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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)


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    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

    2. 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)

    3. 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

    4. 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

    5. 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

    6. SUI FACTORS POP FACTORS Parity Aging, menopause Hormonotherapie Diabete Obesite hysterectomie dementia Abdominal hyperpressure (sports),COPD Obstructifsanorectal symptoms Obesity Pregnancy VD Hysterectomie Age parity

    7. 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

    8. 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!

    9. Pelvic Organ Prolapse Surgical Treatment • Abdominal Approach • Sacro-Colpopexy • Laparotomy • Laparoscopy • Vaginal approach • Without prosthesis Sacro-spinous fixation Richter • Unilateral • Bilateral • With prothesis

    10. 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

    11. +/- 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.

    12. Fernandez Decisional Algorithm