Dr. Ahlam Al-Kharabsheh: Assistant Professor, OBS & GYN Department Mu'tah University

Dr.
Ahlam Al-Kharabsheh
Assistant Professor, OBS & GYN department
Mu’tah University
 A prolapse is a protrusion of an organ or structure
beyond its normal anatomical site.
 Pelvic Organ Prolapse (POP) is usually classified

according to its location and the organ contained within
it.
 It affects 12 – 30 % of multiparous and 2% of nulliparous
women.
 It is extremely common problem. About 11 % of women

will have one kind of the operation for prolapse during
their life.*
 *Olsen AL, et al. Obstet Gynecol. 1997; 89(4):501-6

I- Vaginal wall prolapse:
A- Anterior vaginal wall prolapse (Antrior compartment prolpase):

 urethrocele.
 Cystocele.
 cystourethrocele.
B- Posterior vaginal wall prolapse (Postrior compartment

prolapse):
 Rectocele.
 Enterocele.
C- Apical vaginal wall prolapse: (Apical compartment prolapse)

 Vault prolapse (after hysterectomy).
II- Uterine prolapse:Of 3 grades:
Grade 1: descent within the vagina.

Grade 2: Descent of the cervix outside the introitus but not the
body of the uterus.
Grade 3: Descent of the whole uterus outside the introitus
(Procidentia).
III- Combined type.

Grade 0 no prolapse
Grade 1 prolapse halfway to the hymen
Grade 2 prolapse to the introitus
Grade 3 prolapse halfway beyond the
hymen
Grade 4 complete prolapse
 The topography of vagina is described using six points (2 on
anterior vaginal wall, 2 on the superior vagina, 2 on the
posterior vaginal wall). In addition to other 3 points.
 Stage 0: no prolapse
 Stage I: the most distal portion of the prolapse is > 1cm
above the level of the hymen
 Stage II: the most distal portion of the prolapse is  1cm
proximal to or distal to the hymen
Stage III: the most distal portion of the prolapse is >
1cm below the plane of the hymen.
 Stage IV: complete eversion of the total length of the
vagina.
1- Congenital (genetic factor):
 Prolapse may occur in nulliparous.
 More common in cretin races than others.
 It is familial.
2- Childbirth:
 Multiparity.
 Prolonged labor.
 Difficult vaginal delivery.
3- After hysterectomy.
4- Raised intra-abdominal pressure:

 Chronic cough.
 Chronic constipation.
 Pregnancy, labor and delivery.
 Large pelvic and abdominal tumor.
 Ascitis.
5- Ageing: common in post menopausal women.
6- Obesity (BMI >25).

History:
 Lump protruding from the vagina either on straining or
even at rest.
 Lower abdominal discomfort and back pain.
 In anterior compartment prolapse: urinary frequency,
urgency, voiding difficulty, urinary tract infections and stress
incontinence.
 Posterior compartment prolapse: incomplete bowel
emptying, constipation.
 Sexual dysfunction.
** Procidentia: Bloody vaginal discharge due to ulceration
and infection of the most dependent part of
prolpase(Decubitus ulcer).
Abdominal examination: to exclude tumors,
organomegaly and ascitis.
Vaginal examination:
 On dorsal position, the prolapse could be seen
protruding through the introitus. If not, the patient
should be asked to push down or cough.
 Any ulceration should be detected.
 Bimanual exam to exclude pelvic tumors.
 By Sim’s speculum and the patient in the left lateral

position, the type of prolapse should be identified.
 By combined rectal and vaginal digital exam, we can

differentiate between rectocele and enterocele.
 Congenital or inclusion vaginal cysts.
 Urethral diverticulum.
 Large uterine polyp.
 Pedunculated fibroid.
 In case of urinary symptoms, GUE, urine culture,
cystometry, and cystoscopy may be considered to
exclude local causes in the bladder.
 In major degree of prolonged uterine prolapse, renal

function should be studied to exclude renal failure
due to kinking of the ureters.
 Imaging study: MRI.

