Uterine prolapse diagnostic and surgical management 1
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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


Uterine prolapse diagnostic and surgical management 1

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


Uterine prolapse diagnostic and surgical management 1

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.


Fernandez decisional algorithm

Fernandez Decisional Algorithm


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