Instructions: Listen to the podcast episode available below, and then submit your answers to the multiple choice questions. You will review the answers and the material covered during your next Continuity Clinic Session.
1) An 87-year-old multiparous woman with multiple medical comorbidities comes to your office for evaluation of pelvic organ prolapse noted during her recent hospitalization for myocardial infarction. She reports no typical prolapse symptoms but has urinary incontinence. On examination, her anterior vaginal wall is prolapsed 6 cm beyond the hymen, and her cervix is at the hymen. You obtain a postvoid residual urine volume, which is 260 mL. Urinalysis is negative for nitrites, leukocytes, and blood. The best next step in her management is
2) A 45-year-old woman comes to your office with symptomatic stage III pelvic organ prolapse. She has been using a pessary for the past 5 years, but now she desires surgical management. She is an avid triathlete, and she recently completed her first Ironman race. She does not report any urinary or bowel symptoms and is sexually active. Her apex and anterior vaginal wall are 5 cm outside the hymen. She desires the most durable repair with the quickest recovery time. The most appropriate surgical procedure for her is
3) A 58-year-old woman comes to your office with a vaginal bulge that she has felt for the past year. In order to defecate, she has to use her fingers to push on her perineum and inside her vagina. She tells you, “It feels like my stool is getting stuck.” She has not experienced bowel leakage. She has no significant prior medical history and has never had surgery. She is sexually active. She had a forceps delivery of a 3,629-g (8-lb) infant and recalls a tear into her rectum. A rectovaginal examination demonstrates a distal pocket and laxity. She desires definitive surgical management. On examination, her pelvic organ prolapse quantification test result is as follows: Aa -2, Ba -2, C -7, GH 4, PB 2, TVL 10, Ap +3, Bp +4, D -8. You recommend