1. Pelvic Organ Prolapse (POP)
Kristin Rooney, MD, FACOG,FPMRS
Assistant Professor
Dept. of Obstetrics and Gynecology

2. Disclosure
I have nothing to disclose

3. Objectives
To present an overview of the prevalence, risk factors and presenting symptoms of POP.
Discuss diagnosis of POP.
Discuss stress urinary incontinence(SUI).
Review treatments of POP and SUI.

4. Symptoms of POP Pelvic pressure and pain Bulge SUI Urge incontinence
Defecatory problems
Splinting the rectum
Not emptying completely
Constipation
Vaginal bleeding and excoriation

5. Why do they have these symptoms? What and where are these defects?

6. Female Pelvic Anatomy

9. Cystocele Anterior Compartment Prolapse

10. Cystocele Anterior Compartment Prolapse

11. Rectocele Posterior Compartment Prolapse

12. Rectocele Posterior Compartment Prolapse

13. Uterine Prolapse Vaginal Cuff Prolapse Apical Compartment Prolapse

14. Pathophysiology
Damage to the complex support system
“Hernias”

15. Prevalence In the US – 24 % have some POP(up to 50% of parous)
8% of women will require surgery by 80 yoa
WHI
34 % had anterior vaginal wall prolapse
19 % had posterior vaginal wall prolapse
14 % had uterine prolapse
Population based surveys
4-10 % report symptoms of pelvic organ prolapse
African-American women report symptoms less often

16. Risk Factors Vaginal births and pregnancy in general Smoking Steroids
3rd and 4th degree tears
Smoking
Steroids
Obesity
Chronic cough
Heavy lifting
Collagen defects
Marfan’s, Ehlers-Danlos
Family History

17. Exam

18. Work Up for POP History Physical PVR Qtip test for SUI Speculum exam
Lying
Standing
Rectal Exam

19. POP-Q

20. POP-Q

21. Treatments Conservative Surgical “wait and see” approach
Lifestyle modification
Kegel Exercises
Pessaries
Surgical

22. Conservative Treatments
Weight loss, eliminate constipation, reduce inciting activities(coughing, steroids, heavy lifting)
Physical Therapy
Pessary

23. Pessaries and how they fit

24. Surgical Treatments Need to address each “compartment”individually
Where is the prolapse?
Anterior?
Posterior?
Apical?
USUALLY ALL OF THE ABOVE!

25. Surgical Treatments Anterior compartment Posterior compartment
Anterior repair (anterior colporrhaphy)
Posterior compartment
Posterior repair (posterior colporrhaphy)
Perineorrhaphy
Apical compartment
Sacrospinous ligament suspension
Uterosacral ligament suspension
Sacral colpopexy
Colpocleisis

26. Anterior and Posterior Repairs

27. Sacrospinous ligament suspension - extraperitoneal

28. Uterosacral ligament suspension - intraperitoneal

29. Sacral colpopexy – intraperitoneal approach, buried beneath peritoneum

30. Surgical considerations…
Failure
Dyspareunia
Pelvic Pain
Mesh erosion
Preoperative health
Postoperative expectations
Risk for underlying urinary incontinence

31. Surgical Treatments Mesh kits FDA-black box warning
Require special consent

32. Modify risk factors. Counsel about Kegels.
Thank you.
Modify risk factors.
Counsel about Kegels.