Uterine ProlapseUterine Prolapse DI WEN DI WEN M.D., Ph.D., M.D., Ph.D.,

Professor & Chairman Professor & Chairman Department Of Obstetrics & GynecologyDepartment Of Obstetrics & Gynecology Renji Hospital Affiliated to SJTU School of MedicineRenji Hospital Affiliated to SJTU School of Medicine

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The uterus gradually The uterus gradually

descends in the axis of the descends in the axis of the

vagina taking the vaginal vagina taking the vaginal

wall with it. It may present wall with it. It may present

clinically at any level, but is clinically at any level, but is

usually classified as one of usually classified as one of

three degrees.three degrees.

DefinitionDefinition

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CausesCauses

1. The stretching of muscle and fibrous 1. The stretching of muscle and fibrous

tissuetissue

2. Increased intra-abdominal pressure2. Increased intra-abdominal pressure

3. A constitutional predisposition to 3. A constitutional predisposition to

stretching of the ligaments as a stretching of the ligaments as a

response presumably to years in the response presumably to years in the

erect positionerect position

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• In recent years,the incidence of prolapsIn recent years,the incidence of prolapse is greatly reduced. The more liberal ue is greatly reduced. The more liberal use of caesarean section and the eliminase of caesarean section and the elimination of labours are probably the two motion of labours are probably the two most important factors. st important factors.

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SymptomsSymptoms

• Something coming downSomething coming down• BackacheBackache• Increased frequency of micturitionIncreased frequency of micturition• A ‘bearing down’ sensationA ‘bearing down’ sensation• Stress incontinenceStress incontinence• Coital problemsCoital problems• Difficulty in voiding urineDifficulty in voiding urine

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Degrees of uterine prolapseDegrees of uterine prolapse

First degreeFirst degree: cervix still inside vagina: cervix still inside vagina

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Degrees of uterine prolapseDegrees of uterine prolapse• Second degreeSecond degree: the cervix appears outside : the cervix appears outside

the vulva. The cervical lips may become the vulva. The cervical lips may become congested and ulceratedcongested and ulcerated

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Degrees of uterine prolapseDegrees of uterine prolapse

• Third degreeThird degree: complete prolapse.In the picture the uterus is ret: complete prolapse.In the picture the uterus is retroflexed,and the outline of bladder can be seen.This is sometiroflexed,and the outline of bladder can be seen.This is sometimes called complete procidentia.mes called complete procidentia.

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Diagnosis Diagnosis

• A pelvic examination reveals protrusion of the A pelvic examination reveals protrusion of the cervix into the lower part of the vagina (cervix into the lower part of the vagina (mild pmild prolapserolapse), past the vaginal introitus/opening (), past the vaginal introitus/opening (mmoderate prolapseoderate prolapse), or protrusion of the entire u), or protrusion of the entire uterus past the vaginal introitus/opening (terus past the vaginal introitus/opening (seversevere prolapsee prolapse).).

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TreatmentTreatment

Pessary treatmentPessary treatment Indications:Patient prefers a pessary.Indications:Patient prefers a pessary. Pelvic surgery unaviodable risksPelvic surgery unaviodable risks Prolapse amenable to pessaryProlapse amenable to pessary The patient is not fit for surgeryThe patient is not fit for surgery Patient wishes to delay operationPatient wishes to delay operation

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* Anterior colporrhaphy* Anterior colporrhaphy

(and repair of cystocele)(and repair of cystocele) * Posterior colpoperineorrhaphy* Posterior colpoperineorrhaphy (including repair of rectocele)(including repair of rectocele) * Manchester repair* Manchester repair * Vaginal hysterectomy* Vaginal hysterectomy

SurgerySurgery

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DI WEN DI WEN M.D., Ph.D.M.D., Ph.D.

Professor & ChairmanProfessor & Chairman Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology Renji Hospital Affiliated to SJTU School of MedicineRenji Hospital Affiliated to SJTU School of Medicine

Thanks for Your AttentionThanks for Your Attention

DI WEN DI WEN M.D., Ph.D.M.D., Ph.D.

Professor & ChairmanProfessor & Chairman Department of Obstetrics & GynecologyDepartment of Obstetrics & Gynecology Renji Hospital Affiliated to SJTU School of MedicineRenji Hospital Affiliated to SJTU School of Medicine

Thanks for Your AttentionThanks for Your Attention