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Genital Prolapse 1

Genital prolapse is the descent of genital organs beyond their normal anatomical position, often caused by factors such as childbirth, increased intra-abdominal pressure, and aging. It is classified into anterior, posterior, and apical vaginal wall prolapses, with common symptoms including a feeling of something coming down, urinary issues, and bowel difficulties. Treatment options include conservative methods like pessaries and surgical interventions aimed at restoring anatomy and function.

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6 views24 pages

Genital Prolapse 1

Genital prolapse is the descent of genital organs beyond their normal anatomical position, often caused by factors such as childbirth, increased intra-abdominal pressure, and aging. It is classified into anterior, posterior, and apical vaginal wall prolapses, with common symptoms including a feeling of something coming down, urinary issues, and bowel difficulties. Treatment options include conservative methods like pessaries and surgical interventions aimed at restoring anatomy and function.

Uploaded by

twwmhhtwwmhh
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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GENITAL

PROLAPSE

DR. GAMAR BUSHRA OMER


Definition:

Genital prolapse is the downward descend


of the genital organs behind their normal
anatomical confines, towards or through
the introitus
Genital supports

1. Cervical ligaments(main uterine support )


Cardinal ligament: from the cx and the vaginal
vault to the lateral pelvic wall
Uterosacral :to the 3rd piece of the sacrum
Pubocervical, pubourethral, puborectal ligament to
the back of s. pubis.
2. Pelvic floor muscles :
Mainly levator ani and illiococcygeus
3. Antivertion of the uterus: longitudinal axis of the
uterus is perpendicular to the longitudinal axis
of the vagina .
Genital supports
Aetiology

1. Childbirth
2. Increased intra-abdominal pressure
3. Congenital
4. Ageing
5. Postoperative
6. Racial
Grading

There are 3 degree of prolapse assessed


whilst the pt is straining.
1st decent within the vagina
2nd decent to the introitus.
3rd decent outside the vagina(procidentia)
Classifications

Anterior vaginal wall prolapse :


1. Urethrocele
2. Cystocele
3. Cystourethrocele
 Posterior vaginal wall prolapse:
1. Recocele
2. enterocele
3. Apical vaginal wall prolapse:
 Uterovaginal
 vault
Classifications
Clinical presentation

 Always presents with the complaint of


“something coming down”
 Urinary symptoms when there is
cystocele or cystourthrocele : a.
Increased frequency
because of persistent residual urine

b.Recurrent
urinary tract infection because of stasis
Clinical presentation

Bowel symptoms:
1 difficulty in defecation
2 Incontinence of flatus and stool.
3 Digitation of perineum to complete
defecation
4 Feeling of incomplete evacuation
 Coital difficulties.
Ex and investigations

Chest ;abdominal ,VE.


Routine invest. CXR, U/S , RFT.
Treatment

Prior to specific treatment;


Treatment

Treatment

Medical
or Surgery
Conservative
(Silicon rubber-based ring, pessaries)
Indications for pessary treatment

1. Medically unfit.
2. During and after pregnancy
3. Childbearing not complete
4. While waiting for surgery

Complications :vaginal ulceration and


infection
Ring pessary
Surgery

The aim of surgery is to restore anatomy


and function.
Vaginal and abdominal operations
Cystourethrocele:
anterior repair or colporrhaphy is the
commonest surgery performed
Rectocele :
Posterior colporrhaphy
surgery

Enterocele :
like ant. And post. Repair but
the peritoneal sac containing the bowel
should be excised.
Uterovaginal prolapse:
Vaginal hysterectomy and
anterior and posterior repair . If ut
conservation is required, Manchester
operation is done.
Vault prolapse:
Sacrocolpopexy, v. vault to the
sacrum using mesh
Chronic cough
Constipation
Intra-abdominal masses
Ascites
Heavy lifting

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