PELVIC ORGAN PROLAPSE

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PELVIC ORGAN PROLAPSE

• Dr. Hazem Al-Mandeel
• 481 GYN
• Department of Obstetrics Gynecology

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Objectives

• To define pelvic organ prolapse
• Recognize pelvic anatomy
• Determine the Pathophysiology
• Discuss the predisposing factors
• Understand the grading systems
• Be aware of the options of management

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Pelvic Organ Prolapse

• Is the descent of the pelvic organs as a result
  of the loss of muscular and fascial structural
  support .

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Anatomic Supports

• Muscular Levator Ani (Pelvic Floor Ms.)
• Ligaments Uterosacral-Cardinal Complex
• Fascial Endopelvic (Pubocervical
  Rectovaginal)

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Levator Ani

• Major structure of pelvic floor
• Anterior/posterior orientation
• Perforated by urogenital hiatus
• Consists of Pubococcygeus
• Iliococygeus
• Puborectalis
• Coccygeus

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Endopelvic Fascia

• Fibromuscular layer
• Local condensations are ligaments
• Principal ligaments are Uterosacral
• 
  Cardinal
• Pubocervical and Rectovaginal Fascia important in
  specific surgical correction

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Pathophysiology

• Direct Trauma to pelvic soft tissues
• Neurological injury
• Connective tissue disorders

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Predisposing Factors

• Hereditary (genetic) predisposition
• Race White gt Black gt Asian
• Pregnancy and Vaginal Childbirth
• Age and Menopause
• Raised intra-abdominal pressure (e.g. obesity,
  cough, constipation, lifting, etc)
• Iatrogenic surgical procedure

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Types of Pelvic Organ Prolaopse

• 1. Urethra
• 2. Bladder
• 3. Uterus/ Vaginal Vault
• 4. Small Bowel
• 5. Rectum
• 6. Perineum

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Compartments

• Anterior Cystocele
• Urethrocele
• Middle Uterine prolapse
• Enterocele/vault prolapse
• Posterior Rectocele
• Rectal prolapse

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Classification of Prolapse

• Baden Walker (1972)
• Each site graded from 1 4
• POPQ quantifies using specific points
• Measured relation to the hymenal ring
• More widely used

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Symptoms of Prolapse

• Pelvic pressure
• Pelvic pain
• Feeling of a lump
• Back pain
• Urinary dysfunction
• Bowel dysfunction

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Complications of Prolapse

• Bleeding
• Infection
• Recurrent UTIs
• Urinary obstruction
• Renal failure

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Associated conditions

• Urinary Incontinence Stress
• Urge
• Mixed
• Fecal Incontinence sphincter injury

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Options of Management

• No Treatment ( pelvic floor exercise)
• Conservative such as
• Physiotherapy or Pessary
• Surgical Treatment

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Aims of prolapse surgery

• Alleviate symptoms
• Restore normal anatomy
• Restore normal visceral function
• Avoid new bladder or bowel symptoms
• Preserve sexual function
• Avoid surgical complications

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Conclusions

• Pelvic organ prolapse is common
• Results from injury to soft tissue and nerves
• Childbirth most significant association
• Treatment requires understanding of anatomic
  relationships
• Treated with a combination of physio/pessary and
  often complex surgery