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Uterine prolapse Diagnostic and surgical management (1). Dr. Laleh AMINI French Board of OB&GYN Jam General Hospital Ir CS Annual Meeting June 2 nd 2011 Tehran-Iran. Definition.

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Uterine prolapse diagnostic and surgical management 1

Uterine prolapseDiagnostic and surgical management (1)

Dr. Laleh AMINI

French Board of OB&GYN

Jam General Hospital

Ir CS Annual Meeting June 2nd 2011 Tehran-Iran


Definition
Definition

ICS-IUGA Standardized Terminology in Urinary Incontinence and pelvic floor disorders in www. ir-cs.com

Herniation of genital organ from vaginal mucosa

(Different from herniation from rectum)


Classification
Classification

  • Baden et al/ Ingelmann-Sundberg

    POP-Q pelvic organ prolapse quantification

  • Anatomic

  • Should be associated to the health care questionnaire from ICIQ, ICIQ-SF


Pop q stages
POP-Q stages

  • Stage 0 AaApBaBp C D -3 cm

  • Stage 1 -1

  • Stage 2 -1- +1

  • Stage 3 +1

  • Stage 4 complete vaginal procidencia


Physiopathology
Physiopathology

It s essential to know anatomy / physiology then to understand patho-physiology in order to think of how

to repair.

Great Names: De Lancey and Papa Petros


SUI FACTORS

POP FACTORS

Parity

Aging, menopause

Hormonotherapie

Diabete

Obesite

hysterectomie

dementia

Abdominal hyperpressure (sports),COPD

Obstructifsanorectal symptoms

Obesity

Pregnancy

VD

Hysterectomie

Age

parity


Genetics and constitutional
Genetics and constitutional

*Genetics and constitutional factors incriminated

because of SUI and POP in nulliparous women ( Norvegian National Registry ( n=38 000)

* homozygote and heterozygote twins ( Swedish) twin Registry n=3376/n=5067)

* Chromosome 9q21 predisposition gene for Pelvic floor disorders

*Connective tissue disease with 30% less collagen concentrations in the POP population


Surgical treatment
Surgical Treatment

Are considered malpractice or obsolete all surgical procedures using natural defective tissus ( Macenroth, Kapanji, ventrofixation…)

Patient will come back with recurrence or will not come back at all!


Pelvic organ prolapse surgical treatment
Pelvic Organ Prolapse Surgical Treatment

  • Abdominal Approach

    • Sacro-Colpopexy

      • Laparotomy

      • Laparoscopy

  • Vaginal approach

    • Without prosthesis

      Sacro-spinous fixation Richter

      • Unilateral

      • Bilateral

    • With prothesis


Cochrane Database Syst Revue 2006 on conservative

Managament

  • >50 publications laparoscopic sacrocolpopexy since 15 years

  • Recurrence after laparoscopy <10%

  • NICE recommendations 2008 on vaginal surgeries based on 10 randomized clinical trials.

    • Recurrence 9%,18% and 30% with synthetique, biologic and without prothese

  • recommendations AFNOR NF S94-801 for mesh quality


Anti incontinence surgery
+/- Anti-incontinence surgery?

Associated to systematic prophylactic anti incontinence surgery in our practice

  • 30% de novo SUI without anti-incontinence surgery

  • Burch colpo suspension procedure with 2 or 4 sutures in laparotomy

  • Mid-urethral sling procedures when done by laparoscopy

  • When a rectocele repair is indicated it s done at the beginning of the surgery.



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