1. Pelvic Organ Prolapse Stephen Jeffery Consultant Urogynaecologist
Good morning and welcome to Cape Town
Pelvic Organ Prolapse
Stephen Jeffery
Consultant Urogynaecologist
Groote Schuur Hospital and University of Cape Town

2. Soranus of Ephesus (2nd century AD)
First hysterectomy for prolapse, gangrenous uterus
The first operation done for Apical Prolapse was by SofE. He was a Greek physcian who worked in Rome. We aren’t told about his technique for suspension of the vault and whether the patient returned with vault prolapse

3. 1550 BC Egypt: Ebers Papyrus
Prolapse reduced using a lotion of honey and petroleum and the fumes of wax and hot charcoal.
The Ebers Papyrus begins with a long series of prescriptions for various diseases. It also has a more updated treatment for prolapse which included reducing it with a _______________ It draws attention to urinary incontinence, also mentioning means of treatment. It records the use of "bread in a rotten condition" to treat bladder diseases, and clearly refers to hematuria, suggesting that it is caused by parasites.

4. 460 BC
Hippocrates
Intravaginal squashed bedbugs, charred deer horn and hot air insufflation
Hippocrates (c BC) devoted a special book to the study of the urine and recognized at least four conditions of the urinary tract that could be evaluated by the nature and appearance of the urinary outflow According to Hippocrates urine is a fundamental means for a correct diagnosis. He also described a new treatment for prolapse including ____________________________________

5. Pelvic Organ Prolapse
DEFINITION

6. Clinical Presentation
Often multi-compartment defect in association with:
* Cystocele
* Vault /Uterine
* Rectocele

7. Clinical Presentation
As a single compartment defect, the woman may complain of:
Dragging sensation
Feeling of a lump in the introitus, or between the groin.
Passage of vaginal wind
Dyspareunia
Vaginal discharge or staining
Discomfort and pain on sitting or walking

8. Clinical Presentation
Bladder Function
Voiding difficulties
Irritative symptoms
Incontinence
We need to remember bladder function including new voiding diff, irritative symptoms or incontinence

9. Clinical Presentation
Bowel Function
Defecatory difficulties
Incontinence
We need to include bowel symptoms

10. Clinical Presentation
Sexual Function
Dysparenia
Apareunia
Slackness
What about “Hispareunia”
Dr de Jong once told me that the most important organ in the pelvis was the penis.
We need to bear in mind that it does not help if the prolapse is cured but the women has Dyspareunia, Apareunia or even Hispareunia

11. Options: Non-surgical
A broad range of options are availaable.

12. Options: Non-surgical
Physiotherapy
Pessaries
These days, we have the option of physio and pessariues broad range of non-surgical options are availaable including physio and pessaries

13. Pessaries
Pessaries remain a good option in those women not wanting surgery

14. If you were an Egyptian gynaecologist in ancient times – you would have had a pomegranate tree in your Garden and these worked pretty well

15. We now have a broad selection of pessaries
We now have a broad selection of pessaries. The commonly used rings aren’t very successful in vault prolapse and therefore

16. The cube is occasionally successful in this group of women
The cube is occasionally successful in this group of women. Unfortunately, they need a reasonable amount of dexterity because ethis needs to removed cleaned and reinsrted about twice a week.

17. Other shapes also work lik this gelhorn -type

18. And the donut shape. These are available in SA

19. Physiotherapy
Physio does improve overall pelvic fllor tone and can address concomitant symptoms of bladder and bowel dysfunction

20. Surgical Options
There is howver a group of women who require surgery

21. Goals of Reconstruction
Restore anatomy
Maintain or restore normal bowel & bladder function
Maintain vaginal capacity for sexual intercourse
but we need to remember that at the same time we must: _______________________________