Answer
1) Uterovaginal prolapsed grade III
2)Clinical presentation
-Non specific clinical presentation (lump, local discomfort, bachache, bleeding/infection, dyspareunia)
-Specific; cystourethrocele- urinary frequency and urgency, voiding difficulty, UTI, stress incontinence.
-Rectocele; incomplete bowel emptying, digitations, splinting.
-Worsening protrusion through the vaginal opening over time
3)Ring Pessary (Silicon-rubber based or Shelf pessary)
4)Two complication
-Vaginal erosions and ulcers
-Vaginal tract Infection
-Urinary tract infection
-bleeding
-irritative symptoms
-Stress urinary incontinence
-interfere with sexual intercourse
-difficulty with bowel movement
5)Definitive treatment
Vaginal hysterectomy with colporrhaphy
Notes:
Grading is done while patient is straining and prolapsed is described as lowest or most dependent portion
Grade 1: descent within vagina
Grade 2: Descent into introitus
Grade 3: Descent outside introitus