Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Uterovaginal prolapse By Dr rizwan ullah khan

1,664 views

Published on

Uterovaginal prolapse By Dr rizwan ullah khan

Published in: Health & Medicine
  • Be the first to comment

Uterovaginal prolapse By Dr rizwan ullah khan

  1. 1. UTEROVAGINAL PROLAPSE
  2. 2. CASE : A 62 years old woman complains of low back pain and perineal pressure for 1 and half years. She has been prescribed a pessary which she is reluctant to wear. On pelvic examination a 2nd degree uterine prolapse with cystocele and rectocele is observed.
  3. 3. UTERINE PROLAPSE: “Is the condition of the uterus collapsing, falling down, or downward displacement of the uterus with relation to the vagina. It is also defined as the bulging of the uterus into the vagina.’’ VAGINAL PROLAPSE: “ Is characterized by a portion of the vaginal canal protruding from the opening of the vagina.”
  4. 4. ANATOMY: In the pelvic floor, pelvic diaphragm is divided into anterior triangle and posterior triangle. Anterior triangle consist of urethra and vagina. Posterior triangle consist of rectum.
  5. 5. SUPPORTS OF THE UTERUS: 1. Cardinal ligament(mackenrodt’s, transcervical,lateral Cx ligament) 2. Uterosacral ligament 3. Pubocervical fascia
  6. 6. SUPPORTS OF VAGINA: 1. Cardinal ligament 2. Pubo cervical ligament 3. Pelvic floor muscles 4. Perineal body
  7. 7. HISTORY:  First recorded in about 2000 BC.  First ever successful vaginal hysterectomy for prolapse was done by a peasent woman on her own. She cut down her uterus,but end up with urinary incontinence.
  8. 8. TYPES OF VAGINAL PROLAPSE • a.Urethrocele b.cystocele • c.Cystourethrocele Anterior vaginal wall prolapse • a.Rectocele • b.Enterocele Posterior vaginal wall prolapse • a.Uterovaginal • b.vault prolapse Apical vaginal prolapse
  9. 9. Degrees of prolapse of uterus: There is usual a Right angle Relationship between uterus and vagina. How the uterus changes into the same plane as the vagina? As the uterus gets start descending, the uterus starts moving down and down and down until Outside of the body. When it almost outside the body is called procidentia: marked prolapse
  10. 10. Grade I: cervix is not in vagina. Grade II: cervix is now in vaginal opening. Grade III: (procidentia) The uterus is hanging outside and here it is wrapped by anterior and posterior wall of vagina.
  11. 11. ETIOLOGY of Pelvic Relaxation It is most commonly related to CHILD BIRTH. When you push a nine pounds baby through a pelvic floor, injury is not uncommon.
  12. 12. 1-EVALUATION 1-HISTORY a-non specific symptoms b-specific symptoms c-also ask about PARITY MODE OF DELIVERIES
  13. 13. 2-PHYSICAL EXAMINATION 1-GENERAL EXAMINATION 2-SPECULUM/VAGINAL EXAMINATION Sim’s position 3-RECTAL EXAMINATION
  14. 14. 3-INVESTIGATIONS A-BASE LINE FBC,UCE,FBS,Blood group X match,Urine microscopy,CXR,ECG B-ADDITIONAL RFTs,U/S,CT, MRI
  15. 15. DIFFERENTIAL DIAGNOSIS  Cervical polyp  Large endometrial polyp  Cervical cancer  Metastasis of ut.cancer  Pedunculated myoma  Urethral diverticulum  Vaginal wall cyst
  16. 16. COMPLICATIONS  Decubitus ulcers  Keratinization of vagina  Hypertrophy of cervix  Recurrent UTI  Acute urinary retention  Hydroureter/hydronephrosis  Renal failure  Incarceration
  17. 17. MANAGEMENT  According to age of the patient,level of fitness,her wish for future fertility. a-counselling b-prevention c-treatment
  18. 18. TREATMENT  DIVIDED INTO TWO CATEGORIES A-MEDICAL Pessary B-SURGICAL
  19. 19. SURGICAL *CYSTOCELE/URETHROCELE 1-Anterior colporrhaphy 2-Burch colposuspension
  20. 20. *RECTOCELE 1-Conservative 2-Posterior colporrhaphy
  21. 21. *ENTEROCELE 1-ABDOMINAL APPROACH 2-VAGINAL APPROACH Sacrospinous fixation
  22. 22. *Uterovaginal prolapse 1-CONSERVATIVE a-Manchester repair b-Sling operation 2-RADICAL a-Vaginal hysterectomy
  23. 23. *Vault prolapse 1-Le fort’s operation 2-Utero sacral ligament suspension 3-Sacro spinous ligament fixation
  24. 24. THANK YOU Rizwan Ullah Khan Roll No: 08-157 Batch: ‘I’

×