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Obstetrics & Gynecology Hospital Fudan University Pelvic Floor Dysfunction.

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Presentation on theme: "Obstetrics & Gynecology Hospital Fudan University Pelvic Floor Dysfunction."— Presentation transcript:

1 Obstetrics & Gynecology Hospital Fudan University Pelvic Floor Dysfunction

2 Obstetrics & Gynecology Hospital Fudan University Pelvic Organ Prolapse Lower Urinary Tract disorder Anorectal Disorder

3 Obstetrics & Gynecology Hospital Fudan University Not life threatening But life quality worsening

4 Obstetrics & Gynecology Hospital Fudan University Pelvic Floor

5 Obstetrics & Gynecology Hospital Fudan University Pelvic Floor Pelvic diaphragm Funnel-shaped fibromuscular partition Forms the primary supporting structure for the pelvic contents Composition –Levator ani –Coccygeus muscles –their superior and inferior fasciae Forms the ceiling of the ischiorectal fossa

6 Obstetrics & Gynecology Hospital Fudan University

7 Obstetrics & Gynecology Hospital Fudan University Pelvic Organ Prolapse

8 Obstetrics & Gynecology Hospital Fudan University Pelvic Organ Prolapse (POP) bulge or protrusion of pelvic organs and their associated vaginal segments into or through the vagina Incidence increases with aging –anterior pelvic organ prolapse 34.3% –posterior wall prolapse 18.6% –uterine prolapse in 14.3% Vaginal delivery as a significant risk factor history of hysterectomy; obesity ; history of previous prolapse operations; race Optical surgical treatment remains elusive

9 Obstetrics & Gynecology Hospital Fudan University Pathophysiology attenuation of the supportive structures –endopelvic connective tissue –levator ani muscular support  by actual tears or “breaks”  by neuromuscular dysfunction

10 Obstetrics & Gynecology Hospital Fudan University Definitions Rectocele Enterocele Cystocele Uterine prolapse –Procidentia

11 Obstetrics & Gynecology Hospital Fudan University Definitions

12 Obstetrics & Gynecology Hospital Fudan University Symptoms Pelvic organ prolapse Symptoms of voiding dysfunction –Urinary incontinence –Obstructive voiding symptoms –Urinary urgency and frequency –Urinary retention and upper renal compromise Defecatory problems (e.g., constipation, diarrhea, tenesmus, fecal incontinence) Pelvic pain Back and flank pain Overall pelvic discomfort Dyspareunia

13 Obstetrics & Gynecology Hospital Fudan University Symptoms

14 Obstetrics & Gynecology Hospital Fudan University Physical examination Divide the pelvis into compartments Apical compartment ---- Graves speculum or Baden retractor The anterior and posterior compartments ---- univalve or Sims' speculum Rectovaginal examination ---- distinguish a posterior vaginal wall defect from a dissecting apical enterocele Anterior lateral detachment defect----Baden retractor Valsalva is encouraged standing straining examination

15 Obstetrics & Gynecology Hospital Fudan University Pelvic Organ Prolapse Quantitation System

16 Obstetrics & Gynecology Hospital Fudan University Pelvic Organ Prolapse Quantitation System

17 Obstetrics & Gynecology Hospital Fudan University Pelvic Organ Prolapse Quantitation System

18 Obstetrics & Gynecology Hospital Fudan University Pelvic Muscle Function Assessment Bladder Evaluation

19 Obstetrics & Gynecology Hospital Fudan University Treatment Nonsurgical Therapy –Mild to moderate prolapse –Desire future childbearing –Not suitable or desire surgery

20 Obstetrics & Gynecology Hospital Fudan University Conservative Management pelvic floor muscle training (PFMT) Lifestyle intervention –weight loss –reduction of activities that increase intra–abdominal pressure Mechanical Devices

21 Obstetrics & Gynecology Hospital Fudan University Surgical Management OPTIONAL!!! relieve symptoms restore vaginal anatomy vaginal, abdominal, and laparoscopic routes involve a combination of repairs directed to the anterior vagina, vaginal apex, posterior vagina, and perineum None is perfect

22 Obstetrics & Gynecology Hospital Fudan University Surgical Management Procedures Restorative: use the patient's endogenous support structures Compensatory: replace deficient support with permanent graft material Obliterative: close or partially close the vagina.

23 Obstetrics & Gynecology Hospital Fudan University

24 Obstetrics & Gynecology Hospital Fudan University Lower Urinary Tract Disorders

25 Obstetrics & Gynecology Hospital Fudan University Normal Urethral Closure

26 Obstetrics & Gynecology Hospital Fudan University Stress Urinary Incontinence Most common type of urinary continence in women Leaking when sneezing, coughing, or exercise Urethral sphincter defect and/or urethral hypermobility Urge Urinary Incontinence and Overactive Bladder most common form of incontinence in older women involuntary leakage of urine accompanied by or immediately preceded by urgency may or may not be caused by detrusor overactivity

27 Obstetrics & Gynecology Hospital Fudan University Mixed Incontinence have symptoms of both stress and urge urinary incontinence in older women mixed and urge incontinence is predominate

28 Obstetrics & Gynecology Hospital Fudan University Evaluation Q–tip test Voiding Diary Urinalysis Postvoid Residual Volume Cough Stress Test Pad Tests Urodynamics

29 Obstetrics & Gynecology Hospital Fudan University Nonsurgical treatment Lifestyle Changes Weight loss Postural change Decrease caffeine intake Physical Therapy pelvic floor muscle training Behavioral Therapy and Bladder Training

30 Obstetrics & Gynecology Hospital Fudan University Vaginal and Urethral Devices

31 Obstetrics & Gynecology Hospital Fudan University Medications Stress incontinence –α– adrenergic activity Urge Incontinence and Overactive Bladder –anticholinergic agents

32 Obstetrics & Gynecology Hospital Fudan University Surgical Treatment for Stress incontinence TVTTVT/SPARCSPARC

33 Obstetrics & Gynecology Hospital Fudan University TVTTVT/SPARCSPARC

34 Obstetrics & Gynecology Hospital Fudan University Key Points

35 Obstetrics & Gynecology Hospital Fudan University Thank you !


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