Dr. Hazem Al-Mandeel 481 GYN Department of Obstetrics & Gynecology PELVIC ORGAN PROLAPSE السلايد كافي كمرجع – طبقا لكلام الدكتور تم اضافه نوت من التيم Dr. Hazem Al-Mandeel 481 GYN Department of Obstetrics & Gynecology
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
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
Anatomic Supports مهمه جدا – ( محل اسئله ) Muscular : Levator Ani (Pelvic Floor Ms.) Ligaments : Uterosacral-Cardinal Complex Fascial : Endopelvic (Pubocervical & Rectovaginal)
1- Levator Ani Major structure of pelvic floor Anterior/posterior orientation Perforated by urogenital hiatus Consists of : Pubococcygeus Iliococygeus Puborectalis Coccygeus اول اثنين اهم شي
2- Endopelvic Fascia Fibromuscular layer Local condensations are ligaments Principal ligaments are Uterosacral Cardinal Pubocervical and Rectovaginal Fascia important in specific surgical correction
Pathophysiology Direct Trauma to pelvic soft tissues Neurological injury Connective tissue disorders
Predisposing Factors مهمه 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
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 )
Compartments according to the relation to the vagina Anterior : Cystocele Urethrocele Middle : Uterine prolapse Enterocele/vault prolapse Posterior : Rectocele Rectal prolapse
middle
The pt had hysroectomy
Rectocele
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
Symptoms of Prolapse مهمه – اسئله Pelvic pressure Pelvic pain Feeling of a “lump” Back pain Urinary dysfunction Bowel dysfunction
Complications of Prolapse Bleeding Infection Recurrent UTI’s Urinary obstruction Renal failure
Associated conditions Urinary Incontinence : Stress Urge Mixed Fecal Incontinence : sphincter injury
Options of Management it is not emergency No Treatment ( pelvic floor exercise) Conservative: such as Physiotherapy or Pessary ( انظر الشريحه القادمه Surgical Treatment
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
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