The choice of treatment depends on:
 The patient wish.
 Age of patient and parity.
 Preservation of sexual function.
The treatment is conservative and/or surgical.

History of POP treatment
Kahun gynecological Hippocratic Succussion

papyrus
19th
century
Pessary
1867
 Attempt should be made to correct obesity, chronic
cough and constipation.
 If decubitus ulcer is found, then local estrogen for 7
days should be used.

 Pelvic floor muscle exercises.
Pessary:
Support Pessary: Ring Pessary:
 A silicon rubber-based ring pessaries are most popular for
conservative therapy.
 Space- Filling Pessary: Donut, Gellhorn.
 They are inserted in the vagina, but should be
changed at regular intervals.
 The use of ring pessaries my be complicated by
vaginal ulceration and infection.
Indications of pessaries:
1. As a therapeutic test.
2. Medically unfit for surgery or refused surgery.
3. During and after pregnancy.
4. While awaiting for surgery.
Cystourethrocele: Anterior colporrhaphy operation.
Rectocele: Posterior colpo-perinorrhaphy.
Enterocele: Posterior colporrhaphy with excision of the
peritoneal sac.
Uterine Prolapse:
 Vaginal hysterectomy: in elderly patients and those
who completed the family or with other uterine or
cervical pathology. Adequate vault support of the utero-
sacral ligement or the sacrospinous ligament (SSL
fixation) is needed.
 Manchester operation: amputation of the cervix,
bringing of the cardinal ligaments and uterosacral
ligaments anterior to the lower uterine segment followed
by vaginal repair.
 Sacrohysteropexy: this is an abdominal operation. It

involves attachment of a synthetic mesh from the
uterocervical junction to the anterior longitudinal
ligament of the sacrum.
 Trans-vaginal mesh (TVM):
Vault prolapse:
 Sacrocolpopexy: The vaginal vault is attached to the
sacrum by synthetic mesh.
 Sling operation: The vaginal vault is slinged to the anterior abdominal wall
by two strips of anterior rectus sheath.
 Both operations are carried out by abdominal approach.
 Vaginal procedures:
Sacrospinous ligament fixation (SSLF), Uteroscaral ligament
suspension, ileococcygeous suspension, Vaginal mesh kits,

Dr. Ahlam Al-Kharabsheh: Assistant Professor, OBS & GYN Department Mu'tah University

Uploaded by

Copyright:

Available Formats

Dr. Ahlam Al-Kharabsheh: Assistant Professor, OBS & GYN Department Mu'tah University

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Dr. Ahlam Al-Kharabsheh: Assistant Professor, OBS & GYN Department Mu'tah University

Uploaded by

Copyright:

Available Formats

Dr.

 Pelvic Organ Prolapse (POP) is usually classified

 It is extremely common problem. About 11 % of women

 *Olsen AL, et al. Obstet Gynecol. 1997; 89(4):501-6

A- Anterior vaginal wall prolapse (Antrior compartment prolpase):

B- Posterior vaginal wall prolapse (Postrior compartment

C- Apical vaginal wall prolapse: (Apical compartment prolapse)

Grade 1: descent within the vagina.

III- Combined type.

4- Raised intra-abdominal pressure:

5- Ageing: common in post menopausal women.

6- Obesity (BMI >25).

 Bimanual exam to exclude pelvic tumors.

 By Sim’s speculum and the patient in the left lateral

 By combined rectal and vaginal digital exam, we can

 In major degree of prolonged uterine prolapse, renal

 Imaging study: MRI.

 Age of patient and parity.

 Preservation of sexual function.

The treatment is conservative and/or surgical.

Kahun gynecological Hippocratic Succussion

days should be used.

 Sacrohysteropexy: this is an abdominal operation. It

 Both operations are carried out by abdominal approach.

You might also like

Pfad - The Proxy pFad of © 2024 Garber Painting. All rights reserved.