384 Obstetrics and Gynecology Board Review •••
❍ What are some of the factors physicians should discuss with patient when deciding surgical versus medical
therapy?
Desire to have intercourse
Durability
Recovery time
Type of complications rate
Surgical candidacy?
Foreign body risks
❍ In a patient with apical defect, is there a benefit of vaginal sacrospinous l suspension versus abdominal
sacrocolpopexy?
There are no clear studies. Recently various small randomized trials have been done, showing similar patient
satisfaction at a distant follow-up care, although, objective findings of anatomical prolapse outcome are more
superior with the abdominal approach. Each patient must be evaluated individually and have a full disclosed
discussion of all possible treatment regiment and true long-term success rates.
❍ What is the success rate of sacrospinous ligament suspension?
63 to 97%.
❍ What are the complications of sacrospinous ligament suspension?
Pudendal hemorrhage, bowel/bladder injury, and possible entrapment of the sciatic nerve causing sever pain in the
posterior leg/gluteal area (upon diagnosis needs to remove stitches immediately).
❍ What are the possible treatments in hemorrhage from middle sacral artery/venous plexus during sacral
colpopexy?
Sterile thumbtacks, ligation (if vessel is visualized,) bone wax, various thrombogenic materials (Gelfoam,
FLOSEAL, Surgicel, thrombin, and Arista), and finally abdominal packing with VAC closure and reexploration
in 48 hours.
❍ Is fecal incontinence a symptom of posterior wall prolapse?
No.
❍ Which pessary is specifically designed to correct rectoceles?
Gehrung pessary.
❍ What are possible complications of pessary use?
Urinary retention, vaginal irritation, new onset urinary incontinence, vaginal ulceration, recurrent UTIs, and
abnormal d/c (foreign body reaction).
❍ What can local vaginal estrogen be used for?
Prevention of ulcers and discomfort with pessary use, increase lubrication for sexual intercourse, treating vaginal
dryness, and preventing recurrent UTIs in postmenopausal patients.