PelvicOrganProlapse.ppt_20251015_170822_0000.pdf

Pelvic organlar

1. Theme : Pelvic organs and
abnormalities
502 b group
Khakimov Akhadjon

2. Elements comprising the Pelvis
Bones
Ilium, ischium and pubis fusion
Ligaments
Muscles
Obturator internis muscle
Arcus tendineus levator ani or white line
Levator ani muscles
Urethral and anal sphincter muscles

3. Endopelvic fascia
Meshwork of collagen, elastin and smooth
muscle
Extends from the level of uterine artery to
the fusion of the vagina and levator ani
Attached to uterus is parametrium –
cardinal-uterosacral ligament complex
Attached to vagina is paracolpium –
pubocervical and rectovaginal fasciae

4. Normal Vaginal Support
Anatomy
Bladder, upper two-third vagina and
rectum lie in a horizontal axis
Urethra, distal one-third vagina and
anal canal are vertical in orientation
Pelvic floor is horizontal and like a
hammock – levator plate
Levator ani muscles and perineal body
support the vertical orientation

5. The axes of pelvic support
Three support axes
Upper vertical axis (cardinal-uterosacral
ligament complex)
Horizontal axis leads to lateral and
paravaginal supports
Two platforms pubocervical fascia and
rectovaginal septum
Lower vertical axis supports the lower third of
the vagina, urethra and anal canal

6. Fascial and Muscular layers of
the Pelvic Floor

7. Perineum
Anterior pubic arch, posterior coccyx tip,
lateral ischiopubic rami, ischial tuberosities
and sacrotuberous ligaments frame the
perineum into a diamond shape
Divided into two angulated triangles
Posterior anal triangle contains the anal canal
Anterior urogenital triangle contains the
vagina and urethra

8. External genital muscles and
the Urogenital diaphragm

9. Pelvic Relaxation
Cystocele
Stress urinary incontinence
Rectocele
Enterocele
Uterine and vaginal prolapse
Result of weakness or defect in supporting tissues
- endopelvic fascia and neuromuscular damage

10. PROLAPSE
Mutifactorial involving both neuromuscular
and endopelvic fascial damage
Relaxation of the tissues supporting the pelvic
organs may cause downward displacement of
one or more of these organs into the vagina,
which may result in their protrusion through
the vaginal introitus.

11. Factors promoting prolapse
Erect posture causes increased stress on
muscles, nerves and connective tissue
Acute and chronic trauma of vaginal delivery
Aging
Estrogen deprivation
Intrinsic collagen abnormalities
Chronic increase in intraabdominal pressure
heavy lifting
coughing
constipation

12. Clinical Evaluation
Hormonal and neurologic evaluation
Level of estrogenization
Sensory and sacral reflex activity
Quantitative site-specific assessment of pelvic
floor components
in lithotomy position, patient sitting
at rest and with valsalva
ability to contract levator and anal sphincter
muscles

13. Type English term Description Diagram summary
1
Uterine agenesis /
aplasia
Uterus completely
absent
No uterus at all
2 Unicornuate uterus
Only one Müllerian
duct develops → half
uterus
One-sided small
uterus, one tube
3
Didelphys uterus
(Uterus didelphys)
Complete failure of
fusion → two
separate uteri and
two cervices
Double uterus and
cervix
4 Bicornuate uterus
Partial failure of
fusion → heart-
shaped uterus with
two horns
Two upper cavities,
one cervix
5 Septate uterus
Normal external
shape but internal
septum divides the
cavity
One uterus divided by
wall
6 Arcuate uterus
Small indentation at
the fundus (mild
anomaly)
Slight dip on top of
uterus
I. Uterine (Bachadon) anomalies

15. Type English term Description
1 Cervical agenesis Cervix absent
2
Double cervix
(cervical
duplication)
Two cervices (often
with didelphys uterus)
3 Cervical atresia
Cervical canal closed or
not open properly
4 Cervical dysgenesis
Incomplete or
abnormal cervical
development
II. Cervical anomalies (Bachadon bo‘yni)

16. Type English term Description
1
Vaginal agenesis
(Mayer-Rokitansky-
Küster-Hauser
syndrome)
Upper part or entire
vagina absent; uterus
often absent too
2
Transverse vaginal
septum
Wall separates upper
and lower vagina
3
Longitudinal vaginal
septum
Vagina divided into two
channels (may
accompany double
uterus)
4 Imperforate hymen
Hymen without an
opening → menstrual
blood accumulates
(hematocolpos)
III. Vaginal anomalies (Qin)

17. Type English term Description
1 Labial fusion
Labia minora fused
together
2 Clitoral hypertrophy
Enlarged clitoris (may
be due to congenital
adrenal hyperplasia)
3 Ambiguous genitalia
External genitalia not
clearly male or female
4
Bifid clitoris or
duplicated vulva
Rare duplication
defects
IV. Vulvar / External genital anomalies (Tashqi jinsiy a’zolar)

19. Type English term Description
1 Ovarian agenesis
One or both ovaries
absent
2
Supernumerary
ovary
Extra ovary (rare)
3
Accessory ovarian
tissue
Small pieces of ovarian
tissue separate from
main ovary
V. Ovarian anomalies (Tuxumdon)