Prolapse & Urogynaecology
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Transcript Prolapse & Urogynaecology
Craig Dyson
Sioned Griffiths
October 2013
Normal Anatomy
Causes of prolapse
Types of Prolapse
Investigation
Management
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“To fall out”
Protrusion of an organ or structure beyond its
normal confines and with an epithelial surface
Genitourinary prolapse – Descent of one or
more of pelvic organs.
41% of 50-79 year old’s but uncertain
Uterocoele, Cystocoele, Rectocoele, Enterocoele
Levator Ani/Endopelvic Fascia important
Damage to these structures can occur through:
Trauma
Neuropathic Injury
Disruption/Stretching
Multifactorial – Orientation of bones may be a
factor.
Increasing Age
(Double risk with
every decade)
Vaginal Delivery
Increasing parity
Obesity
Spina Bifida
Pregnancy Variables
Macrosomia
Prolonged 2nd stage
Episiotomy
Use of
forceps/oxytocin
FH of prolapse
Constipation
Connective Tissue
Disorder
Occupation
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Anterior
Urethrocoele
Urinary Stress
Incontinence
– Rare
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Cystocoele
Increased frequency
– UTI
– Sensation of mass
– No Symptoms
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Both
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Most Common
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Middle
Uterine Prolapse
Vaginal Vault Prolapse
Post Hysterectomy
– Assoc with cystocoele,
rectocoele and
enterocoele.
– Retention
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Enterocoele
Pouch of Douglas
– Cough Impulse
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Posterior
Rectocoele
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Pelvic Organ Prolapse Quantification System
Valsalva - ? Left Lateral
Stage 0
Stage 1 – 1cm above hymen
Stage 2 - Within 1 cm of hymen
Stage 3 - >1cm below plane of hymen but <2cm
of total length of vagina
Stage 4 – Complete eversion of vagina
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General
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Urinary
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Incontinence
Frequency
Coital
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Fullness
Sensation of bulge
Backache
Dypareunia
Flatus
Bowel
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Constipation/Incontinence
Need to apply digital pressure
History and
Examination
Urinalysis
Post-Voidal Urine
volume testing
Urodynamics
US
Urea/Creatinine
Conservative
Watchful Waiting
Lifestyle Modification
Pelvic Floor Exercises
Evidence?
Vaginal Oestrogen
Creams
Pessary
Inserted into vagina to
reduce prolapse
Made of silicon or
plastic or Soaked in
wine…
Good short term
option
Surgical
Effective
Re-operation required
in 29% of cases
Fitness of patient
Sexually Active
Surgeons Advice
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Anterior Colporrhaphy
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Hysterectomy
Sacrospinous Fixation
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Involves plication of anterior vaginal wall to
reinforce.
Unilateral or bilateral fixation of uterus to
sacrospinous ligament
Sacocolpoplexy
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Mesh used to attach top of vagina to sacrum.
Prolapse is increasingly common with age.
Can be classified according to compartment or
level of prolapse
Can be clear on examination
Good conservative and surgical options
available
Good prognosis
Pessary treatment for pelvic organ prolapse and health-related quality of life: a review. Lamers BH, Broekman
BM, Milani AL - Int Urogynecol J (2011)
Rev Urol. 2004; 6(Suppl 5): S2–S10. PMCID: PMC1472875. Female Pelvic Floor Anatomy: The Pelvic Floor,
Supporting Structures, and Pelvic Organs. Sender Herschorn
Herschorn S, Carr LK. In: Campbell’s Urology. 2002:1092–1139.
Rectocele | Vaginal Surgery & Urogynecology Institute .vaginalsurgeryandurogynecologyinstitute.com
Int J Med Sci 2012; 9(10):894-900. doi:10.7150/ijms.4829. Three-dimensional Ultrasound Appearance of Pelvic Floor in
Nulliparous Women and Pelvic Organ Prolapse Women. Tao Ying Corresponding address, Qin Li, Lian Xu, Feifei Liu,
Bing Hu
http://www.patient.co.uk/health/Genitourinary-GU-Prolapse.htm
www.pelvicfloor.com/knowledge/imagelibrary/1/img/1.jpg
www.bristolsurgery.com/images/Preop%20Rectocele.jpg