Scribd
Upload
36 views

Pelvic Organ Prolapse Types and Stages

1. Pelvic organ prolapse is common and results from damage to soft tissues and nerves during childbirth. 2. The document discusses the types and stages of pelvic organ prolapse including cystocele, apical prolapse, and rectocele. 3. Treatment options include conservative measures like physiotherapy or pessaries as well as various surgical procedures depending on the type and severity of prolapse.

Uploaded by

layth hammad
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
36 views

Pelvic Organ Prolapse Types and Stages

1. Pelvic organ prolapse is common and results from damage to soft tissues and nerves during childbirth. 2. The document discusses the types and stages of pelvic organ prolapse including cystocele, apical prolapse, and rectocele. 3. Treatment options include conservative measures like physiotherapy or pessaries as well as various surgical procedures depending on the type and severity of prolapse.

Uploaded by

layth hammad
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
You are on page 1/ 55

PELVIC ORGAN PROLAPSE

TYPES AND STAGES

Dr Hamza Al-Amoosh
JBOG, FRCOG, MSc laparoscopy, ATSM Urogynaecology
Assistant Professor Hashmite University
Pelvic Organ Prolapse
Etiology
• Parity is the strongest risk factor
Oxford Family Planning Association Study 1997

• Increasing Parity and Maximum Birth Weight

Samuelsson EC Am J Obs Gyn 1999


Rinne KM Eur J obs Gyn 1999
Swift SE Am J Obs Gyn 2000
Pelvic Organ Prolapse
Etiology
• AGE and MENOPAUSE. Conflicting.
Significant increased risk. Swift SE 2000

No relation. Olsen AL 1997


Progetto Menopause italian study 2000
Pelvic Organ Prolapse
Etiology
• Constipation and Straining.

A Case-Control Study.
61% of women with Constipation and Straining will
develop POP.
4% of women with NO Constipation and Strain
will develop POP.
Spence-Jones C Br J Obset Gynecol 1994
Pelvic Organ Prolapse
Etiology
• HEAVY LIFTING

• OBESITY

• CHRONIC PULMONARY DISEASE


(increase abdominal pressure)
Pelvic Organ Prolapse
Etiology
• HYSTERECTOMY.
11.6% risk ( Prolapse)
1.8% risk ( No Prolapse )
Marchionni M J Reprod Med 1999

• Colposuspension (Enterocele) Wiskind Am J 1992


• Sacrospinous Fixation (anterior compartment
prolapse) Bump RC Am J Obs Gyn 1996
Pelvic Organ Prolapse
Etiology
• Vaginal Route > Abdominal.
Damage to pudendal nerve.
Benson JT Am J Obs Gyn 1996

• Vaginal = Abdominal
Maher CF Qatawneh Am J 2004
Pelvic Organ Prolapse
Etiology
Collagen Abnormalities.
• C.T. disorder associated with prolapse

• Women with genital prolapse  joint hyper mobility

• Women with genital prolapse > proportion type 111 (weaker


but flexible) collagen than type 1
•  total collagen,  collagenase, elastolytic
Epidemiology of Surgery for Pelvic
Organ Prolapse

1. 50% of women develop prolapse


10-20% of these seek medical treatment
(Beck 1983)

2. 11.1% lifetime risk of a single operation for pelvic


organ prolapse and or urinary incontinence
29.2% reoperation
(Olsen 1997)
Mechanism of normal supports of Uterus
and Vagina
Interaction between :
• Pelvic muscles ( Levator Ani group)
Primary support gives a firm elastic base on
which organs rest.
2. Connective Tissue
Stabilize the organs in Correct position

What happens during Micturition and Defecation?


Mechanism of normal supports of Uterus
and Vagina

• Levels of vaginal supports.


1. Level I . Cardinals and Uterosacrals

2. Level II.Arcus Tendineus(white line)

3.Level III.Perineal memb. and Body


Anterior Vaginal Wall Prolapse
Cystocele
• Pathologic descent of the anterior vaginal
wall and the overlying bladder base.
• Two Types
1. Distension
2. Displacement
Apical Prolapse
Uterine and Vault
• Damage to the Uterosacral-Cardinal ligament
Complex.
Uterine Prolapse
• Loss of the integrity of the anterior and
posterior vaginal walls.
Post hysterectomy or vault
Posterior Vaginal Wall Prolapse
Rectocele and Enterocele
• Enterocele: is a hernia in which the
peritoneum is in contact with the vaginal
mucosa. Absent endopelvic fascia.

• Rectocele: Defect in the Rectovaginal


Septum .
General Symptoms associated
prolapse
• Bulge, heaviness, or dragging
• backache
• vaginal dryness or irritation
• need to push the prolapse back after straining (
defecation)
• sexual activity embarrassing or painful
Urinary tract dysfunction and prolapse
Stress urinary incontinence
Bladder neck hyper mobility
Urinary frequency and urgency
Occult stress incontinence
Voiding dysfunction
Recurrent UTI
Ureters
Symptoms related to rectoceles
• Incomplete bowel emptying
• obstructed defecation
• constipation
• inability empty rectum without reducing
prolapse
• fecal incontinence if rectal prolapse
Grading System
• Cystocele Anterior wall
1st degree . Half way to the Hymen
2nd degree . To the Hymen
3d degree. Outside the Hymen
• Uterine or Vault Cervix or Vaginal apex
1st degree.
2nd degree.
3d degree.
Grading System

• Rectocele Posterior wall


1st degree.
2nd degree.
3d degree.
• Enterocele enterocele sac
1st degree
2nd degree
3d degree
New Classification
POP-Q System
• ICS 1996 Bump et al.
Standardization of terminology
Pelvic Organ Anatomy
Site – Specific
Quantitative
Compartments or Segments.
Options of Management
• No Treatment ( pelvic floor exercise)

• Conservative: such as
Physiotherapy or Pessary

• Surgical Treatment
Aims of prolapse surgery
• Alleviate symptoms

• Restore normal anatomy

• Restore normal visceral function

• Avoid new bladder or bowel symptoms

• Preserve sexual function

• Avoid surgical complications


Classisfication of prolapse
surgery
• Vaginal • Abdominal • Laparoscopic

Primary Primary All of the Abdominal


Vaginal hysterectomy procedures +/-
Paravaginal repair
Anterior/Posterior repair reinforcement
Hysteropexy

Secondary
Sacrospinous fixation Secondary +- reinforcement
Iliococcygeus fixation Sacrocolpopexy
Uterosacral fixation Uterosacral/Sacrospinous
fixation
Recurrent+/- reinforcement
Synthetic mesh/autologous/
donor/Xenograft
Conclusions
• Pelvic organ prolapse is common
• Results from injury to soft tissue and nerves
• Childbirth most significant association
• Treatment requires understanding of anatomic
relationships
• Treated with a combination of physio/pessary and
often complex surgery

You might also like