Genital Prolapse

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Genital Prolapse

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

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