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Staging and Management of Genital Prolapse. Dr. V.P.Paily MD; FRCOG Professor Jubilee Mission Medical College, Thrissur, Kerala. Consultant, Mother Hosp.

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Presentation on theme: "Staging and Management of Genital Prolapse. Dr. V.P.Paily MD; FRCOG Professor Jubilee Mission Medical College, Thrissur, Kerala. Consultant, Mother Hosp."— 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. Very common problem. Confusion regarding assessing degree / stage Confusion regarding assessing degree / stage

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6 Conventional Staging Cervix is the main point. Cervix is the main point.

7 Conventional staging Difference between British and American System. Difference between British and American System.

8 Baden Walker Halfway System

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

11 Pelvic organ prolapse Quantification Quantification POP Q POP Q

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

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

14 Quantification Length of vagina Length of vagina Diameter of introitus Diameter of introitus Perineal body Perineal body

15 POP- Q

16 Quantification AaBaC ghpbtvl ApBpD

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18 POP-Q Drawbacks Appears complicated Appears complicated Doesnt include lateral prolapse. Doesnt include lateral prolapse.

19 Comprehensive pattern required incorporating defects at various levels & compartments Comprehensive pattern required incorporating defects at various levels & compartments

20 Look for defects At 3 levels UpperMiddleLower

21 Look for defects At two compartments Anterior Anterior Posterior Posterior

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

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

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

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

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

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

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

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

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

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

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

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37 Management Restore anatomy by correcting the defect. Restore anatomy by correcting the defect.

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39 Special Situations Special Situations

40 Nulliparous prolapse Nulliparous prolapse

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42 Older age with weak tissues Older age with weak tissues

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

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

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