Perioperative management - Supracervical hysterectomy, cervicosacropexy with gyno-mesh, bilateral adnexectomy, and anterior colporrhaphy, laparoscopic

• Specific pelvic floor symptoms: Severity and impact on quality of life
• Personal, family, obstetric, and social history: Pregnancy and birth course, genetic predisposition
• Previous conservative and surgical therapy: Pelvic floor training, pessary therapy, previous surgeries
• Sexual function and quality of life: Dyspareunia, limitations in intimacy
• Social and occupational factors: Heavy physical labor as a risk factor
• Comorbidities: Obesity, COPD, constipation, connective tissue disorders (e.g., Marfan syndrome), nicotine abuse
• Medication history: Influence of medications on continence and voiding functions (antidepressants, diuretics)

• Inspection of the external genitalia: Descent, fistulas, malformations, tumors
• Speculum examination: Assessment of vaginal skin, degree of estrogenization, descent diagnostics
• Palpation: Pelvic floor tone, levator avulsion, sphincter tone
• Cough stress test: Detection of stress incontinence with and without repositioning of the prolapse
• Urinalysis: Dipstick test, urine culture if infection is suspected
• Residual urine determination: Sonographically or with a single-use catheter to assess bladder emptying

Genital prolapse is classified into different grades that describe the extent of the prolapse. The common classifications are:

ICS/IUGA Standardization (International Continence Society/International Urogynecological Association):

• Stage 0: No descent visible or palpable.
• Stage 1: The lowest point of the descent is more than 1 cm proximal (inside) to the hymenal ring.
• Stage 2: The lowest point of the descent is between 1 cm proximal and 1 cm distal (outside) to the hymenal ring.
• Stage 3: The lowest point of the descent is more than 1 cm distal to the hymenal ring, but not a complete prolapse.
• Stage 4: Total prolapse of the uterus and/or vagina.

Commonly used clinical grading:

• Grade I: Descent within the vagina.
• Grade II: Descent reaches the introitus vaginae (vaginal opening).
• Grade III: Descent extends beyond the introitus vaginae.
• Grade IV: Total prolapse of the uterus and/or vagina.

• Sonography: Pelvic floor, introitus, perineal, and vaginal sonography for the diagnosis of prolapse
• Dynamic MRI: For complex findings for comprehensive assessment
• Urodynamics: Differentiation between urge and stress incontinence
• Cystourethroscopy: In cases of unclear hematuria or bladder complaints to clarify tumors or bladder stones