Pelvic Organ Prolapse Flashcards
1
Q
What does the word prolapse refer to
A
- Falling or slipping of the viscous
- Protrusion of an organ or structure beyond its normal anatomical confines
2
Q
What is female pelvic organ prolapse (POP)
A
- refers to the descent of the pelvic organs towards or through the vagina
3
Q
Incidence of POP
A
- 12-30% of multiparous women
- 2% of null parous
4
Q
Prevalence of POP
A
- 2% symptomatic prolapse to 50% asymptomatic prolapse
- Leading cause of hysterectomies
5
Q
What is the pelvic floor
A
- The bottom of the abdomino-pelvic cavity (box)
- Consists of all the soft tissue structures that close the space between the pelvic bones
- If normal, pelvic viscera maintained in position both at rest and during increased intra-abdominal pressure
- The pelvic floor is 1 functional unit
6
Q
What are the layers of the pelvic floor
A
- 3 distinct layers - do not parallel each other and vary in strength and thickness
- Endopelvic fascia
- Pelvic diaphragm
- Urogenital diaphragm
7
Q
Describe the endopelvic fascia layer of the pelvic floor
A
- Network of fibro-muscular connective tissue that has a ‘hammock-like’ configuration and surrounds the various visceral structures (uterosacral ligaments/pubocervical fascia/rectovaginal fascia)
8
Q
Describe the pelvic diaphragm layer of the pelvic floor
A
- Layer of striated muscle with its fascial coverings (levator ani & coccygeus)
9
Q
Describe the urogenital diaphragm layer of the pelvic floor
A
- The superficial & deep transverse perineal muscles with their fascial coverings
10
Q
How do the components of the endopelvic fascia act
A
- Fibro-muscular component can stretch (uterosacrals)
- Connective tissue does not stretch or attenuate - breaks
11
Q
What forms the utero-sacral/cardinal complex
A
- Medially to uterus, cervix, lateral vaginal fornices & pubocervical & rectovaginal fascia
- Laterally to the sacrum & fascia overlying the piriforms muscle
12
Q
What are the features of the utero-sacral/cardinal complex
A
- Easily palpated by down traction on the cervix and if intact allows limited side-side movement of the cervix
- Tends to break medially (around the cervix)
13
Q
What is the anatomy of the pubocervical fascia
A
- Trapezoidal fibro-muscular tissue: provide the main support of the anterior vaginal wall
- Centrally - merges with the base of the cardinal ligament & cervix
- Laterally - arcus tendinous fascia pelvis
- Distally - urogenital diaphragm
14
Q
Where does the pubocervical fascia tend to break
A
- 3 support = 3 defects
- Tends to break at lateral attachments or immediately in front of cervix
15
Q
What is the anatomy of the rectovaginal fascia
A
- Fibro-musculo - elastic tissue
- Centrally - merge with the base of cardinal/uterosacral ligaments & peritoneum
- Laterally - fuses with fascia over the levator ani
- Distally - firmly to the perineal body