Presentation on theme: "Uterovaginal Prolapse"— Presentation transcript:
1Uterovaginal Prolapse Dr. Nusrat NisarDepartment of Obstetrics & GynaecologyLiaquat University of Medical &Health Sciences, Jamshoro
2Uterovaginal prolapse is defined as protrusion of uterus or vagina beyond their normal anatomical confines
3Incidence:12 – 30% in multiparous women.2% in nulliparous women.
4Grading: 1st degree: 2nd degree: 3rd degree: Descent with in vagina. Descent up to the introitus.3rd degree:Descent out side the introitus also known as procidentia & usually accompanied by cystourethrocele & Rectocele.
7Posterior vaginal wall prolapse; Rectocele;Rectal descent.Enterocele;Small bowel descent.Apical vaginal prolapse;Uterovaginal;Uterine descent with inversion of vaginal apex.
8Vault prolapse;Post hysterectomy inversion of vaginal apex.
9Etiology Extremely common in multiparous women. Congenital; 2% symptomatic prolapse occur in nulliparous.Congenital weakness of connective tissue.Multiparity;Multiple vaginal deliveries;Causes damage to major supports of vagina,nerves,endopelvic fascia & levator ani.
10Raised intra abdominal pressure; Chronic cough.Constipation.Post menopausal;Estrogen deficiency.Post operative;Vault prolapse.
11Diagnosis Diagnosis is made by clinical examination; Clinical features;Symptoms;Non specific;Lump.Local discomfort.Backache.Bleeding / infection if ulceration.Dyspareunia or apareunia.In sever cystourethrocele, uterovaginal or vault prolapse renal failure may occur.
13Abdominal examination; Should perform to exclude organomegaly or abdomino-pelvic mass.Vaginal examination;Prolapse may be obvious.Ulceration.Pelvic examination to exclude pelvic mass.Combine rectal & vaginal examination to differentiate Rectocele from Enterocele.
15Investigation; No essential investigation. If urinary symptoms present;Urine microscopy.Cystometry.Cystoscopy.If renal failure suspected;B.Urea.S.Creatinine.U/s of renal areas.
16Treatment Depends upon patient`s wishes. Correct obesity. To treat chronic cough.Constipation.If ulceration then seven days course of local estrogen.
17Prevention; Shortening the 2nd stage of labor. Reducing traumatic delivery.Use of episiotomy.HRT in menopausal women.
18Medical Treatment Conservative therapy; Indications; Complications; Silicon rubber based ring pessaries.Indications;Patient`s wish.As a therapeutic test.Child bearing not complete.Medically unfit for surgery.During & after pregnancy.While awaiting surgery.Complications;Vaginal ulceration & infection.
19Surgical TreatmentAim of surgical repair is to restore anatomy & function.Cystourethrocele;Anterior repair or colporrhaphy.Rectocele;Posterior repair or colporrhaphy.Enterocele;Anterior & posterior repair & peritoneal sac containing the small bowel should be excised.
20Utero vaginal prolapse; Vaginal hysterectomy;If patient completed her family.Manchester repair;Involves partial amputation of cervix & approximation of cardinal ligaments.Usually combined with anterior & posterior repair.
21Sacrohysteropexy; Abdominal procedure, Attachment of synthetic mesh from the utertocevical junction to the anterior longitudinal ligament of the sacrum.
22Vault prolapse; Sacrocolopopexy; Similar to Sacrohysteropexy but the inverted vaginal vault is attached to the sacrum.Sacrospinous ligament fixation.
23Fascial defect repairs; Fascial or muscle plication or attachment to ligaments to support the vagina in its presumed original position.