Urogenital ImagingUterine prolapse
condition in which the uterine cervix descends outside of the vaginal introitus and is usually associated with severe pelvic relaxation. Most patients are multiparous, so the most probable aetiology is repeated childbirth. Uterine prolapse is often associated with a concomitant rectocoele, cystocoele, (see
cystocoele bladder) and/or an
enterocoele. Moderate degrees of prolapse are often associated with a feeling of pelvic heaviness or fullness or low back pain. The symptoms usually worsen with exertion and ease with bed rest. In severe prolapse, the cervix may descend outside the vaginal introitus, and patients may complain that a "mass" is protruding from the vagina. The commonly associated problems of cystocoeles and rectocoeles may lead the patient to complain of difficulty in voiding and defaecating and recurrent urinary infections.
Imaging is not generally performed for this condition as it is a clinical diagnosis. However, to assess the extent, and any associated cystocoele or enterocoele the multiplanar capability of MRI may be useful.
Mild cases of uterine prolapse do not require therapy unless the patient is symptomatic; in most cases of second or third degree prolapse, however, patients may be quite uncomfortable and desire therapy. Nonsurgical options, such as a pessary, are usually tried first if the patient desires conservative therapy. Operative repair for uterine prolapse is usually approached vaginally if the uterus is small. An abdominal approach may be preferred if the uterus is large or if the woman has had multiple previous pelvic procedures or has extensive endometriosis or other processes that may obliterate the cul-de-sac.
HH