Uterovaginal prolapse By Dr rizwan ullah khan

1. UTEROVAGINAL PROLAPSE

2. CASE :
A 62 years old woman complains of low back
pain and perineal pressure for 1 and half years. She
has been prescribed a pessary which she is reluctant
to wear. On pelvic examination a 2nd degree uterine
prolapse with cystocele and rectocele is observed.

3. UTERINE PROLAPSE:
“Is the condition of the uterus collapsing, falling
down, or downward displacement of the uterus with
relation to the vagina. It is also defined as the bulging of
the uterus into the vagina.’’
VAGINAL PROLAPSE:
“ Is characterized by a portion of the
vaginal canal protruding from the opening of the vagina.”

4. ANATOMY:
In the pelvic floor, pelvic diaphragm is divided into
anterior triangle and posterior triangle.
Anterior triangle consist of urethra and vagina.
Posterior triangle consist of rectum.

5. SUPPORTS OF THE UTERUS:
1. Cardinal ligament(mackenrodt’s, transcervical,lateral
Cx ligament)
2. Uterosacral ligament
3. Pubocervical fascia

7. SUPPORTS OF VAGINA:
1. Cardinal ligament
2. Pubo cervical ligament
3. Pelvic floor muscles
4. Perineal body

11. HISTORY:
 First recorded in about 2000 BC.
 First ever successful vaginal hysterectomy for prolapse
was done by a peasent woman on her own. She cut
down her uterus,but end up with urinary incontinence.

12. TYPES OF VAGINAL PROLAPSE
• a.Urethrocele
b.cystocele
• c.Cystourethrocele
Anterior
vaginal
wall
prolapse
• a.Rectocele
• b.Enterocele
Posterior
vaginal
wall
prolapse
• a.Uterovaginal
• b.vault prolapse
Apical
vaginal
prolapse

13. Degrees of prolapse of uterus:
There is usual a Right angle Relationship between
uterus and vagina.
How the uterus changes into the same plane as the
vagina?
As the uterus gets start descending, the uterus
starts moving down and down and down until
Outside of the body.
When it almost outside the body is called
procidentia: marked prolapse

15. Grade I: cervix is not in vagina.
Grade II: cervix is now in vaginal opening.
Grade III: (procidentia)
The uterus is hanging outside and here it
is wrapped by anterior and posterior wall of
vagina.

16. ETIOLOGY of Pelvic Relaxation
It is most commonly related to
CHILD BIRTH.
When you push a nine pounds baby through a pelvic floor,
injury is not uncommon.

17. 1-EVALUATION
1-HISTORY
a-non specific symptoms
b-specific symptoms
c-also ask about
PARITY
MODE OF DELIVERIES

18. 2-PHYSICAL EXAMINATION
1-GENERAL EXAMINATION
2-SPECULUM/VAGINAL EXAMINATION
Sim’s position
3-RECTAL EXAMINATION

19. 3-INVESTIGATIONS
A-BASE LINE
FBC,UCE,FBS,Blood group
X match,Urine microscopy,CXR,ECG
B-ADDITIONAL
RFTs,U/S,CT, MRI

20. DIFFERENTIAL DIAGNOSIS
 Cervical polyp
 Large endometrial polyp
 Cervical cancer
 Metastasis of ut.cancer
 Pedunculated myoma
 Urethral diverticulum
 Vaginal wall cyst

21. COMPLICATIONS
 Decubitus ulcers
 Keratinization of vagina
 Hypertrophy of cervix
 Recurrent UTI
 Acute urinary retention
 Hydroureter/hydronephrosis
 Renal failure
 Incarceration

22. MANAGEMENT
 According to age of the patient,level of fitness,her wish
for future fertility.
a-counselling
b-prevention
c-treatment

23. TREATMENT
 DIVIDED INTO TWO CATEGORIES
A-MEDICAL
Pessary
B-SURGICAL

24. SURGICAL
*CYSTOCELE/URETHROCELE
1-Anterior colporrhaphy
2-Burch colposuspension

25. *RECTOCELE
1-Conservative
2-Posterior
colporrhaphy

26. *ENTEROCELE
1-ABDOMINAL APPROACH
2-VAGINAL APPROACH
Sacrospinous fixation

27. *Uterovaginal prolapse
1-CONSERVATIVE
a-Manchester repair
b-Sling operation
2-RADICAL
a-Vaginal hysterectomy

28. *Vault prolapse
1-Le fort’s operation
2-Utero sacral ligament suspension
3-Sacro spinous ligament fixation

29. THANK
YOU
Rizwan Ullah Khan
Roll No: 08-157
Batch: ‘I’