••• Chapter 38^ Pelvic Organ Prolapse^383
❍ What is the specific defect seen in enterocele?
Disruption of cervical ring between pubocervical fascia and rectovaginal fascia.
❍ What other condition beside prolapse of pelvic organ should be evaluated before corrective surgery?
Urinary incontinence.
❍ What is Occult Stress Urinary Incontinence?
Stress urinary incontinence revealed with reduction of prolapse during urodynamic testing, usually performed prior
to surgical correction of prolapse.
❍ What material makes up these commonly used permanent sutures in pelvic organ prolapse surgery; Prolene,
Ethibond and Gore-tex?
Polypropylene, polyester and expanded polytetrafluoroethylene (PTFE), respectively.
❍ What is the best position for examination?
Supine position with heels in stirrups with full Valsalva. Standing position with straining can be attempted as well.
In women with pessaries, remove pessary first. Following a standard examination, always perform a single blade
examination, which allows site-specific evaluation.
For enterocele detection the best position is a standing position with one leg elevated while performing a
rectovaginal examination.
❍ Does estrogen have a role in treatment or prevention of prolapse?
No.
❍ What are the considerations in selecting synthetic meshes?
Pore size and subsequent rates if infection, vaginal versus abdominal approach, and degree of mesh erosion and
presence of chemical coating and subsequent failure rates.
❍ What type of mesh have studies found to be more effective for the treatment of apical prolapse at time of
abdominal sacrocolpopexy; allograft, autograft, xenograft or synthetic?
Synthetic mesh in the form of polypropylene has been shown to be the most durable.
❍ What is the most common sit of prolapse?
Anterior vaginal wall prolapse (40% of evaluated prolapse).
❍ Is there a relationship between prolapse and incontinence?
Not direct relationships, but it is found that up to 40% of patients with prolapse will develop incontinence. Upon
evaluation in office, always reduce prolapse and evaluate for different types of incontinence (beneficial for patient
to consider two procedures at the same time.)