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PELVIC ORGAN PROLAPSE Dr. Hazem Al-Mandeel 481 GYN Department of Obstetrics & Gynecology السلايد كافي كمرجع – طبقا لكلام الدكتور تم اضافه نوت من التيم.

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Presentation on theme: "PELVIC ORGAN PROLAPSE Dr. Hazem Al-Mandeel 481 GYN Department of Obstetrics & Gynecology السلايد كافي كمرجع – طبقا لكلام الدكتور تم اضافه نوت من التيم."— Presentation transcript:

1 PELVIC ORGAN PROLAPSE Dr. Hazem Al-Mandeel 481 GYN Department of Obstetrics & Gynecology السلايد كافي كمرجع – طبقا لكلام الدكتور تم اضافه نوت من التيم

2 Objectives To define pelvic organ prolapse Recognize pelvic anatomy Determine the Pathophysiology Discuss the predisposing factors Understand the grading systems Be aware of the options of management

3 Pelvic Organ Prolapse Is the descent of the pelvic organs as a result of the loss of muscular and fascial structural support. The only orifice for prolapse is the vagina Cause : destruction of one or more of the Anatomical support

4 Anatomic Supports مهمه جدا – ( محل اسئله ) Muscular : Levator Ani (Pelvic Floor Ms.) Ligaments : Uterosacral-Cardinal Complex Fascial : Endopelvic (Pubocervical & Rectovaginal)

5 1- Levator Ani Major structure of pelvic floor Anterior/posterior orientation Perforated by urogenital hiatus Consists of : Pubococcygeus Iliococygeus Puborectalis Coccygeus اول اثنين اهم شي

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8 2- Endopelvic Fascia Fibromuscular layer Local condensations are ligaments Principal ligaments are Uterosacral Cardinal Pubocervical and Rectovaginal Fascia important in specific surgical correction

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12 Pathophysiology Direct Trauma to pelvic soft tissues Neurological injury Connective tissue disorders

13 Predisposing Factors مهمه Hereditary (genetic) predisposition Race: White > Black > Asian Pregnancy and Vaginal Childbirth Age and Menopause Raised intra-abdominal pressure (e.g.: obesity, cough, constipation, lifting, etc) Iatrogenic: surgical procedure

14 Types of Pelvic Organ Prolaopse 1. Urethra 2. Bladder 3. Uterus/ Vaginal Vault 4. Small Bowel 5. Rectum 6. Perineum body ( between the vagina and the uterus )

15 Compartments according to the relation to the vagina Anterior : Cystocele Urethrocele Middle : Uterine prolapse Enterocele/vault prolapse Posterior : Rectocele Rectal prolapse

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21 The pt had hysroectomy

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24 Rectocele

25 Classification of Prolapse Baden Walker (1972) Each site graded from 1 – 4 POPQ: quantifies using specific points Measured relation to the hymenal ring More widely used

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28 Symptoms of Prolapse مهمه – اسئله Pelvic pressure Pelvic pain Feeling of a “lump” Back pain Urinary dysfunction Bowel dysfunction

29 Complications of Prolapse Bleeding Infection Recurrent UTI’s Urinary obstruction Renal failure

30 Associated conditions Urinary Incontinence : Stress Urge Mixed Fecal Incontinence : sphincter injury

31 Options of Management  it is not emergency No Treatment ( pelvic floor exercise) Conservative: such as Physiotherapy or Pessary ( انظر الشريحه القادمه Surgical Treatment

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34 Aims of prolapse surgery Alleviate symptoms Restore normal anatomy Restore normal visceral function Avoid new bladder or bowel symptoms Preserve sexual function Avoid surgical complications

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40 Conclusions Pelvic organ prolapse is common Results from injury to soft tissue and nerves Childbirth most significant association Treatment requires understanding of anatomic relationships Treated with a combination of physio/pessary and often complex surgery


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