Case VI.

68 years old, G3P3, NSD menopause for complains of an introital mass and leakage of urine
when coughing or sneezing. On physical exam, introital mass measures 6 x 5 cms, POP-Q Aa +3, Ap
+2, C+ 6, Ba+ 6, Bp + 6, TVL 8 cms

Complete Diagnosis:

Pelvic Organ Prolapse Stage 4

Uterine Prolapse (4th degree), Cystocoele (marked),

Rectocoele (marked), Stress Incontinence

The pelvic organ prolapse of the patient in this case is at Stage IV since there is essentially a complete
eversion of the total length of the lower genital tract or the most distal prolapse protrudes to at least
(TVL−2) cm. the leading edge of the prolapse were points Aa, Ba, Ap, Bp and C. Aa and Ba represented
the anterior vaginal wall ad Ap and Bp represented posterior vaginal wall, while C represented the most
distal edge of the cervix. Aa and Ba were both the leading edges of the cystourethrocele that have +3
points and + 6 points, respectively, which means that the cystocele prolapsed down to the introitus,
implying a marked cystocele. The cystocele can be supported by the symptom of leakage of urine when
coughing or sneezing. C represented the most distal edge of the cervix which had a point of +6, which
means Vagina is everted around the uterus and cervix and is completely exteriorized, implying a 4th
degree or total uterine prolapse. Ap and Bp represented the posterior vaginal wall, which had +2 points
and +6 points respectively, which the leading edges of the rectocele. In this case, the patient had a marked
rectocele, which means that the rectocele prolapsed down the introitus of the patient.

Treatment
PFME is suitable for mild to moderate POP but not for high-grade POP (POP-Q stage III and IV).
Vaginal Pessaries
For Non-surgical management ,vaginal pessaries of the space-filling type, such as Cube and Inflato ball
pessaries for stages III and IV POP are found to be effective.
Partial Colpocleisis
Colpocleisis has advantages in elderly patients with multiple comorbidities and who do not desire sexual
activity. This procedure has other advantages, such as a short operation time and the ease and safety of
employing regional or local anesthesia, minimizing the uncommon complications of hemorrhage or nerve
injury.
These procedures include partial or total colpocleisis and colpectomy. In the absence of a uterus, either
complete colpocleisis or colpectomy can be performed, whereas the presence of the uterus necessitates
partial colpocleisis, which creates two lateral channels to allow uterine drainage.