Overview
Complete uterine prolapse with enterocele involves the descent of the uterus and small bowel into the vaginal canal, significantly impacting pelvic organ support and often necessitating surgical intervention 123.Diagnosis
Clinical Presentation: Symptoms include vaginal bulging, pelvic pressure, and potential urinary or bowel dysfunction.
Physical Examination: Definitive diagnosis through pelvic examination, assessing the degree of prolapse and presence of enterocele.
Grading: Uterine prolapse graded using the POP-Q system; enterocele is identified by the presence of a peritoneal sac behind the uterus 1.Management
Surgical Intervention: Hysterectomy via vaginal approach is common, often performed under local anesthesia with conscious sedation 1.
Anesthesia Considerations: Dexmedetomidine may reduce intraoperative fentanyl requirements compared to propofol in elderly patients undergoing vaginal hysterectomy 1.
Adjunctive Treatments: Vitamin D analog supplementation may improve levator ani muscle strength, potentially aiding in pelvic floor support 2.Special Populations
Elderly: Local anesthesia with conscious sedation shows favorable outcomes in elderly patients undergoing hysterectomy 1.
Comorbidities: No specific recommendations provided for comorbidities; focus on safe anesthesia and surgical approaches 1.Key Recommendations
Consider vaginal hysterectomy under local anesthesia with conscious sedation for elderly patients to optimize recovery outcomes (Evidence: Moderate 1).
Evaluate and potentially supplement Vitamin D in postmenopausal women with uterine prolapse to enhance levator ani muscle strength (Evidence: Moderate 2).
Repair uterine prolapse with enterocele surgically, addressing both the prolapse and enterocele to resolve symptoms effectively (Evidence: Weak 3).References
1 Hadzilia S, Grigoriadis T, Prodromidou A, Stamatakis E, Papadopoulou D, Zacharakis D et al.. Propofol . In vivo (Athens, Greece) 2024. link
2 Kurniadi A, Dewi AK, Sasotya RMS, Purwara BH, Kireina J. Effect of Vitamin D analog supplementation on levator ani strength and plasma Vitamin D receptor expression in uterine prolapse patients. Scientific reports 2023. link
3 Chapman RH. Ureteric obstruction due to urine prolapse. British journal of urology 1975. link