Pelvic Organ Prolapse Lecture

Question 1

What are the 3 distinct layers of the pelvic floor?

Answer 1

Endo-pelvic fascia
Pelvic diaphragm
Urogenital diaphragm

Question 2

What is the endo-pelvic fascia?

Answer 2

A network of fibre-muscular connective–type tissue that has a hammock-like configuration and surrounds the various visceral structures (Uterosacral ligaments, pubocervical fascia and rectovaginal fascia)

Question 3

What is the pelvic diaphragm?

Answer 3

A layer of started muscles with its fascial coverings (elevator ani and coccygeus)

Question 4

What is the urogenital diaphragm?

Answer 4

The superficial and deep transverse perineal muscles with their fascial coverings

Question 5

What are the characteristics of the end-pelvic fascia?

Answer 5

Fibromuscular component that can stretch (uterosacrals)

Connective tissue does not stretch of attenuate. Instead it breaks

Question 6

What does the utero-sacral/cardinal complex connect to?

Answer 6

Medially to uterus, cervix, lateral vaginal fornices and pubocervical and rectovaginal fascia

Laterally to the sacrum and fascia overlying the pirformis muscle

Question 7

How is the utero-sacral complex palpated?

Answer 7

Down traction on the cervix

If intact allows limited side-side movement of the cervix

Question 8

Where does the utero-sacral complex tend to break?

Answer 8

Medially

Question 9

What is the function of the pubocervical fascia?

Answer 9

Provides the main support of the anterior vaginal wall

Question 10

What is the pubocervical fascia attached to?

Answer 10

Centrally: Merges with the base of the cardinal ligaments and the cervix

Laterally: Arcus tendineus fascia pelvis

Distally: Urogenital diaphragm

Question 11

Where does the pubocervical fascia tend to break?

Answer 11

At the lateral attachments or immediately in from of the cervix

Question 12

What is the rectovaginal fascia?

Answer 12

Fibre-muscular elastic tissue

Question 13

What are the connections for the rectovaginal fascia?

Answer 13

Centrally: Merges with the base of the cardinal ligaments and peritoneum

Laterally: Fuses with fascia over the elevator ani

Distally: Firmly over the perineal body

Question 14

Where does the rectovaginal fascia tend to break and what does this cause?

Answer 14

Centrally

If upper defect: enterocoele

If lower defect: perineal body descent and rectocele

Question 15

What are the 3 levels of endopelvic support?

Answer 15

Level 1:

• Uterosacral ligaments
• Cardinal ligaments

Level 2:
- Para-vagina to arcus tendineus fascia: Pubocervical/Rectovaginal fascia

Level 3:

• Urogenital diaphragm
• Perineal body