Presentation on theme: "Uterovaginal Prolapse Dr. Nusrat Nisar Department of Obstetrics & Gynaecology Liaquat University of Medical & Health Sciences, Jamshoro."— Presentation transcript:
Uterovaginal Prolapse Dr. Nusrat Nisar Department of Obstetrics & Gynaecology Liaquat University of Medical & Health Sciences, Jamshoro
Uterovaginal prolapse is defined as protrusion of uterus or vagina beyond their normal anatomical confines
Incidence: 12 – 30% in multiparous women. 2% in nulliparous women.
Grading: 1 st degree: Descent with in vagina. 2 nd degree: Descent up to the introitus. 3 rd degree: Descent out side the introitus also known as procidentia & usually accompanied by cystourethrocele & Rectocele.
Posterior vaginal wall prolapse; Rectocele; Rectal descent. Enterocele; Small bowel descent. Apical vaginal prolapse; Uterovaginal; Uterine descent with inversion of vaginal apex.
Vault prolapse; Post hysterectomy inversion of vaginal apex.
Etiology 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.
Raised intra abdominal pressure; Chronic cough. Constipation. Post menopausal; Estrogen deficiency. Post operative; Vault prolapse.
Diagnosis 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.
Abdominal 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.
Differential Diagnosis Anterior wall prolapse; Congenital or inclusion dermoid vaginal cyst. Urethral diverticulm. Uterovaginal prolapse; Large uterine polyp.
Investigation; No essential investigation. If urinary symptoms present; Urine microscopy. Cystometry. Cystoscopy. If renal failure suspected; B.Urea. S.Creatinine. U/s of renal areas.
Treatment Depends upon patient`s wishes. Correct obesity. To treat chronic cough. Constipation. If ulceration then seven days course of local estrogen.
Prevention; Shortening the 2 nd stage of labor. Reducing traumatic delivery. Use of episiotomy. HRT in menopausal women.
Medical Treatment Conservative therapy; 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.
Surgical Treatment Aim 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.
Utero 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.
Sacrohysteropexy; Abdominal procedure, Attachment of synthetic mesh from the utertocevical junction to the anterior longitudinal ligament of the sacrum.
Vault prolapse; Sacrocolopopexy; Similar to Sacrohysteropexy but the inverted vaginal vault is attached to the sacrum. Sacrospinous ligament fixation.
Fascial defect repairs; Fascial or muscle plication or attachment to ligaments to support the vagina in its presumed original position.