) questionnaire (Digesu et al. 2005). POP-Q assessment and vaginal examination was performed to determine whether there was recurrence of pelvic organ prolapse or mesh-related complications as recommended by International Continence Society (ICS) and the International Urogynecological Association (IUGA) (Haylen et al. 2011; Toozs-Hobson et al. 2012).