Pop Flashcards
Def
Incidence
-Descend of one or more of the pelvic organs below the normal anatomical position. ( ischial spine )
-15-30%
Et
Types
-Weak support of
- lig
~makenrodts
~ utero-sacral
~pubocervical
-muscles
~levator ani
-fascia
-AVF or RVF position of UT
-perineal body and perineal muscles
through
1-repeated childbirth
2-atrophy of menopause
3-iatrogenic weakness (hysterectomy)
4-congenital weakness (weak mesenchyme :flat foot, varicose vein, multiple hernias,)(nulliparous prolapse)
+
precipitating factors :anything that increases intra-abdominal pressure
-types : vaginal
•ant : cystocele ,urethrocele or combined,
•POST :deficient perineum, rectocele ,enterocele or omentocele
•apical :the vault of the vagina descend after hysterectomy
UT prolapse
-degree 1:the cervix descend but the external os doesn’t reach, the introitis
-degree 2 : external os reach or slightly seen through the introitis
- degree 3 :the whole uterus except fundus is outside the introitis
-procedentia :all of the uterus outside the introitis.
Pathology
(6)
1-Vaginal kretinization
2-Vaginal and Cervical Ulceration due to Friction, ~>Loss of Rugae ~>Decubitus Ulceration
3-Cervical Hypertrophy due to Congestion
4-Supravaginalis Elongation of Cervix due to Stretched Makenrodit Ligament
5-In case of Cystocele ,Stasis of Urine, Stretch of Neck and Urethral Sphincter Causing SUI
6-Compression and Kinking of the Ureter Causing Hydroureter and Hydronephrosis.
Sym
Signs
-sym
•Type of patient :
-repeated childbirth
-menopause
-hysterectomy
-weak mesenchme
+
precipitating factors
4 ( general )
- asymptomatic
-heaviness at the end of day or mass protruding, -back ache, especially in UT prolapse due to uterosacral ligament stretching
-pelvic congestion symptoms :dysmenorrhea, leukocoria.
*In case of deficient perineum :sexual dissatisfaction.
*In case of cystocele :frequency, dysuria, SUI, unable to complete urination unless it’s reducible.
*In case of rectocele: unable to complete defecation unless it’s reducible.
-Signs
•general :looking for anything that causes intra-abdominal pressure, weak mesenchme
• PV :while straining
1-inspection
2-palpation
3-gargling sensation in enterocele
4-doughy in omentocele
5-using sound to measure supravaginalis elongation
6-rducing it ,asking for coughing, to detect involuntary escape of urine through urethra, to diagnose SUI.
Dd
Inv
1-UT prolapse ;fibroid polyp, inversion of uterus,
2-urethrocele :urethral diverticulum on compressing~> pus or urine
3-rectocele, cystocele :cyst of aNT and POST vaginal walls that is not compressible nor reducible,
INV
1-urine analysis
2-INV for SUI
3-ECG
4-X-ray.
P
Ttt
P
1-Proper spacing between preg.
2-Avoid bearing down in 1st stage.
3-Avoid difficult labor in 2nd stage.
4-Avoid vaginal laceration, instead do episiotomy in 2nd stage.
5-Treat any cough or anything that increases intra-abdominal pressure.
Ttt
Non-surgical
•Kegel’s exercise :delay for surgery in mild case, should be done 3 to 6 months after delivery.
•Pessary :Temporary aiming at reduction of prolapsed organ until the surgery is ready or for those unfit for surgery.
Surgical
-Vaginal
•ANT :ANt repair or colporraphy + SUI TTT
•POST :POST repair or colporraphy
•Cystorectocele ( ant+post) :classical repair
•apical (5)
1-abdominal sacro colpo pexy
2 -vaginal sacrospinous ligament fixation
3 -vaginal mesh repair
4 -le fort technique :obliteration or closure of vagina within the prolapsed organs, in old, not sexually active, unfit for surgery
5-modified le fort technique :canal for discharge,
-Ut prolapse
1-First degree :no TTT needed
2-Second degree :
-if alone :sacrospinous fixation
-If with supravaginal elongation : fothergrills or Manchester op(Amputation of portiovaginals. Shortening of Makenrodts ligament )+classical repair +sacrospinous fixation.
3-Third degree :
-if she wants fertility :sacrospinous fixation.
-If she doesn’t want fertility :hysterectomy+classical repair
*Increase in success rate.
1-Proper pre-operative preparation.
2-Treating the main cause (increased intra-abdominal pressure)
3-Absence of sexual intercourse for one to two months
4-Delay of pregnancy for one year
5-If vaginal delivery after that, episiotomy should be done.
