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Craig Dyson Sioned Griffiths October 2013.  Normal Anatomy  Causes of prolapse  Types of Prolapse  Investigation  Management.

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Presentation on theme: "Craig Dyson Sioned Griffiths October 2013.  Normal Anatomy  Causes of prolapse  Types of Prolapse  Investigation  Management."— Presentation transcript:

1 Craig Dyson Sioned Griffiths October 2013

2  Normal Anatomy  Causes of prolapse  Types of Prolapse  Investigation  Management

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6 “To fall out” Protrusion of an organ or structure beyond its normal confines and with an epithelial surface Genitourinary prolapse – Descent of one or more of pelvic organs. 41% of year old’s but uncertain Uterocoele, Cystocoele, Rectocoele, Enterocoele

7  Levator Ani/Endopelvic Fascia important  Damage to these structures can occur through:  Trauma  Neuropathic Injury  Disruption/Stretching  Multifactorial – Orientation of bones may be a factor.

8  Increasing Age (Double risk with every decade)  Vaginal Delivery  Increasing parity  Obesity  Spina Bifida  Pregnancy Variables  Macrosomia  Prolonged 2 nd stage  Episiotomy  Use of forceps/oxytocin  FH of prolapse  Constipation  Connective Tissue Disorder  Occupation

9 Anterior Urethrocoele – Urinary Stress Incontinence – Rare Cystocoele – Increased frequency – UTI – Sensation of mass – No Symptoms Both – Most Common

10 Middle Uterine Prolapse Vaginal Vault Prolapse – Post Hysterectomy – Assoc with cystocoele, rectocoele and enterocoele. – Retention Enterocoele – Pouch of Douglas – Cough Impulse

11  Posterior  Rectocoele

12 Pelvic Organ Prolapse Quantification System Valsalva - ? Left Lateral Stage 0 Stage 1 – 1cm above hymen Stage 2 - Within 1 cm of hymen Stage 3 - >1cm below plane of hymen but <2cm of total length of vagina Stage 4 – Complete eversion of vagina

13 General – Fullness – Sensation of bulge – Backache Urinary – Incontinence – Frequency Coital – Dypareunia – Flatus Bowel – Constipation/Incontinence – Need to apply digital pressure

14  History and Examination  Urinalysis  Post-Voidal Urine volume testing  Urodynamics  US  Urea/Creatinine

15  Conservative  Watchful Waiting  Lifestyle Modification  Pelvic Floor Exercises  Evidence?  Vaginal Oestrogen Creams  Pessary

16  Inserted into vagina to reduce prolapse  Made of silicon or plastic or Soaked in wine…  Good short term option

17  Surgical  Effective  Re-operation required in 29% of cases  Fitness of patient  Sexually Active  Surgeons Advice

18 Anterior Colporrhaphy – Involves plication of anterior vaginal wall to reinforce. Hysterectomy Sacrospinous Fixation – Unilateral or bilateral fixation of uterus to sacrospinous ligament Sacocolpoplexy – Mesh used to attach top of vagina to sacrum.

19  Prolapse is increasingly common with age.  Can be classified according to compartment or level of prolapse  Can be clear on examination  Good conservative and surgical options available  Good prognosis

20  Pessary treatment for pelvic organ prolapse and health-related quality of life: a review. Lamers BH, Broekman BM, Milani AL - Int Urogynecol J (2011)  Rev Urol. 2004; 6(Suppl 5): S2–S10. PMCID: PMC Female Pelvic Floor Anatomy: The Pelvic Floor, Supporting Structures, and Pelvic Organs. Sender Herschorn Sender Herschorn  Herschorn S, Carr LK. In: Campbell’s Urology. 2002:1092–1139.  Rectocele | Vaginal Surgery & Urogynecology Institute.vaginalsurgeryandurogynecologyinstitute.com  Int J Med Sci 2012; 9(10): doi: /ijms Three-dimensional Ultrasound Appearance of Pelvic Floor in Nulliparous Women and Pelvic Organ Prolapse Women. Tao Ying Corresponding address, Qin Li, Lian Xu, Feifei Liu, Bing Hu   


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