2025 Urogynecology for the Advanced Practice Provider-Prolapse

Video Transcription

Video Summary

The presentation focused on pelvic organ prolapse, a common condition in women characterized by the descent of the vaginal walls, uterus, or vaginal apex. The speaker emphasized understanding prolapse as essentially a hernia where organs fall through the vagina. Approximately 40% of women exhibit prolapse on examination, with only 3% experiencing symptoms. The typical presentation age is around 60 years, with 11% requiring surgery. Key risk factors include age, parity, obesity, previous hysterectomy, genetic predispositions, and connective tissue disorders.<br /><br />Understanding prolapse involves two primary theories: loss of vaginal support and levator muscles injury. The speaker detailed the three levels of vaginal support and how childbirth and other factors can cause injuries leading to prolapse. Different types of prolapse were described, including anterior and posterior vaginal wall prolapse, uterine prolapse, vaginal vault prolapse, and enterocele.<br /><br />Assessment involves history, validated symptom measures, and the pelvic organ prolapse quantification (POPQ) system. Treatment options range from observation, physical therapy, pessaries, to surgery depending on prolapse stage and symptoms. The presentation addressed considerations such as uterine sparing, genital hiatus size, vaginal length post-hysterectomy, and concomitant stress incontinence.

Asset Subtitle

At the end of this session, the learner should be able to:

Identify the changes in pelvic anatomy and support that lead to female pelvic organ prolapse
List the key components of the physical examination for POP
Understand how exam findings correlate with presenting symptoms
Examine how exam findings and patient priorities may influence treatment options

Speaker - Charelle Carter-Brooks, M.D., M.Sc.

Keywords

pelvic organ prolapse

vaginal support

levator muscles injury

prolapse treatment

risk factors

POPQ system

surgery