378 Obstetrics and Gynecology Board Review •••
❍ True or False: Pain is a common symptom of pelvic organ prolapse?
False, pain should alert a further workup for cause. Extremely rarely, severe prolapse can become incarcerated,
causing pain.
❍ Name four medical conditions that make worsen or lead to pelvic organ prolapse?
Smoking, chronic cough, obesity and chronic constipation.
❍ Name two urological findings that are contraindications to expectant management of uterine prolapse.
Hydroureter and hydronephrosis.
❍ What is the most successful procedure for high-grade prolapse in postmenopausal women who are not
sexually active?
Colpocleisis.
❍ What is a colpocleisis procedure or colpectomy?
Skinning of the vaginal wall and suturing the vaginal wall mucosa together.
❍ What is a partial colpocleisis or Le Fort procedure?
This an obliterative prolapse surgery done on candidates for colpectomy who still have their uterus and cervix,
where two canals are left at either side of the closed vagina to allow discharge to pass through.
❍ What is the gold standard reconstructive surgical procedure for high-grade apical pelvic organ prolapse?
Transabdominal sacral colpopexy.
❍ What type of mesh is commonly used in sacral colpopexy?
Type I macroporous mesh, synthetic.
❍ What is a sacral colpopexy?
Transabdominal placement of Y-shaped mesh from longitudinal sacral ligament to anterior and posterior
vaginal wall.
❍ What are the risks of abdominal sacral colpopexy?
Mesh exposure, mesh erosion, bowel perforation, bleeding/injury to presacral plexus, and rarely osteomyelitis.
❍ The standard Le Fort procedure or colpectomy is contraindicated in the postmenopausal patient with a
desire to preserve what function?
Coital function.
❍ What did the January 2012 FDA statement of vaginal mesh warn consumers about?
The FDA statement addressed the use of vaginal for reconstruction as being associated with safety risks and
being of unknown efficacy. It did not include the use of mesh transabdominally for sacrocolpopexy or the use of
transvaginal mesh as sling for urinary incontinence procedures.