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Cirurgia Vaginal Para Urologistas

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

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  1. Cirurgia Vaginal Para Urologistas Prof Paulo Palma Titular Urologia Feminina UNICAMP

  2. Anterior Vaginal Prolapse (AVP) Central Defect Uterus P Tendineous Arc Lateral Defect Vagina

  3. Possible fascial tearings Davila, Guerette.IUGA 2004

  4. Transverse defect

  5. Anterior Vaginal Prolapse • Anterior repair

  6. Paravaginal repair Richardson, 1976

  7. Anterior Vaginal Prolapse (AVP) Uterus P Vagina

  8. 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

  9. Posterior vaginal wall prolapses The past Levator ani Miorraphy The Present Pericervical ring reconstruction Posterior Slings

  10. Levator miorraphy Anti anatomic Pain, dypareunia, recurrency

  11. Rectovaginal Fascia Connective Tissue between the vagina and the rectum Smooth Muscle fibers

  12. Rectovaginal Fascia Preserve vaginal lengh and helps rectal function Main supportive element of the posterior wall

  13. Anatomical levels Support Lateral Fusion Stenchever,Urogynecology and Reconstructive Pelvic Surgery, Vol. V

  14. 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

  15. 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

  16. Pericervical Ring

  17. Posterior Defect Posterior Vaginal Prolapse (PVP) Rectum Uterus Tendineous Arc P Vagina Levator ani

  18. Pericervical Ring

  19. Surgical Approach

  20. Utero Reto Arco tendineo P Vagina Elevador ânus Surgical Approach

  21. Posterior Vaginal Prolapse Repair Rectum Uterus Tendineous Arc P Sacrospinal Ligament Vagina Levator ani

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