Pelvic Organ Prolapse (POP)

Pelvic Organ Prolapse(POP)

Kristin Rooney, MD, FACOG,FPMRS

Assistant Professor

Dept. of Obstetrics and Gynecology

Disclosure

I have nothing to disclose

Objectives

To present an overview of the prevalence, risk factors and presenting symptoms of POP.

Discuss diagnosis of POP.

Discuss stress urinary incontinence(SUI).

Review treatments of POP and SUI.

Symptoms of POP

Pelvic pressure and pain

Bulge

SUI

Urge incontinence

Defecatory problems

Splinting the rectum

Not emptying completely

Constipation

Vaginal bleeding and excoriation

Why do they have these symptoms?

What and where are these defects?

Female Pelvic Anatomy

CystoceleAnterior Compartment Prolapse

CystoceleAnterior Compartment Prolapse

RectocelePosterior Compartment Prolapse

RectocelePosterior Compartment Prolapse

Uterine ProlapseVaginal Cuff ProlapseApical Compartment Prolapse

Pathophysiology

Damage to the complex support system

Hernias

Prevalence

In the US 24 % have some POP(up to 50% of parous)

8% of women will require surgery by 80 yoa

WHI

34 % had anterior vaginal wall prolapse

19 % had posterior vaginal wall prolapse

14 % had uterine prolapse

Population based surveys

4-10 % report symptoms of pelvic organ prolapse

African-American women report symptoms less often

Risk Factors

Vaginal births and pregnancy in general

3rd and 4th degree tears

Smoking

Steroids

Obesity

Chronic cough

Heavy lifting

Collagen defects

Marfans, Ehlers-Danlos

Family History

Exam

Work Up for POP

History

Physical

PVR

Qtip test for SUI

Speculum exam

Lying

Standing

Rectal Exam

POP-Q

POP-Q

Treatments

Conservative

wait and see approach

Lifestyle modification

Kegel Exercises

Pessaries

Surgical

Conservative Treatments

Weight loss, eliminate constipation, reduce inciting activities(coughing, steroids, heavy lifting)

Physical Therapy

Pessary

Pessaries and how they fit

Surgical Treatments

Need to address each compartmentindividually

Where is the prolapse?

Anterior?

Posterior?

Apical?

USUALLY ALL OF THE ABOVE!

Surgical Treatments

Anterior compartment

Anterior repair (anterior colporrhaphy)

Posterior compartment

Posterior repair (posterior colporrhaphy)

Perineorrhaphy

Apical compartment

Sacrospinous ligament suspension

Uterosacral ligament suspension

Sacral colpopexy

Colpocleisis

Anterior and Posterior Repairs

Sacrospinous ligament suspension - extraperitoneal

Uterosacral ligament suspension - intraperitoneal

Sacral colpopexy intraperitoneal approach, buried beneath peritoneum

Surgical considerations

Failure

Dyspareunia

Pelvic Pain

Mesh erosion

Preoperative health

Postoperative expectations

Risk for underlying urinary incontinence

Surgical Treatments

Mesh kits

FDA-black box warning

Require special consent

Thank you.

Modify risk factors.

Counsel about Kegels.