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Dr. Hazem Al-Mandeel 481 GYN Department of Obstetrics & Gynecology

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Presentation on theme: "Dr. Hazem Al-Mandeel 481 GYN Department of Obstetrics & Gynecology"— Presentation transcript:

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

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



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




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





20 middle

21 The pt had hysroectomy



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



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



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






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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