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Examination B
Published in Aalia Khan, Ramsey Jabbour, Almas Rehman, The New DRCOG Examination, 2017
Aalia Khan, Ramsey Jabbour, Almas Rehman
A prolapse of the posterior vaginal wall is a rectocele and a cystocele is a prolapse of the anterior vaginal wall and bladder. Prolapse of the urethra is known as a urethrocele. A first degree prolapse is one in which there is cervical descent, but it does not reach the introitus. A third degree prolapse is one in which the cervix and uterine body lies outside of the introitus (procidentia). Enteroceles may present with bowel obstruction, but this is rare and is caused by incarceration. A ring pessary needs to be inserted to occupy the posterior fornix and the lower part of anterior vaginal wall. It should be changed at least every six months. If it is incorrectly fitted it can cause a great deal of discomfort and erosions. A ring pessary is effective for anterior vaginal and uterovaginal prolapses. HRT, in any form, will only help with some of the symptoms associated with a prolapse (e.g. vaginal dryness/irritation). It is not a widely-used treatment option as surgery is the mainstay.
Urogenital prolapse
Published in David M. Luesley, Mark D. Kilby, Obstetrics & Gynaecology, 2016
Sushma Srikrishna, Dudley Robinson
Urogenital prolapse is classified anatomically depending on the site of the defect and the pelvic viscera that are involved. Urethrocele: prolapse of the lower anterior vaginal wall involving the urethra only.Cystocele: prolapse of the upper anterior vaginal wall involving the bladder. Generally, there is also associated prolapse of the urethra and hence the term cystourethrocele is used.Uterovaginal prolapse: this term is used to describe prolapse of the uterus, cervix and upper vagina.Enterocele: prolapse of the upper posterior wall of the vagina, usually containing loops of small bowel. A traction enterocele is secondary to uterovaginal prolapse, a pulsion enterocele is secondary to chronically raised intraabdominal pressure, and an iatrogenic enterocele is caused by previous pelvic surgery. An anterior enterocele may be used to describe prolapse of the upper anterior vaginal wall following hysterectomy.Rectocele: prolapse of the lower posterior wall of the vagina involving the anterior wall of the rectum.
History and Clinical Investigations: Patient Complaints in Perspective
Published in Victor Gomel, Bruno van Herendael, Female Genital Prolapse and Urinary Incontinence, 2007
The relaxation of the anterior wall results in an urethrocele (urethra and bladder neck) and a cystocele. While an urethrocele results in stress incontinence, a cystocele without descent of the bladder neck causes obstructed micturition.
The Skene’s gland cyst that was not: an atypical presentation of a leiomyoma
Published in Journal of Obstetrics and Gynaecology, 2020
Erich T. Wyckoff Facog, Girard M. Cua, Leora Lieberman, Ashwin S. Akki
While Skene’s glands rarely cause pathology, mechanical obstruction or trauma can cause cysts or abscesses to occur in about 1/2000–1/7000 women (Kruger et al. 2016). An enlarged, inflamed mass can cause dysuria, voiding dysfunction, dyspareunia and positional discomfort (Reis et al. 2011). Diagnosis is primarily made through history and a physical exam, with a transvaginal ultrasound (TVUS) or magnetic resonance imaging (MRI) aiding pre-operative and surgical planning (Lucioni et al. 2007). MRI is the imaging modality of choice (Shah et al. 2012). Tissue sampling serves to confirm the diagnosis post-operatively. However, clinicians must still consider a complete differential diagnosis for an anterior vaginal mass, such as: Skene’s gland cyst or abscess, urethrocele, urethral diverticulum, Gardner’s Cyst, epidermoid cyst, endometrial cyst, and urethral or paraurethral tumours (Dwyer 2012). A literature search was performed of Leiomyomas arising from the Skene’s gland and yielded no prior reports. The literature search was remarkable, however, for periurethral Leiomyomas arising from the urethra. These are also rare (1/1000 women) and present most frequently on the proximal urethra (Fridman et al. 2018). In our patient, the MRI showed no communication of the mass with the urethra, making the possibility of a Leiomyoma of urethral origin to be less likely.
A peri-urethral mass – what are the possible diagnoses?
Published in Journal of Obstetrics and Gynaecology, 2018
A 67-year-old lady presented to a general gynaecology clinic in March 2015 after noticing a vaginal lump over a few months. The patient had no pain or bleeding. Her only gynaecological symptom of note was stress incontinence. All smears had been up-to-date and normal. Her medical history included hypothyroidism and hypertension, and the patient had undergone an ovarian cystectomy in the 1970s. On examination, a 2 cm fluctuant area was noted in the lower part of the vagina, 2 cm from the urethral meatus. The differential diagnosis at this point included a vaginal cyst or urethrocele, and after a discussion with a consultant urogynaecologist, a MRI was advised.