1. Female POP (Pelvic Organ Prolapse) For the students of Gulf Medical University, Ajman, MBBSDr. Seyed Morteza Mahmoudi, MBBS Gulf Medical University, Ajman

2. Contents Anatomical relations Support of female pelvic organs Pelvic organ prolapse * Clinical features* Imaging* Treatment * 3. Contents Anatomical relations Support of female pelvic organs Pelvic organ prolapse * Clinical features* Imaging* Treatment * 4. anteverted (angled forward at the junction of the cervix and vagina) 5. anteflexed (angled forward at the junction of the body and cervix) 6. The Urogenital Diaphragm 7. v Factors supporting the uterus: a. Position of the uterus. b. Position of the surrounding organs. c. Perineal body. d. Tone of pelvic diaphragm e. Ligaments of uterus: Round lig. of uterus. Transverse cervical lig. (Mackenrodts lig.). Utero-sacral lig. Pubo-vesical (cervical) lig. 8. Contents Anatomical relations Support of female pelvic organs Pelvic organ prolapse * Clinical features* Imaging* Treatment * 9. POP (Pelvic Organ Prolapse) Prolapse: protrusion of a viscus through an aperture. Pelvic organ prolapse is descent of followings alone orin combination: Anterior vaginal wall Posterior vaginal wall Uterus The apex of the vagina after hysterectomy, 10. Types Cystocele (bladder into vagina) Enterocele (small intestine into vagina) Rectocele (rectum into vagina) Urethrocele (urethra into vagina) Uterine prolapse (uterus into vagina) Vaginal vault prolapse (roof of vagina) - afterHysterectomy 11. Risk factors Pregnancy Vaginal childbirth Menopause Aging Hypoestrogenism Chronically increased intraabdominal pressure Chronic obstructive pulmonary disease (COPD) Constipation Obesity Pelvic floor trauma Genetic factors Connective tissue disorders 12. Contents Anatomical relations Support of female pelvic organs Pelvic organ prolapse * Clinical features* Imaging* Treatment * 13. Diagnosis of POP Detailed history and physical examination Pelvic ultrasound Fluoroscopy of rectum & bladder Magnetic resonance imaging (MRI) 14. Lower Urinary Tract Symptoms caused by Pelvic Organ Prolapse Stress incontinence Frequency, urgency, urge incontinence Hesitancy, weak stream, incomplete empty Manual reduction of prolapse for voiding 15. Bowel Symptoms caused by Pelvic Organ Prolapse Difficulty with defecation Fecal incontinence Fecal staining of underwear Digital manipulation to complete defecation Feeling of incomplete evacuation Rectal protrusion during or after defecation 16. Local symptoms caused by Pelvic Organ Prolapse Vaginal pressure or heaviness Vaginal or perineal pain Low back pain Abdominal pressure or pain Observation or palpation of a mass 17. Physical examination of Uterine Prolapse 18. Baden-Walker Halfway System 19. Contents Anatomical relations Support of female pelvic organs Pelvic organ prolapse * Clinical features* Imaging* Treatment * 20. Descent of Bladder during Stress 21. MRI of Cystocele 22. MRI of Enterocele 23. MRI of Rectocele 24. MRI of Uetrine Prolapse 25. Contents Anatomical relations Support of female pelvic organs Pelvic organ prolapse * Clinical features* Imaging* Treatment * 26. Treatment Conservative Measures Pessary Pelvic floor muscle exercises Estrogens Surgical Measures 27. Surgery Indications Urinary incontinence Urinary obstruction- hydronephrosis Pressure sores and erosions Difficulty defecation Small bowel obstruction 28. Surgeries Obliterative Procedures (Lefort colpocleisis) Reconstructive Procedures Anterior Vaginal Prolapse ANTERIOR VAGINAL COLPORRHAPHY Posterior Vaginal Prolapse Posterior vaginal repair Apical Vaginal Repair SACROSPINOUS LIGAMENT FIXATION UTEROSACRAL LIGAMENT SUSPENSION ABDOMINAL SACROCOLPOPEXY 29. Anterior Vaginal Colporrhaphy 30. Colpopexy/ Hysteropexy 31. http://www.nezhat.org/pelvic_floor_prolapse/pelvic_floor_prolapse.php