9. Pubocervical fascia
n Extend between the two
isch spine at level of
cervical ring and laterally
inserted at the white line
which is the arcus
tendenus
10. Rectovaginal fascia
n Extend between the two
isch spine at level of
cervical ring and laterally
inserted at the white line
which is the arcus
tendenus
12. White Line
arcus tendenus
n Is condensation of fascia
at the lavator ani muscaly
that extend from isch
spine to the back of
sympesis pubis at the
level of pubic tubercal
n Its detachment cause
paravaginal defect
14. Pelvic floor Muscle
n Levator ani
muscle
1- Pubovisceral muscle
Hammock muscle
( u shape muscle) sling
like arrangement
Include puboccygeous
and puborectalis
2- Iliococcygeous
muscle
Triangle muscle
n Coccygeus
15.
16.
17.
18. Pelvic support
n Not important in pelvic support:
Urogenital diaphragm
Superficial perineal muscle
Bulbocavernosus muscle
Round ligament
Broad ligament
19. DeLancey levels of vaginal support
n Level I suspension:
uterus and vagina vault
utrerosacral
n loss of this support result in vaginal
and uterine prolapse
n Level II: attachment
bladder and rectum
pubocervical and rectovaginal fascia)
(loss of this support result in cystocele
and rectocele
n Level III Fusion
diffuse to perineal body
20. Pelvic Organ Prolapse (POP)
Protrusion of the pelvic organs into, or
out of, the vaginal canal
34. Uterine prolapse
n First degree:
descend below ischial spine not reach
introits
n Second degree :
cervix visible at introits
n Third degree:
procidentia
the whole uterus is out side the introits
38. Epidemiology of POP
n Life time risk of developing POP: 11.1%
n 13% of hysterectomies in all ages
n Most common reason for hysterectomy in
women > 50
Olsen 1997, Allard 1991
39. Epidemiology of POP
Post-hysterectomy vault prolapse (PHVP):
n 11.6%: hysterectomy for pelvic prolapse
n 1.8%: hysterectomy for other benign
disease
Marchionni 1999
42. Damage to pelvic support
n Neuromuscular damage
n Connective tissue damage
43. Symptoms and Signs
n A symptomatic
n Heaviness / full feeling in the pelvis
n Some thing coming down
n Lump in vagina
n Urinary symptoms( up to anuria)
n Difficult in defection
n Difficulty in walking
n Vaginal discharge and bleeding
n Dysparonia ( the muscle are slack)
n Vagina flatus ( whoopee cushion)
47. Kegal Exercise
n Find the right muscle:
Lavator ani muscle
(Hammock muscle/Triangle muscle)
1- stop the flow of urine
2- stop passing gas
3- squeezes your finger in vagina
n How frequent you do
n Repeat but don't overdo it
48.
49.
50. 1. Obliterative (colpocleisis)
2. Reconstructive
Ø Abdominal/laparoscopic:
o Para-vaginal repair
Ø Vaginal:
o Anterior colporrhaphy
o Graft interposition
o Para-vaginal repair
Ant. POP: Surgical management
