Vault prolapse -Urogyn Module part2
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1) Vault prolapse can be prevented at the time of vaginal hysterectomy by:
A 49-year-old woman who has multiple uterine fibroids is booked for total abdominal hysterectomy with conservation of the ovaries. What is her risk of developing post-hysterectomy vault prolapse (PHVP)?
You see a frail 85-year-old woman in your gynaecology clinic. She is known to have vaginal vault prolapse following a vaginal hysterectomy 15 years ago. She has been using a shelf pessary for the management of her prolapse, but she is now keen to seek surgery. Which of the following is the most appropriate and least invasive procedurethatyouwillo erher?
An 84-year-old patient who had a previous history of vaginal hys- terectomy presents with a stage 3 vault prolapse. The patient has limited mobility and has previously had difficulty with the use of vaginal pessaries. What is the most appropriate treatment option?
You see a 58-year-old woman in your gynaecology clinic. She has had a vaginal hysterectomy 12 years ago for menorrhagia and now presents with a 6-month history of a lump coming down in the vagina. T e lump is uncomfortable during sexual intercourse. She does not have a signi cant medical history and denies urinary incontinence. On examination a vaginal vault prolapse is identi ed. She wishes de nitive surgical management, and you consent her for an abdominal sacrocolpopexy. Which of the following is a recognized complication?
A 50-year-old woman presents with a 3 month history of a vaginal lump. This has been affecting her day-to-day activities and also causes dyspareunia. She has no bladder or bowel symptoms. She had a total abdominal hysterectomy with ovarian preservation at the age of 42 for fibroids. She has no other significant past medical or surgical history. Her general and abdominal examination was unremarkable. Vaginal examination findings are shown below: What is the most appropriate treatment?
A 77-yr old healthy woman presents once again to her gynaecologist with symptoms suggestive of prolapse. She has struggled for many years with this problem, and indeed has undergone a number of surgeries, including vaginal hysterectomy, to treat prolapse in all 3 compartments. The problem has recurred and examination shows a recurrence of stage 2-3 prolapse. Pessaries have previously been poorly tolerated. She is not sexually active.
A 56-year-old para 4 woman presents with a vault prolapse. The patient is sexually active and urodynamic investigations fail to reveal urodynamic stress incontinence even after reduction of the prolapse. The patient is keen on having surgery. Which of the following operations should be offered?
A 48-yr old woman presents with something coming down for the past 6 months. She has previously had a vaginal hysterectomy for heavy periods. She is sexually active and denies any bladder or bowel symptoms. On examination she has stage 3 vault prolapse and stage 1 anterior prolapse.
A 60-yr old woman presents with something coming down and difficulty emptying her bowels. She has had a vaginal hysterectomy and posterior repair 5 years ago and was well for the first 2 years post-operation. She does not report any urinary symptoms. She is not sexually active. Examination reveals a stage 2 posterior wall prolapse, stage 1 vault descent, and a well-supported anterior vaginal wall
Colpocleisis is a safe and effective procedure that can be considered for frail women and/or women who do not wish to retain sexual function. What proportion of cases of colpocleisis that are performed would be considered successful?
A 55-year-old is about to undergo a vaginal hysterectomy. With regard to closure of the vault, what is the main difference between using the vertical and the horizontal approach?
A healthy, 58-yr old sexually active woman presents with a sensation of a bulge down below and difficulty sometimes initiating urinary voiding. On examination she has stage 2 anterior compartment prolapse. The vault is well supported, as is the posterior vaginalwall. She is having to spend increasing amounts of time caring for her invalid child and is keen on a definitive treatment as soon as possible.
What is the main difference between laparoscopic closure of the vaginal vault at hysterectomy and closure vaginally?
A 55-year-old woman is seen in the clinic complaining of feeling a lump in the vagina. She has a history of vaginal hysterectomy six years previously. On examination, she has a complete vaginal vault prolapse, stage 4 POPQ. Which of the following options would you recommend to her?
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