·
After obtaining the history and physical
examination and evaluating a urinalysis (including urine culture), initial evaluation of the incontinent patient
includes a cystometrogram, check for
residual urine volume, stress test, and urinary diary.
·
The degree or severity of pelvic relaxation is rated on a scale of 1 to 3,
based on the descent of the organ or structure involved. First-degree prolapse involves descent limited to the upper
two-thirds of the vagina. Second-degree prolapse
is present when the structure is at the vaginal introitus.
In cases of third-degree prolapse, the
structure is outside the vagina. Total procidentia
of the uterus is the same as a third-degree prolapse,
which means that the uterus would be located outside the body.
The primary reason to
perform a cystometrogram is to rule out uninhibited detrusor contractions.
·
Partial colpocleisis by the Le Fort procedure is
reasonable for elderly patients who are not good candidates for vaginal
hysterectomy and A&P (anterior and posterior) repair as treatment for
vaginal and uterine prolapse. Urinary incontinence can be a side effect of this procedure, so
care must be exercised in the denudation of vaginal mucosa near the bladder. In
a patient who already has urinary incontinence, the Le
Fort operation would be relatively contraindicated.
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