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Staging and Management of Genital Prolapse

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Presentation on theme: "Staging and Management of Genital Prolapse"— Presentation transcript:

1 Staging and Management of Genital Prolapse

2 Dr. V.P.Paily MD; FRCOG Professor
Jubilee Mission Medical College, Thrissur, Kerala. Consultant, Mother Hosp and Raji Nursing Home , Thrissur, Kerala

3 Prolapse Very common problem.
Confusion regarding assessing degree / stage

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6 Conventional Staging Cervix is the main point.

7 Conventional staging Difference between British and American System.

8 Baden Walker Halfway System

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10 Prolapse quantification
Pelvic organ prolapse quantification(POP-Q) Recommended by ICS, society of Gyn.Surgeons &Amer. Urogyn. Surgeons

11 Pelvic organ prolapse Quantification POP Q

12 Quantification Vault, Cx or Posterior fornix
Anterior & Posterior walls Introitus Perineal body Length of vagina

13 Quantification Anterior (a) -- Point A & B
Posterior (p) Point A & B Point C Lips of Cervix Point D Post.fornix

14 Quantification Length of vagina Diameter of introitus Perineal body

15 POP- Q

16 Quantification Aa Ba C gh pb tvl Ap Bp D

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18 POP-Q Drawbacks Appears complicated Doesn’t include lateral prolapse.

19 Comprehensive pattern required incorporating defects at various levels & compartments

20 Look for defects At 3 levels Upper Middle Lower

21 Look for defects At two compartments Anterior Posterior

22 Compartmental approach
Level 1 Descent of cervix Descent of vault Enterocele

23 Compartmental Approach
Level 2 Anterior segment – cystocele Posterior segment – rectocele Lateral detachment

24 Compartmental Approach
Level 2 High rectocele can extend up to post fornix and has to be differentiated from enterocele.

25 Compartmental Approach
Level 2 Midline defects are due to tear or weakness of fascial envelope – pubo vesico cervical fascia and rectovaginal fascia ( Denonvilliers).

26 Compartmental Approach
Level 3 Anteriorly – Urethrocele Posteriorly – Detached perineal body

27 Compartmental Approach
Level 3 Detached Perineal body Reattach to recto vaginal fascia

28 Practical approach to Level 3 defects
Common complaint Sound of air being sucked in

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30 Compartmental Approach
Lateral detachment Reattach to Arcus Tendineus Fascia pelvis or Arcus Tendineus Fascia Rectovaginalis

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32 Compartmental Approach
Anterior Lateral detachment Richardson’ s operation Transvaginal Transabdominal Endoscopic

33 Compartmental Approach
Posterior Lateral detachment Reattach to Arcus tendineus fascia rectovaginalis

34 Symptomatology Record symptoms related to Anatomical descent
Urinary function Sexual function Reproductive need GI symptoms Air suction

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37 Management Restore anatomy by correcting the defect.

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39 Special Situations

40 Nulliparous prolapse

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42 Older age with weak tissues

43 Mesh for Repair Concept borrowed from Hernia repair
Special mesh being developed. (Gyne mesh) We have tried prolene mesh.

44 Conclusions Detailed record of defects Detailed record of symptoms
Individualised surgery

45 Thank you


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