Presentation is loading. Please wait.

Presentation is loading. Please wait.

Uterovaginal Prolapse Dr. Nusrat Nisar Department of Obstetrics & Gynaecology Liaquat University of Medical & Health Sciences, Jamshoro.

Similar presentations


Presentation on theme: "Uterovaginal Prolapse Dr. Nusrat Nisar Department of Obstetrics & Gynaecology Liaquat University of Medical & Health Sciences, Jamshoro."— Presentation transcript:

1 Uterovaginal Prolapse Dr. Nusrat Nisar Department of Obstetrics & Gynaecology Liaquat University of Medical & Health Sciences, Jamshoro

2 Uterovaginal prolapse is defined as protrusion of uterus or vagina beyond their normal anatomical confines

3 Incidence: 12 – 30% in multiparous women. 2% in nulliparous women.

4 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.

5

6 Classification Anterior vaginal wall prolapse; Urethrocele; Urethral descent. Cystocele; Bladder descent. Cystourethrocele; Descent of bladder & urethra.

7 Posterior vaginal wall prolapse; Rectocele; Rectal descent. Enterocele; Small bowel descent. Apical vaginal prolapse; Uterovaginal; Uterine descent with inversion of vaginal apex.

8 Vault prolapse; Post hysterectomy inversion of vaginal apex.

9 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.

10 Raised intra abdominal pressure; Chronic cough. Constipation. Post menopausal; Estrogen deficiency. Post operative; Vault prolapse.

11 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.

12 Specific; Cystourethrocele; Urinary frequency. Urgency. Voiding difficulty. Urinary tract infection. Stress incontinence. Rectocele; Incomplete bowel emptying. Digitation. Splinting.

13 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.

14 Differential Diagnosis Anterior wall prolapse; Congenital or inclusion dermoid vaginal cyst. Urethral diverticulm. Uterovaginal prolapse; Large uterine polyp.

15 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.

16 Treatment Depends upon patient`s wishes. Correct obesity. To treat chronic cough. Constipation. If ulceration then seven days course of local estrogen.

17 Prevention; Shortening the 2 nd stage of labor. Reducing traumatic delivery. Use of episiotomy. HRT in menopausal women.

18 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.

19 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.

20 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.

21 Sacrohysteropexy; Abdominal procedure, Attachment of synthetic mesh from the utertocevical junction to the anterior longitudinal ligament of the sacrum.

22 Vault prolapse; Sacrocolopopexy; Similar to Sacrohysteropexy but the inverted vaginal vault is attached to the sacrum. Sacrospinous ligament fixation.

23 Fascial defect repairs; Fascial or muscle plication or attachment to ligaments to support the vagina in its presumed original position.

24

25

26

27

28

29

30

31

32

33


Download ppt "Uterovaginal Prolapse Dr. Nusrat Nisar Department of Obstetrics & Gynaecology Liaquat University of Medical & Health Sciences, Jamshoro."

Similar presentations


Ads by Google