Translate Lydia Grade Iii Uterine Prolapse 2k262t

Grade III Uterine prolapse, grade III cystocele, grade II rectocele → Conservative/operative 1. Good morning, I'm dr. xxx, I’m doctor on duty, i want to ask you something and i will do some examination before I know the conclusions from your complaints and the plan that will be done. 2. Taking History: a. b. c. d.

How long the complaints occur ? 8 months Are the lumps feels out when you do some activities? Stand up? defecate? Are the lumps reduced when you lying/rest? Are you still having sex with your husband? Yes, but rarely, maybe once a

1 week e. Are you already menopause? How long you do not menstruation? > 5 Years f. Obstetrics History i. How many children do you have? 5 ii. If you had a miscarriage? 1 iii. Are all your children was born with spontaneous/normal? Yes iv. How the most your children birth weight? 3900 grams g. Present Status i. Height/weight ? 150/67, BMI : 29.71 ii. BP/Pulse/RR/ Tax: DBN h. General Status: In a normal limits KIE: get into the examination table please. I will do the examination in lithotomy position, the felt may uncomfortable fro you because I will do the vaginal toucher examination, just relax so that doesn’t hurt and do not straining. i. Gynecology Status

o How the Abdomen? How much the height of fundus? Are you can palpable the mass? (-) o Inspection of the vulva/vagina: found the cervical mass outside the vagina, the surface was smooth, portion, no erosion, no mass, the vagina was smooth. o Speculum examination of the vulva/vagina: found the cervical mergeal → atrophy Walls of vagina is pale o VT: corpus uteri < normal Adnexal mass (-) Tenderness (-) Uterine Sondage test? 5cm, ante flexion KIE: Ok, try coughing please. Cough test? (-) Now you can straining please. cystocele uterus rectocele TVL → cut off point TVL → -2 Tonus levator ani (Oxford scale)? 2 Ok, from the examination, I found that you have grade III uterine prolaps 

Grade III uterine prolapse, grade III cystocele, rectokel grade cIII o Overweight

There are 2 options therapy that can be done :

 Conservative → using pessaries  Operative → TVH + SSF + KA + colpoperineorrhaphy Non TVH  Sacrospinosus hysteropexy + KA + colpoperineorrhaphy The complaint you should ask 1. Anterior Compartment: urinary incontinence, retention Are you difficult to delay the urinate? Do you can complete the urinate? Are you feel the pain when urinate? 2. Apical Compartments: Uterine / Peak Vagina 3. Posterior Compartment: retention 4. Impairment of sexual function But, from our consideration 1. 2. 3. 4.

You have enough children Your age was 60 years old & Already menopause There are hormonal changes due to menopause Still have sex with your husband (sexual functions)

Compared to using pessaries (ring), with several complications like: o o o o

You should to visit every 3 months Having less comfortable sex vaginal discharge may occur Risk factor for vaginal abrasion

I suggest you to undergo surgery : TVH + SSF + KA + colpoperineorrhaphy → Yes doc Oke, I should preparing you for the surgery, because you are > 50 years old. I will preparing you for:

 Laboratory tests: complete blood count, ECG  Preparation of Patients: o Consult to anesthetist o Consult to Internist o Consult to Cardiologist  Prepare the operations schedule KIE post-op 1. You can go home if you can completely to urinate. 2. Urine catheter is released until 24 hours post-operation, then I will do 6 hours observation for your urinate. 3. Recurrence rate → 29% → not caused by surgical technic, but your tissue was not good like when you are young 4. Recurrence can be prevented, you should do this at home: o Reduce your body weight (set yout Diet & exercise) → because the patient is overweight. o Do not lift heavy loads. o Reduce straining (High-fiber diet, drinking water ± 2 L/day) o Kegel training → to strengthen the pelvic muscles Kegel → no limits  

More longer, more ↑ Patients in lithotomy position ↓ Identification the trained muscles

↓ Insert the finger to the vagina (introitus) ↓ Pinch the finger → Repetitive → Strength