Pelvic Organ Prolapse Stephen Jeffery Consultant Urogynaecologist Good morning and welcome to Cape Town Pelvic Organ Prolapse Stephen Jeffery Consultant Urogynaecologist Groote Schuur Hospital and University of Cape Town

Soranus of Ephesus (2nd century AD) First hysterectomy for prolapse, gangrenous uterus The first operation done for Apical Prolapse was by SofE. He was a Greek physcian who worked in Rome. We aren’t told about his technique for suspension of the vault and whether the patient returned with vault prolapse

1550 BC Egypt: Ebers Papyrus Prolapse reduced using a lotion of honey and petroleum and the fumes of wax and hot charcoal. The Ebers Papyrus begins with a long series of prescriptions for various diseases. It also has a more updated treatment for prolapse which included reducing it with a _______________ It draws attention to urinary incontinence, also mentioning means of treatment. It records the use of "bread in a rotten condition" to treat bladder diseases, and clearly refers to hematuria, suggesting that it is caused by parasites.

460 BC Hippocrates Intravaginal squashed bedbugs, charred deer horn and hot air insufflation Hippocrates (c. 460-377 BC) devoted a special book to the study of the urine and recognized at least four conditions of the urinary tract that could be evaluated by the nature and appearance of the urinary outflow According to Hippocrates urine is a fundamental means for a correct diagnosis. He also described a new treatment for prolapse including ____________________________________

Pelvic Organ Prolapse DEFINITION

Clinical Presentation Often multi-compartment defect in association with: * Cystocele * Vault /Uterine * Rectocele

Clinical Presentation As a single compartment defect, the woman may complain of: Dragging sensation Feeling of a lump in the introitus, or between the groin. Passage of vaginal wind Dyspareunia Vaginal discharge or staining Discomfort and pain on sitting or walking

Clinical Presentation Bladder Function Voiding difficulties Irritative symptoms Incontinence We need to remember bladder function including new voiding diff, irritative symptoms or incontinence

Clinical Presentation Bowel Function Defecatory difficulties Incontinence We need to include bowel symptoms

Clinical Presentation Sexual Function Dysparenia Apareunia Slackness What about “Hispareunia” Dr de Jong once told me that the most important organ in the pelvis was the penis. We need to bear in mind that it does not help if the prolapse is cured but the women has Dyspareunia, Apareunia or even Hispareunia

Options: Non-surgical A broad range of options are availaable.

Options: Non-surgical Physiotherapy Pessaries These days, we have the option of physio and pessariues broad range of non-surgical options are availaable including physio and pessaries

Pessaries Pessaries remain a good option in those women not wanting surgery

If you were an Egyptian gynaecologist in ancient times – you would have had a pomegranate tree in your Garden and these worked pretty well

We now have a broad selection of pessaries We now have a broad selection of pessaries. The commonly used rings aren’t very successful in vault prolapse and therefore

The cube is occasionally successful in this group of women The cube is occasionally successful in this group of women. Unfortunately, they need a reasonable amount of dexterity because ethis needs to removed cleaned and reinsrted about twice a week.

Other shapes also work lik this gelhorn -type

And the donut shape. These are available in SA

Physiotherapy Physio does improve overall pelvic fllor tone and can address concomitant symptoms of bladder and bowel dysfunction

Surgical Options There is howver a group of women who require surgery

Goals of Reconstruction Restore anatomy Maintain or restore normal bowel & bladder function Maintain vaginal capacity for sexual intercourse but we need to remember that at the same time we must: _______________________________