Prolapse - 1

Prolapse - 1

1. Prolapse Dr P.Pallavee

2. At the end of the class you should be able to diagnose and manage a case of pelvic organ prolapse

3. Case scenario A 43 yr old para 3 presents to opd with complaints of mass descending per vaginum for one year and difficulty in initiating micturition. What details will you ask in history?

4. History History of presenting complaints History of precipitating factor Obstetric history Menstrual history chronic cough , constipation, abdominal mass number of deliveries place of delivery prolonged labour instrumental delivery big babies sepsis lack of perineal exercise early resumption of heavy work short inter pregnancy interval postmenopausal status menstrual abnormalities Duration of prolapse rate of increase of severity bladder and bowel problems irreducibility of prolapse discharge per vaginum,postcoital bleeding

5. What are the common urinary symptoms? frequency and dysuria- associated cystitis stress urinary incontinence- descent of urethrovesical junction retention of urine. hydronephrosis and pyelonephritis in chronic cases difficulty in initiating urination

6. What important things you will note in examination? General examination Abdominal examination Pelvic examination Nutritional status anemia mental status lymphadenopathy Mass, hernial sites, free fluid inspection of external genitalia eliciting stress incontinence examination of prolapse bimanual pelvic examination

7. Anterior vaginal wall prolapse

8. Posterior vaginal wall prolapse

9. Uterine prolapse

10. classification of prolapse Shaws Malpas Jeffcoates Baden walker POP-Q

11. SHAWS

12. POSITION OF 9 SITES ARE MEASURED IN RELATION TO HYMEN IN CM. NEGATIVE NUMBER FOR PROXIMAL AND POSITIVE NUMBER FOR DISTAL RECORDED IN GRID FORM. POPQ- pelvic organ prolapse quantification

13. Differential diagnosis INVERSION OF UTERUS Fibroid polyp

14. How will you investigate? Baseline assessment- hemogram,urine routine urine culture and sensitivity. pap smear preoperative assessment

15. What is decubitus ulcer? venous stasis leads to tissue anoxia in most dependant position. vaginal packing with glycerine acriflavine solution. pessary.

16. Management Aim is to restore normal anatomy, maintain visceral function Reconstruction of normal supports Womens wish of retaining menstrual and childbearing function will influence choice of operation

17. Management Conservative Surgical weight reduction lifestyle modifications pelvic floor exercise vaginal pessary Reconstructive Obliterative procedure Hysterectomy Preservation of prolapsed uterus.

18. Pessary pregnancy and puerperium unfit for surgery waiting for surgery decubitus ulcer treatment pessary test

19. Reconstructive anterior colporrhaphy- cystocele posterior colporrhaphy-rectocele perineorrhaphy-gaped introitus Mac call culdoplasty- enterocoele sacrospinous fixation- vault prolapse

20. Obliterative procedure Le forts colpocleisis- elderly frail women not fit for major surgery.

21. Hysterectomy women who have completed family not desirous of future childbearing or menstrual functions associated uterine pathology like fibroid. not the corrective surgery for prolapse should be accompanied by anatomical correction of defects.

22. Preservation of Prolapsed uterus FOTHERGILL/MANCHESTER amputation of cervix cardinal ligaments cut and fixed anteriorly to cervix anterior colporrhaphy if required post colpoperineorrhaphy SLING SURGERIES [nulliparous prolapse]

23. Thank you