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Disclaimer

Disclaimer. My spouse and I have no relevant financial relationship with a commercial interest in any of the material contained within this presentation. Learning Objectives. At the completion of this session, the participant should:

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  1. Disclaimer My spouse and I have no relevant financial relationship with a commercial interest in any of the material contained within this presentation.

  2. Learning Objectives At the completion of this session, the participant should: 1. Recognize the need for accurate assessment of the specific pelvic support defects. 2. Understand how to evaluate 5 specific vaginal sites • Urethra • Bladder • Cervix or cuff • Cul-de-sac • Rectum 3. Understand how to plan the surgical approach for pelvic reconstruction

  3. Genesis 11: 1-9 These are all one people and speak one language... soon they will be able to do anything they want! Let's mix up their language so they will not understand each other.

  4. Language of Pelvic Support Defects • Subjective • Inaccurate • Non-specific

  5. Requirements for Improvement • Define • Normal • Sites to be described • Conditions of examination

  6. Goals • Assessment of specific sites • Description of support loss with maximum stress • Anatomic abnormalities contributing to support loss • Reproducible • Understandable • Usable • Improves patient care

  7. Staging • Oncology • Clinical • Surgical • Infertility • Surgical

  8. Physical Findings

  9. Normal Physical Exam Genital hiatus Closed Urethral meatus parallel to the floor no evidence of urethral prolapse/caruncle Anterior compartment Cervix/Cuff Posterior compartment Neuromuscular assessment of pelvic floor Gynecologic pelvimetry

  10. Results • Office Evaluation • Document symptoms • Objectively describe physical findings

  11. Objective Clinical Evaluation

  12. Visceral and Sexual Function

  13. Results Management Options • Observation or medical therapy • Longitudinal change in symptoms or physical findings • Surgical management • Plan approach based on objective physical findings • Integrate intraoperative findings • Design repair specifically for defects

  14. Results Long Term Follow-up Comparing Site-specific Physical Findings • Prognosis for success or failure • Modification of technique • Accurate communication with others

  15. Learning Objectives At the completion of this session, the participant should: 1. Recognize the need for accurate assessment of the specific pelvic support defects. 2. Understand how to evaluate 5 specific vaginal sites • Urethra • Bladder • Cervix or cuff • Cul-de-sac • Rectum 3. Understand how to plan the surgical approach for pelvic reconstruction

  16. Bibliography • Shull BL: Clinical evaluation of women with pelvic support defects. Clinical Obstet Gynecol, 1993, 36:939-951. • Shull BL, Benn SJ, Kuehl TJ: Surgical management of prolapse of the anterior vaginal segment: an analysis of support defects, operative morbidity, and anatomic outcome, Am J Obstet Gynecol 1994;171:1429-39. • Bump RC, Mattiasson A, Bo K, Brubaker LP, DeLancey JOL, Klarskov P, Shull BL, Smith ARB: The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol, 1996;175:10-7

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