Vault prolapse -Urogyn Module part2

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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.

2) Vault prolapse can be prevented at the time of vaginal hysterectomy by:


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?


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?


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
What is the most appropriate treatment?


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?


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 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
The patient is keen on having surgery.
Which of the following operations should be offered?


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.


What is the main difference between laparoscopic closure of the vaginal vault at hysterectomy
and closure vaginally?


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 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


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?


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)?

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