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PELVIC ORGAN PROLAPSE

PELVIC ORGAN PROLAPSE. Dr. Hazem Al-Mandeel 481 GYN Department of Obstetrics & Gynecology. Objectives. To define pelvic organ prolapse Recognize pelvic anatomy Determine the Pathophysiology Discuss the predisposing factors Understand the grading systems

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PELVIC ORGAN PROLAPSE

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  1. PELVIC ORGAN PROLAPSE Dr. Hazem Al-Mandeel 481 GYN Department of Obstetrics & Gynecology

  2. Objectives • To define pelvic organ prolapse • Recognize pelvic anatomy • Determine the Pathophysiology • Discuss the predisposing factors • Understand the grading systems • Be aware of the options of management

  3. Pelvic Organ Prolapse • Is the descent of the pelvic organs as a result of the loss of muscular and fascial structural support .

  4. Anatomic Supports • Muscular : Levator Ani (Pelvic Floor Ms.) • Ligaments : Uterosacral-Cardinal Complex • Fascial : Endopelvic (Pubocervical & Rectovaginal)

  5. Levator Ani • Major structure of pelvic floor • Anterior/posterior orientation • Perforated by urogenital hiatus • Consists of : Pubococcygeus Iliococygeus Puborectalis Coccygeus

  6. Endopelvic Fascia • Fibromuscular layer • Local condensations are ligaments • Principal ligaments are Uterosacral Cardinal • Pubocervical and Rectovaginal Fascia important in specific surgical correction

  7. Pathophysiology • Direct Trauma to pelvic soft tissues • Neurological injury • Connective tissue disorders

  8. Predisposing Factors • Hereditary (genetic) predisposition • Race: White > Black > Asian • Pregnancy and Vaginal Childbirth • Age and Menopause • Raised intra-abdominal pressure (e.g.: obesity, cough, constipation, lifting, etc) • Iatrogenic: surgical procedure

  9. Types of Pelvic Organ Prolaopse 1. Urethra 2. Bladder 3. Uterus/ Vaginal Vault 4. Small Bowel 5. Rectum 6. Perineum

  10. Compartments • Anterior : Cystocele Urethrocele • Middle : Uterine prolapse Enterocele/vault prolapse • Posterior : Rectocele Rectal prolapse

  11. Classification of Prolapse • Baden Walker (1972) • Each site graded from 1 – 4 • POPQ: quantifies using specific points • Measured relation to the hymenal ring • More widely used

  12. Symptoms of Prolapse • Pelvic pressure • Pelvic pain • Feeling of a “lump” • Back pain • Urinary dysfunction • Bowel dysfunction

  13. Complications of Prolapse • Bleeding • Infection • Recurrent UTI’s • Urinary obstruction • Renal failure

  14. Associated conditions • Urinary Incontinence : Stress Urge Mixed • Fecal Incontinence : sphincter injury

  15. Options of Management • No Treatment ( pelvic floor exercise) • Conservative: such as Physiotherapy or Pessary • Surgical Treatment

  16. 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

  17. 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

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