1. Pelvic Floor Dysfunction

2. Pelvic Organ Prolapse
Lower Urinary Tract disorder
Anorectal Disorder

3. Not life threatening
But life quality worsening

4. Pelvic Floor

5. Pelvic Floor Pelvic diaphragm Funnel-shaped fibromuscular partition
Forms the primary supporting structure for the pelvic contents
Composition
Levator ani
Coccygeus muscles
their superior and inferior fasciae
Forms the ceiling of the ischiorectal fossa

7. Pelvic Organ Prolapse

8. Pelvic Organ Prolapse (POP)
bulge or protrusion of pelvic organs and their associated vaginal segments into or through the vagina
Incidence increases with aging
anterior pelvic organ prolapse 34.3%
posterior wall prolapse 18.6%
uterine prolapse in 14.3%
Vaginal delivery as a significant risk factor
history of hysterectomy; obesity ; history of previous prolapse operations; race
Optical surgical treatment remains elusive

9. Pathophysiology attenuation of the supportive structures
endopelvic connective tissue
levator ani muscular support
by actual tears or “breaks”
by neuromuscular dysfunction

10. Definitions Rectocele Enterocele Cystocele Uterine prolapse
Procidentia

11. Definitions

12. Symptoms Pelvic organ prolapse Symptoms of voiding dysfunction
Urinary incontinence
Obstructive voiding symptoms
Urinary urgency and frequency
Urinary retention and upper renal compromise
Defecatory problems (e.g., constipation, diarrhea, tenesmus, fecal incontinence)
Pelvic pain
Back and flank pain
Overall pelvic discomfort
Dyspareunia

13. Symptoms

14. Physical examination Divide the pelvis into compartments
Apical compartment ---- Graves speculum or Baden retractor
The anterior and posterior compartments ---- univalve or Sims' speculum
Rectovaginal examination ---- distinguish a posterior vaginal wall defect from a dissecting apical enterocele
Anterior lateral detachment defect----Baden retractor
Valsalva is encouraged
standing straining examination

15. Pelvic Organ Prolapse Quantitation System

16. Pelvic Organ Prolapse Quantitation System

17. Pelvic Organ Prolapse Quantitation System

18. Pelvic Muscle Function Assessment
Bladder Evaluation

19. Treatment Nonsurgical Therapy Mild to moderate prolapse
Desire future childbearing
Not suitable or desire surgery

20. Conservative Management pelvic floor muscle training (PFMT)
Lifestyle intervention
weight loss
reduction of activities that increase intra–abdominal pressure
Mechanical Devices

21. Surgical Management OPTIONAL!!! relieve symptoms
restore vaginal anatomy
vaginal, abdominal, and laparoscopic routes
involve a combination of repairs directed to the anterior vagina, vaginal apex, posterior vagina, and perineum
None is perfect

22. Surgical Management Procedures
Restorative: use the patient's endogenous support structures
Compensatory: replace deficient support with permanent graft material
Obliterative: close or partially close the vagina.

24. Lower Urinary Tract Disorders

25. Normal Urethral Closure

26. Stress Urinary Incontinence
Most common type of urinary continence in women
Leaking when sneezing, coughing, or exercise
Urethral sphincter defect and/or urethral hypermobility
Urge Urinary Incontinence and Overactive Bladder
most common form of incontinence in older women
involuntary leakage of urine accompanied by or immediately preceded by urgency
may or may not be caused by detrusor overactivity

27. Mixed Incontinence
have symptoms of both stress and urge urinary incontinence
in older women mixed and urge incontinence is predominate

28. Evaluation Q–tip test Voiding Diary Urinalysis
Postvoid Residual Volume
Cough Stress Test
Pad Tests
Urodynamics

29. Nonsurgical treatment
Lifestyle Changes
Weight loss
Postural change
Decrease caffeine intake
Physical Therapy
pelvic floor muscle training
Behavioral Therapy and Bladder Training

30. Vaginal and Urethral Devices

31. Urge Incontinence and Overactive Bladder
Medications
Stress incontinence
α– adrenergic activity
Urge Incontinence and Overactive Bladder
anticholinergic agents

32. Surgical Treatment for Stress incontinence
TVT/SPARC 32

33. TVT/SPARC 33

34. Key Points

35. Thank you !