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Staging and Management of Genital Prolapse
Dr. V.P.Paily MD; FRCOG ProfessorJubilee Mission Medical College, Thrissur, Kerala. Consultant, Mother Hosp and Raji Nursing Home , Thrissur, Kerala
Prolapse Very common problem.Confusion regarding assessing degree / stage
Conventional Staging Cervix is the main point.
Conventional staging Difference between British and American System.
Baden Walker Halfway System
Prolapse quantificationPelvic organ prolapse quantification(POP-Q) Recommended by ICS, society of Gyn.Surgeons &Amer. Urogyn. Surgeons
Pelvic organ prolapse Quantification POP Q
Quantification Vault, Cx or Posterior fornixAnterior & Posterior walls Introitus Perineal body Length of vagina
Quantification Anterior (a) -- Point A & BPosterior (p) Point A & B Point C Lips of Cervix Point D Post.fornix
Quantification Length of vagina Diameter of introitus Perineal body
Quantification Aa Ba C gh pb tvl Ap Bp D
POP-Q Drawbacks Appears complicated Doesn’t include lateral prolapse.
Comprehensive pattern required incorporating defects at various levels & compartments
Look for defects At 3 levels Upper Middle Lower
Look for defects At two compartments Anterior Posterior
Compartmental approachLevel 1 Descent of cervix Descent of vault Enterocele
Compartmental ApproachLevel 2 Anterior segment – cystocele Posterior segment – rectocele Lateral detachment
Compartmental ApproachLevel 2 High rectocele can extend up to post fornix and has to be differentiated from enterocele.
Compartmental ApproachLevel 2 Midline defects are due to tear or weakness of fascial envelope – pubo vesico cervical fascia and rectovaginal fascia ( Denonvilliers).
Compartmental ApproachLevel 3 Anteriorly – Urethrocele Posteriorly – Detached perineal body
Compartmental ApproachLevel 3 Detached Perineal body Reattach to recto vaginal fascia
Practical approach to Level 3 defectsCommon complaint Sound of air being sucked in
Compartmental ApproachLateral detachment Reattach to Arcus Tendineus Fascia pelvis or Arcus Tendineus Fascia Rectovaginalis
Compartmental ApproachAnterior Lateral detachment Richardson’ s operation Transvaginal Transabdominal Endoscopic
Compartmental ApproachPosterior Lateral detachment Reattach to Arcus tendineus fascia rectovaginalis
Symptomatology Record symptoms related to Anatomical descentUrinary function Sexual function Reproductive need GI symptoms Air suction
Management Restore anatomy by correcting the defect.
Older age with weak tissues
Mesh for Repair Concept borrowed from Hernia repairSpecial mesh being developed. (Gyne mesh) We have tried prolene mesh.
Conclusions Detailed record of defects Detailed record of symptomsIndividualised surgery
Pelvic Floor Anatomy and Female Lower Urinary Tract Dysfunction
Avascular Spaces of the Pelvis
PELVIC ORGAN PROLAPSE POP
Pelvic Floor Dysfunction
Pelvic Organ Prolapse : Overview of Causes and Surgical Options
8th Edition APGO Objectives for Medical Students
Dr. Hazem Al-Mandeel 481 GYN Department of Obstetrics & Gynecology
ANATOMY OF THE FEMALE REPRODUCTIVE SYSTEM
بسم الله الرحمن الرحيم Genital prolapse.
Pelvic Organ Prolapse(POP) Treatment: A Urogynecology Perspective
Anatomy of the Female Genital Tract & Pelvic Floor
Transvaginal Apical Repair (non-mesh)
Anatomy of normal pelvis & Fetal skull
Pelvic Prolapse and Lower Urinary Tract Symptoms
Relaxation of Pelvic Supports (Pelvic Organ Prolapse)
Management Of Genital Prolapse
Treatment of Pelvic Organ Prolapse: Controversies in Surgical Care and Nonsurgical Options Raymond T. Foster, Sr., M.D., M.S., M.H.Sc. Assistant Professor.
Genital Organ Displacement
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