••• Chapter 38^ Pelvic Organ Prolapse^381
❍ What complication of ovarian malignancy can cause a cystocele?
Ascites.
❍ Name a group of women more likely than Asian women to develop prolapse?
Caucasian.
❍ The anterior separation between the levator ani is known by what term?
Levator hiatus.
❍ McCall sutures have what purpose?
Posterior cul-de-sac obliteration to prevent enterocele formation.
❍ If the uterosacral-cardinal ligament complex is too attenuated to use for vaginal suspension, what other
structures can be used?
Higher uterosacral ligament bite or sacrospinous ligaments.
❍ During repair of the perineal body constriction of the posterior fourchette may result in what patient
complaint?
Dyspareunia.
❍ What should be the basic principle in the management of pelvic organ prolapse?
Individualization.
❍ As pelvic organ prolapse is thought to be in many instances a result of vaginal delivery, it is best to defer
surgical treatment until when?
Childbearing is complete.
❍ Name three problems apart from infection and hemorrhage that may be the result of ventral suspension of
the vagina.
Urethral or ureteral kinking and enterocele development.
❍ Name two approaches to paravaginal repair.
Abdominal (open or laparoscopy) and vaginal.
❍ What is the gold standard procedure for stress urinary incontinence?
Tension free suburethral vaginal sling placed at the midurethra, either retropubic or transobturator.
❍ What vaginal complication results from excessive trimming of vaginal mucosa in an anterior colporrhaphy?
Vaginal shortening or stenosis.
❍ Anterior colporrhaphy is indicated for correction of a cystocele caused by what type of vaginal wall defect?
Anterior midline.