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Uterovaginal Prolapse

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Presentation on theme: "Uterovaginal Prolapse"— 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: 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.


6 Classification Anterior vaginal wall prolapse; Urethrocele; Cystocele;
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; Rectocele; 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 2nd stage of labor.
Reducing traumatic delivery. Use of episiotomy. HRT in menopausal women.

18 Medical 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.

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.










33 The End

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