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Cirurgia Vaginal Para Urologistas. Prof Paulo Palma Titular Urologia Feminina UNICAMP. Anterior Vaginal Prolapse (AVP). Central Defect. Uterus. P. Tendineous Arc. Lateral Defect. Vagina. Possible fascial tearings. Davila, Guerette.IUGA 2004. Transverse defect.
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Cirurgia Vaginal Para Urologistas Prof Paulo Palma Titular Urologia Feminina UNICAMP
Anterior Vaginal Prolapse (AVP) Central Defect Uterus P Tendineous Arc Lateral Defect Vagina
Possible fascial tearings Davila, Guerette.IUGA 2004
Anterior Vaginal Prolapse • Anterior repair
Paravaginal repair Richardson, 1976
Anterior Vaginal Prolapse (AVP) Uterus P Vagina
Anterior Vaginal Prolapse Mesh vs Anterior repair n T (m) Success (%) Complications Julian Marlex 12 24 100 25% erosion Colp. Ant. 12 24 66 no Sand Poliglactina 73 12 75 no Colp. Ant. 70 12 57 no Weber Poliglactina 26 23 42 n0 Colp. Ant. 57 23 37 no Modified from Tayrac el al Int Urogyn J 2006, 17:100
Posterior vaginal wall prolapses The past Levator ani Miorraphy The Present Pericervical ring reconstruction Posterior Slings
Levator miorraphy Anti anatomic Pain, dypareunia, recurrency
Rectovaginal Fascia Connective Tissue between the vagina and the rectum Smooth Muscle fibers
Rectovaginal Fascia Preserve vaginal lengh and helps rectal function Main supportive element of the posterior wall
Anatomical levels Support Lateral Fusion Stenchever,Urogynecology and Reconstructive Pelvic Surgery, Vol. V
PERICERVICAL RING AT THE LEVEL OF THE ISCHIAL SPINES; COMPLEX REPRESENTED BY THE CONTINUITY OF THE CARDINAL-UTEROSACRAL LIGAMENTS WITH: • ONE OF THE MOST IMPORTANT CONCEPTS FOR • RECONSTRUCTIVE VAGINAL SURGEONS; • PUBOCERVICAL AND RECTOVAGINAL FASCIA. Adapted from Netter, Atlas of Human Anatomy
CHILDBIRTH AND PVP ON THE DESCEND AND EXTENSION OF THE FETAL HEAD, INTENSE PRESSURE IS EXERTED ON THE SUSPENSORY FUNCTION OF THE UTEROSACRAL LIGAMENTS; CONTINUATION OF THIS PROCESS RESULTS IN A PROXIMAL TRANSVERSE SEPARATION OF THE RECTOVAGINAL SEPTUM FROM THE UTEROSACRAL LIGAMENT AND THE PERICERVICAL RING; Adapted from Williams, Obstetrics
Posterior Defect Posterior Vaginal Prolapse (PVP) Rectum Uterus Tendineous Arc P Vagina Levator ani
Utero Reto Arco tendineo P Vagina Elevador ânus Surgical Approach
Posterior Vaginal Prolapse Repair Rectum Uterus Tendineous Arc P Sacrospinal Ligament Vagina Levator ani