Genital Prolapse
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Genital Prolapse

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Genital Prolapse Genital Prolapse Presentation Transcript

  • Genital prolapse ISMAEL YOUSIF
  • Definition
    • Genital Prolapse:
    • Is herniation of the genital organs
    • through the genital tract.
  •  
  • Support of the pelvic organs:
    • The main support is by the :
    • 1-pelvic floor muscles:
    • -Levator ani
    • -Coccygeus
    • -Internal Obturator
    • -Piriformis
    • -Transverse perineal muscles
  • Support of the pelvic organs
    • 2- Pelvic ligaments:
    • - Transverse cervical ligaments (Cardinal)
    • - Uterosacral ligaments
    • - Pubocervical ligaments
    • - Pubourethral ligaments
    • 3- Pelvic Fascia
  • Minor support:
    • Round ligament
    • Broad ligament
  •  
  • Classification
    • Vaginal wall prolapse:
    • #Anterior:
    • 1- Urethrocele:
    • Descend of the lower part of the anterior vaginal wall containing the urethra.
    • 2- Cyctocele:
    • Descend of the upper part of the anterior vaginal wall containing the bladder.
  • Vaginal wall prolapse:
    • #Posterior:
    • 1- Enterocele:
    • Descend of the upper posterior vaginal wall containing small bowl from the pouch of Douglas
    • 2- Rectocele:
    • Descend of the lower posterior vaginal wall containing the rectum.
  • Vaginal wall prolapse:
    • #Middle:
    • Vault prolapse:
    • Descend of the vaginal vault after hysterectomy , usually contains : small bowl and omentum.
  • Uterine Prolapse:
    • 1- First degree:
    • The uterus is with in the vagina.
    • 2- Second degree:
    • The cervix protrudes outside through the introitus .
    • 3- Third degree (Procidentia):
    • The entire uterus has come out the vagina.
  •  
  •  
  •  
  • Uterine Prolapse
  • Uterine Prolapse
  • Vaginal Vault Prolapse
  • Vaginal Vault Prolapse
  • Aetiology
    • Major causes:
    • 1- C ongenital weakness of the pelvic floor ligaments and fascia.
    • 2- C hild birth:
    • Pregnancy, prolonged or difficult labour,
    • bearing down before full cervical dilatation, multiparity and instrumental delivery.
    • 3- C limacteric: weakness and denervation of the pelvic floor muscles due to oestrogen deficiency.
  • Aetiology
    • Minor causes:
    • - C hronic C ough
    • -Chronic C onstipation
    • -Increased Intra abdominal pressure:
    • .Masses
    • .Ascitis
    • .Pulmonary disease
    • .heavy lifting
  • Presentation:
    • Minor Prolapse can be asymptomatic
    • Uterovaginal prolapse patients can complain of feeling of some thing coming down .
    • . Pelvic insecurity
    • . Low backache ,relieved by lying flat.
    • Procidentia may present with bloody stained vaginal discharge some times purulent due to :
    • Decubitus ulcer of the vaginal skin of the cervix.
  • Presentation:
    • Cyctocele and cyctourethrocele :
    • .Dragging discomfort .
    • .Sensation of lump in the vagina.
    • .Urinary symptoms.
    • .Recurrent UTI.
    • Rectocele:
    • .Difficulty with defecation.
    • .Incomplete defecation.
  • Diagnosis:
    • History:
    • .Age , Obstetric history, Medical history
    • Examination:
    • .General, weight , Chest, Abdomen, Speculum examination.
    • Investigations:
    • .Urine, RFT , Chest X-Ray, U/S
  • Management:
    • Prevention:
    • .Reducing weight
    • .Avoid smoking
    • .Avoid difficult labour
    • .Contraception
    • .Pelvic floor exercise after delivery.
  • Medical management:
    • HRT:
    • .Hormone replacement therapy:
    • Increases vaginal blood supply and collagen turnover
  • Ring Pessaries:
    • Indications:
    • Patient request
    • Patient is medically unfit for surgery
    • Therapeutic test before surgery
    • To relieve symptoms while the patient is awaiting surgery
    • During and after pregnancies if the patient want to preserve her fertility
  • Surgical management:
    • Cyctourethrocele:
    • Anterior Colporrhaphy
    • Rectocele:
    • Posterior Colpoperineorrhaphy
    • Uterine Prolapse:
    • 1 st 2 nd Degree:
    • Manchester Repair
    • 3ed Degree (procedentia):
    • Vaginal hysterectomy
  • Thank You