GENITAL PROLAPSE

GENITAL PROLAPSE PowerPoint PPT Presentation


  • 362 Views
  • Uploaded on
  • Presentation posted in: General

? The pelvic floor, closing the outlet of the pelvis is made up of a number of muscular and facial structures ? the most important of which is the LEVATOR ANI.? These structures are pierced by the RECTUM, VAGINA

Download Presentation

GENITAL PROLAPSE

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


1. GENITAL PROLAPSE DR. IQBAL TURKISTANI Asst. Prof. & Consultant

2. ? The pelvic floor, closing the outlet of the pelvis is made up of a number of muscular and facial structures ? the most important of which is the LEVATOR ANI. ? These structures are pierced by the RECTUM, VAGINA & URETHRA. ? passing through the exterior of the body ? These structures are supported in place by: - ligaments - condensation of facia

3. ? A relaxed vaginal outlet is usually a sequel to mere ? OVERSTRETCHING of the perineal supporting tissues as a result of previous parturition ? Muscular atony and loss of elastic tissue in later life ? lack of hormone ? DENERVATION due to damage to perineal or pelvic nerves ? delivery and pelvic surgery

4. TYPES OF GENITAL PROLAPSE PELVIC ORGAN PROLAPSE (POP) 1. CYSTOCELE = As a result of defect in the pubo-cervical facial plane which support the bladder anteriorly = it tends to permit the bladder to sag down below and beyond the uterus 2. URETHROCELE: = when the defective facia involves the urethra 3. RECTOCELE = due to attenuation in the pararectal facia ? permits the rectum to bulge through 4. ENTEROCELE: = Peritoneal hernial sac along the anterior surface of the rectum = Often contains loops of small intestine

5. DIAGNOSIS OF POP SYMPTOMS: ? Often symptomless ? Complaints of : ? Pressure and heaviness in the vaginal region ? Sensation of “everything dropping out” ? Bearing down discomfort in the lower abdomen ? Backache

6. ? Other associated problems: ? Fecal incontinence (e.g. with complete perineal laceration) and often with loose stools. ? Difficulty in emptying the bladder with marked cyctocele ? Cystitis ? due to residual urine ? ascending UTI ? frequency of micturition ? Urinary incontinence ? stress incont. ? Difficulty of defection and constipation with rectocele ? haemorrhoids ? Lump/mass protruding through ?is marked prolapse

7. SIGNS / EXAMINATION: Inspection ? Gaping introitus ? Perineal scars ? Visible cystocele and rectocele / urethral ? Uterine prolapse ? Cx. Ulceration (contact) = Decubitus ulcer Degree of prolapse

10. TREATMENT Incontinence POP Objective: To provide cure or improvement Treatment options, risks, benefits and outcomes should be discussed. Treatment Options: Can be divided into: Pharmacologal Conservative Surgical Measures intenvention I. CONSERVATIVE TREATMENT: ? Life style interventions ? Physical therapy (PFMT) / Kegel’s Exercise ? Bladder training ? Electrical stimulation ? Behavioral strategies ? Anti- incontinence devices

11. II. PHARMACOLOGICAL TREATMENT: A. Drug used for Urgency Incont. and OAB. i. Antimuscarinic (anticholinergic) agents - Muscanic receptors (M2 & M3) are predominant in the bladder. - These can be blocked by antimuscarinic which act by competing with ACH on the muscarinic receptors mainly during the storage phase e.g. Oxybutinin Tolterodine Solifenacin Tertiary amines Darifanacin Propiverine ? Quarternary amines - Very good efficacy profile - Side effects: ? Dry mouth ? Constipation ? Blurred Vision & Cardiovascular effect – palpitations / tachycardia - Contraindication: ? , Narrow angle glucoma

12. ii. Botulinum Toxin (BTX) - types A & B - local intravesical injection - Blocks the release of Ach from parasympathetic nerve endings at the myo-neuronal junction ? redution in muscle contractility B. DRUGS FOR SUI: Duloxetine = combined norepinephrine and serotonin re-uptake inhibitor ? ? sphincter muscle activity during filling phase of micturition ? significant ? in incont. episode frequency (IEF) >50% from baseline ---> improvement in quality of life SIDE EFFECTS: - Nausea - Others ? fatigue, dry mouth, headache, dizzines C. ESTROGENS = Controversiial ? little effect in the management of SUI

13. SURGICAL TREATMENT FOR INCON. I. SURGERY FOR SUI: 1. Intra-urethral injection therapy 2. Cysto-urethropexies 3. Low-tension vaginal tape - TVT - TOT 4. Classical sling procedures 5. Artificial sphincters II. SURGERY FOR URGNECY INCONT. (UUI) 1. Augmentation cystoplasty 2. Auto-augmentation 3. Sacral nerve stimulation

  • Login