1. 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

2. 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

3. 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

4. Anatomic Supports مهمه جدا – ( محل اسئله )
Muscular : Levator Ani (Pelvic Floor Ms.)
Ligaments : Uterosacral-Cardinal Complex
Fascial : Endopelvic (Pubocervical & Rectovaginal)

5. 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

8. 2- Endopelvic Fascia Fibromuscular layer
Local condensations are ligaments
Principal ligaments are Uterosacral
Cardinal
Pubocervical and Rectovaginal Fascia important in specific surgical correction

12. Pathophysiology Direct Trauma to pelvic soft tissues
Neurological injury
Connective tissue disorders

13. 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

14. 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 )

15. Compartments according to the relation to the vagina
Anterior : Cystocele
Urethrocele
Middle : Uterine prolapse
Enterocele/vault prolapse
Posterior : Rectocele
Rectal prolapse

20. middle

21. The pt had hysroectomy

24. Rectocele

25. 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

28. Symptoms of Prolapse مهمه – اسئله
Pelvic pressure
Pelvic pain
Feeling of a “lump”
Back pain
Urinary dysfunction
Bowel dysfunction

29. Complications of Prolapse
Bleeding
Infection
Recurrent UTI’s
Urinary obstruction
Renal failure

30. Associated conditions
Urinary Incontinence : Stress
Urge
Mixed
Fecal Incontinence : sphincter injury

31. Options of Management  it is not emergency
No Treatment ( pelvic floor exercise)
Conservative: such as
Physiotherapy or Pessary ( انظر الشريحه القادمه
Surgical Treatment

34. 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

40. 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