1. HYSTERECTOMY Role of P.T. after HYSTERECTOMY By Dr. Ali Abd El-Monsif Thabet

2. Definition Surgical removal of the uterus through abdominal or vaginal incision Surgical removal of the uterus through abdominal or vaginal incision

3. Indications of Hysterectomy A)Obstetrical: 1- Rupture of the uterus. 2- Uncontrollable post-partum hemorrhage. 3- Couvelaire's uterus 4- Placenta accreta.

4. B- Gynecological: 1- Inflammatory as some cases of genital tuberculosis. 2- Neoplastic: (a) Benign: some cases of fibroids and benign ovarian tumors in old patients, (b) Malignant tumors of the cervix, body and ovaries. 3- Displacements: some cases of uterine prolapse. 4- Some cases of endometriosis. 5- Some cases of dysfunctional uterine bleeding.

5. Types of abdominal hysterectomy Subtotal Subtotal Total Total Panhysterectomy Panhysterectomy Radical hysterectomy Radical hysterectomy Ultraradical hysterectomy Ultraradical hysterectomy

6. Complication of hysterectomy 1- Respiratory complications 2- Excessive abdominal pain 3- Deep venous thrombosis &pulmonary embolism 4- Dependant edema 5- Intestinal complication 6- Hemorrhage

7. Remote complications (a) Complications of the abdominal scar as keloid formation. (b) Vagina discharge due to infection at the vaginal vault. (c) Vagina vault prolapse after hysterectomy, (d) Dyspareunia, after hysterectomy (e) Low backache due to persistent chronic pelvic cellulitis, (f) Menopausal symptoms following bilateral oophorectomy in a young patient.

8. Role of P.T. in Hysterectomy. Pre operative management Post operative management

9. Pre-operative Aims of pre-operative treatment: 1- To prepare the patient physically and mentally for the operation. 2-Teach her the exercises that will be done post operatively. 3-To improve circulation. 4-To improve respiration. 5-To strengthen the abdominal muscles

10. Methods

11. Postoperative management Program of exercises ElectrotherapyAdvices

12. Post operative aims 1-Improve pulmonary function &prevent its problems. 2-Improve circulatory function &prevent its problems. 3-Decrease incisional pain. 4-Improve wound healing. 6- Avoid muscle wasting 7-Correct posture.

13. Program of exercises

14. Electrotherapy Electrotherapy

15. Advices

16. RETROVERSION AND RETROFLEXION OF THE UTERUS

17. Definition Retro-version means that the uterus is directed backwards towards the sacrum by its rotation round a transverse axis passing through the external os. Retro-version means that the uterus is directed backwards towards the sacrum by its rotation round a transverse axis passing through the external os. Retro-flexion is backward flexion of corpus (body) uteri on the cervix at the level of internal os Retro-flexion is backward flexion of corpus (body) uteri on the cervix at the level of internal os

20. Varieties of retro-version-flexion A)Congenital A)Congenital Retroversion of a hypoplastic uterus Retroversion of a hypoplastic uterus Retroversion of a normal uterus Retroversion of a normal uterus B)Acquired: B)Acquired: Retroversion complicated by pelvic pathological lesions Retroversion complicated by pelvic pathological lesions Puerperal retroversion Puerperal retroversion

22. Degrees of retro-version-flexion First degree: the fundus is directed towards the promontory of the sacrum. First degree: the fundus is directed towards the promontory of the sacrum. Second degree: the fundus is directed towards the sacral concavity. Second degree: the fundus is directed towards the sacral concavity. Third degree: the fundus is directed towards the tip of the sacrum. Third degree: the fundus is directed towards the tip of the sacrum.

24. Symptoms of Retroversion Backache Backache Menorrhagia. Menorrhagia. Dyspareunia Dyspareunia Leucorrhoea Leucorrhoea Sterility Sterility Incarceration Incarceration

25. Treatment of retroversion Treatment of retroversion

26. Surgical Treatment Modified Gilliam's Ventrosuspension Modified Gilliam's Ventrosuspension Fothergill's operation Fothergill's operation

27. Thank you