••• Chapter 38^ Pelvic Organ Prolapse^379
❍ What is commonly associated with pelvic organ prolapse that is revealed after surgery?
Urinary incontinence.
❍ What is the CARE trial?
Colpopexy and Urinary Reduction Efforts study. This study randomized women to have abdominal sacral
colpopexy with and without incontinence surgery. Study showed that the group with the incontinence procedure,
a Burch colposuspension, had clinically significant lower rates of SUI postoperatively thus proposing the
performance of Burch procedure at time of abdominal sacrocolpopexy.
❍ What is the OPUS trial?
The OPUS trial looked at performance of slings at the time of sacral colpopexy procedures for incontinence and
did not come to clear conclusions except that urodynamics prior to sacral colpopexy procedure with prolapse
reduced may help triage patients requiring incontinence surgery concomitantly.
❍ What is a McCall’s Culdoplasty?
The attachment of the vaginal cuff to bilateral uterosacral ligaments at the level of the ischial spine. Usually
performed at time of vaginal hysterectomy to prevent post hysterectomy vaginal vault prolapse.
❍ Failure to recognize and repair what defect results in prolapse of the vaginal vault after hysterectomy?
Failure to suspend vaginal cuff with cardinal and uterosacral ligaments complex.
❍ The need to “splint” the vagina to defecate is indicative of what defect?
Rectocele or posterior compartment prolapse.
❍ The need to “splint” the vagina to fully void is indicative of what defect?
Cystocele or anterior compartment prolapse.
❍ Most women with a rectocele have a concomitant defect of what structure?
Perineal body.
❍ What surgical treatment is standard care of lone posterior compartment prolapse or rectocele?
Posterior colporraphy specifically midline plication has been shown to have the lowest recurrence rate after repair,
but site specific repair is also commonly performed.
❍ What is the drawback of anterior colporrhaphy for anterior compartment prolapse repair?
High rate of prolapse recurrence with anterior native tissue repair alone versus lower recurrence rate with posterior
compartment native tissue repair.
❍ Disorders of what sacral nerves may be responsible for uterine prolapse?
S1-S4.
❍ Inflatable, Gellhorn, Smith-Hodge, donut and ring are types of what device used in pelvic organ prolapse?
Pessaries.