Pelvic Organ Prolapse

Posted by e-Medical PPT
DeLancey’s three levels of vaginal support
Apical suspension       
 Upper paracolpium suspends apex to pelvic walls and sacrum
 Damage results in prolapse of vaginal apex
Midvaginal lateral attachment
 Vaginal attachment to arcus tendineus fascia and levator ani muscle fascia
 Pubocervical and rectovaginal fasciae support bladder and anterior rectum
 Avulsion results in cystocele or rectocele
Distal perineal fusion
 Fusion of vagina to perineal membrane, body and levators
 Damage results in deficient perineal body or urethrocele

Prolapse
Mutifactorial involving both neuromuscular and endopelvic fascial damage
Relaxation of the tissues supporting the pelvic organs may cause downward displacement of one or more of these organs into the vagina, which may result in their protrusion through the vaginal introitus.

Factors promoting prolapse
Erect posture causes increased stress on muscles, nerves and connective tissue
Acute and chronic trauma of vaginal delivery
Aging
Estrogen deprivation
Intrinsic collagen abnormalities
Chronic increase in intraabdominal pressure

Cystocele
Main support of urethra and bladder is the pubo-vesical-cervical fascia
Essentially a hernia in the anterior vaginal wall due to weakness or defect in this fascia
 Midline weakness allows bladder to descend causing central cystocele
 Tearing of endopelvic fascial connections from lateral sulci to arcus tendinii causes lateral or displacement cystocele
 Detachment of pubocervical fascia from pericervical ring causes a transverse or apical cystocele
Symptoms include pelvic pressure and bulge or mass in the vagina

Surgical repair is treatment of choice.Anterior Colporrhaphy,Paravaginal repair and Colpocleisis are the surgical treatment options

Uterine prolapse
Normal cervix located in upper third of vagina
Degree of prolapse measured by position of cervix at maximum intraabdominal pressure, without traction
Complete uterovaginal prolapse is called procidentia

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