Prolapse Organ Pelvic 2010 Rev Hahaha

7/30/2019 Prolapse Organ Pelvic 2010 Rev Hahaha

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PELVIC ORGANPROLAPSE

Prof.Junizaf,MD

Division of Urogynecology Reconstructive

Deptment of Obstetrics and Gynecology

Faculty of Medicine University of Indonesia

Jakarta


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DEFINITION

Pelvic organs prolapse is protrusion of

pelvic organs into the vaginal canal or

outside vaginal introitus


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PREVALENCE

50% women had previous vaginal delivery

20% gynecological cases who will be operated

come from pelvic organs prolapse

At RSCM-FKUI 2000 2005, 240 cases uterine

prolaps treatment by operation, the age of

patients years old 60

70 and parity three ormore


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ETIOLOGY

Damage or the weakness the pelvic

floor support


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PELVIC FLOOR ANATOMYDe Lancey

Endopelvic fascia

Levator ani muscles (pelvic diaphragm)

Urogenital diaphragm


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ENDOPELVIC FASCIA

Cardinal ligaments

Uterosacral ligaments

Rectovaginal fascia

Pubocervical fascia

Paracolpium fascia


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Upper vagina

Cervix Uterus

Cardinal ligaments

Uterosacral

ligaments

Pubocervical Fascia

Rectovaginal Fascia

Mid vagina

Lateral vaginalwall

Sacrum

Arcus Tendineus

Fascia PelvicFascia

paracolpium


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LEVATOR ANI MUSCLES


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LEVATOR ANI MUSCLES

(PELVIC DIAPHRAGM)

Pubococcygeus

Puborectalis

Iliococcygeus


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Arcus tendineus fasia pelvis

FA FA

Uretra

Vagina

Rectum

Pubococcygeus

muscle

LEVATOR ANI MUSCLES/ PUBOCOCCYGEUS


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NORMAL GENITAL POSITION


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Levator ani muscles functions to pull the

rectum, vagina, urethra, anteriorly

towards the pubic bones, compressing

their lumens closed.


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Primary support for the pelvic organs

come from the levator ani muscles.


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UROGENITAL DIAPHRAGM

Function:

Attach to the ischiopubic rami:the lateral walls of vagina perineal body


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PERINEAL BODY

Mass of dense connective tissue:

Fibers from: Bulbocavernosus

Superficial perinei transverse

External anal sphincter

Perineal membrane


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Perineum


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Type pelvic organs prolapse


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Risk Factor

Child birth

Parity

Chronic Intra abdominal pressure Age

Congenital

Genetic

Race

Obesity

Smoking


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ClassificationBaden Walker

Stadium I When the prolapse still on vaginal canal

Stadium II When the prolapse at introitus vaginal

Stadium III When the prolapse outside from introitus vaginal

prolapsus uteri


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POPQ


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Anatomic landmark used during pelvic organ prolapsed quantification

POPQ


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Aa

The point in the midline of the anterior vaginal wall 3cm proximal to the

urethral meatus, corresponding to the urethrovesical junction. Range: -

3 to +3

BaOn the anterior vaginal wall, the most dependent position between

point Aa and the vaginal cuff or anterior vaginal fornix

C Cervix or vaginal cuff (posthysterectomy)

DPosterior fornix corresponding to the pouch of Douglas (in the absence

of cervix)

ApThe point in the midline of posterior vaginal wall 3 cm proximal to the

hymenal ring. Range -3 to +3

BpOn the posterior vaginal wall, the most dependent position between

point Ap and the vaginal cuff or posterior fornix

GhGenital hiatus - midportion of the urethral meatus to the posteriormargin of the genital hiatus

PbPerineal body - between posterior margin of the genital hiatus and the

midportion of the anus

TVL Total vaginal length - greatest depth of the vagina


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Staging of pelvic organ prolapsed

Stage 0 : No prolapse is demonstrated. Points Aa, Ap, Ba, and Bp are all at -3cm and either point C or point D is within 2 cm of TVL

Stage I : The most distal portion of the prolapse is l cm above the level of thehymen (above -1)

Stage II : The most distal portion of the prolapse is l cm or less proximal to ordistal to the hymen.

Stage III : The most distal portion of the prolapse is 1 cm below the hymen butprotrudes no further than 2 cm less than the TVL.

Stage IV : Complete eversion of the total length of the lower genital tract.Distal protrusion quantify >+ [TVL-2] cm. leading edge of theprolapse: cervix or vaginal cuff scar.


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SYMPTOMS

Sensation bulging at introitus vaginal

Sensation of vaginal of pelvic fullness

Back pain and disminish when lying

Vaginal discharge or bleeding

Urinary incontinence

Constipation

Sexual complaints


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Diagnosis

Anamnesis

Physical examination Gynecology examination


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TREATMENT

Prevent Limitations vaginal delivery

Prevent second stage more than two hours

Prevent vaginal delivery by instrument

Prevent placental delivery by crede metode

Repair laseration pelvic floor after vaginaldelivery

Kegel exercise

Prevent or treatment condition can cause intra

abdominal pressure increase

Treatment

Conservative

Operative


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Conservative Treatment

Pessary

Estrogen hormon, special for oldest

women


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OPERATIVETREATMENT

Anterior colporrhaphy

Posterior colporrhaphy

Ventrofixation Vaginal hysterectomy

Colpoperineorhaphy

Colpocleisis

Uterosacropexy

Sacrospinosus fixation


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Documents

Prolapse Organ Pelvic 2010 Rev Hahaha