PELVIC ORGAN PROLAPSE Dr. Hazem Al-Mandeel 481 GYN Department of Obstetrics & Gynecology...
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Transcript of PELVIC ORGAN PROLAPSE Dr. Hazem Al-Mandeel 481 GYN Department of Obstetrics & Gynecology...
![Page 1: PELVIC ORGAN PROLAPSE Dr. Hazem Al-Mandeel 481 GYN Department of Obstetrics & Gynecology السلايد كافي كمرجع – طبقا لكلام الدكتور تم اضافه نوت](https://reader035.fdocuments.us/reader035/viewer/2022062621/551c375a550346a3488b4648/html5/thumbnails/1.jpg)
PELVIC ORGAN PROLAPSE
Dr. Hazem Al-Mandeel
481 GYN
Department of Obstetrics & Gynecology
كمرجع كافي الساليدالدكتور – لكالم طبقا
التيم من نوت اضافه تم
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Objectives
• To define pelvic organ prolapse
• Recognize pelvic anatomy
• Determine the Pathophysiology
• Discuss the predisposing factors
• Understand the grading systems
• Be aware of the options of management
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Pelvic Organ Prolapse
• Is the descent of the pelvic organs as a result of the loss of muscular and fascial structural support .
• The only orifice for prolapse is the vagina
• Cause : destruction of one or more of the Anatomical support
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Anatomic Supportsاسئله – ) ( محل جدا مهمه
• Muscular : Levator Ani (Pelvic Floor Ms.)
• Ligaments : Uterosacral-Cardinal Complex
• Fascial : Endopelvic (Pubocervical & Rectovaginal)
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1- Levator Ani
• Major structure of pelvic floor
• Anterior/posterior orientation
• Perforated by urogenital hiatus
• Consists of : Pubococcygeus
Iliococygeus
Puborectalis
Coccygeus
اثنين اولشي اهم
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2- Endopelvic Fascia
• Fibromuscular layer
• Local condensations are ligaments
• Principal ligaments are Uterosacral
Cardinal
• Pubocervical and Rectovaginal Fascia important in specific surgical correction
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Pathophysiology
• Direct Trauma to pelvic soft tissues
• Neurological injury
• Connective tissue disorders
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Predisposing Factorsمهمه
• Hereditary (genetic) predisposition
• Race: White > Black > Asian
• Pregnancy and Vaginal Childbirth
• Age and Menopause
• Raised intra-abdominal pressure (e.g.: obesity, cough, constipation, lifting, etc)
• Iatrogenic: surgical procedure
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Types of Pelvic Organ Prolaopse
1. Urethra
2. Bladder
3. Uterus/ Vaginal Vault
4. Small Bowel
5. Rectum
6. Perineum body ( between the vagina and the uterus )
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Compartmentsaccording to the relation to the vagina
• Anterior : Cystocele
Urethrocele
• Middle : Uterine prolapse
Enterocele/vault prolapse
• Posterior : Rectocele
Rectal prolapse
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middle
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The pt had hysroectomy
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Rectocele
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Classification of Prolapse
• Baden Walker (1972)
• Each site graded from 1 – 4
• POPQ: quantifies using specific points
• Measured relation to the hymenal ring
• More widely used
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Symptoms of Prolapseاسئله – مهمه
• Pelvic pressure
• Pelvic pain
• Feeling of a “lump”
• Back pain
• Urinary dysfunction
• Bowel dysfunction
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Complications of Prolapse
• Bleeding
• Infection
• Recurrent UTI’s
• Urinary obstruction
• Renal failure
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Associated conditions
• Urinary Incontinence : Stress
Urge
Mixed
• Fecal Incontinence : sphincter injury
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Options of Management it is not emergency
• No Treatment ( pelvic floor exercise)
• Conservative: such as
Physiotherapy or Pessary ( انظرالقادمه الشريحه
• Surgical Treatment
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Aims of prolapse surgery
• Alleviate symptoms
• Restore normal anatomy
• Restore normal visceral function
• Avoid new bladder or bowel symptoms
• Preserve sexual function
• Avoid surgical complications
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Classisfication of prolapse surgery
• Vaginal
PrimaryVaginal hysterectomyAnterior/Posterior repair
SecondarySacrospinous fixationIliococcygeus fixationUterosacral fixation
Recurrent+/- reinforcementSynthetic mesh/autologous/
donor/Xenograft
• Abdominal
Primary
Paravaginal repair
Hysteropexy
Secondary +- reinforcement
Sacrocolpopexy
Uterosacral/Sacrospinousfixation
• Laparoscopic
All of the Abdominal procedures +/-reinforcement
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Conclusions
• Pelvic organ prolapse is common• Results from injury to soft tissue and nerves• Childbirth most significant association• Treatment requires understanding of anatomic
relationships• Treated with a combination of physio/pessary
and often complex surgery