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Genital prolapse – anatomical

• Uterine prolapse
• Anterior vaginal wall prolapse
– cystocele
– cystourethrocele
• Posterior vaginal wall prolapse
– rectocele
Genital prolapse – enterocele
• Other associated conditions – urethral caruncle;
5th Year Medical Students
2005
rectal prolapse; vaginal vault prolpase

Uterovaginal prolapse Cystocele

Rectocele First degree uterine prolapse

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Second degree uterine prolapse Third degree uterine prolapse

Predisposing factors Symptoms


• Congenital pelvic floor weakness – • Pressure symptoms – weight dragging down
collagen, race, anatomy • Mass at introitus
• Difficult or traumatic labour - denervation • Low backache
• Multiparity - trauma • Urinary symptoms – incomplete emptying of
• Chronic disorders – chronic obstructive bladder, retention of urine, recurrent UTI
airway, constipations, straining • Bladder symptoms – constipation, mass
• Abdominal tumours protruding at defaecation
• Obesity, smoking, heavy lifting • Others – bleeding, discharges, stress
incontinence, discomfort
• Steroids, menopause, pelvic surgery

Cystocele –
Findings
paravaginal defect & midline defect
• Uterine prolapse – first, second or third
degree (complete procidentia)
• Anterior vaginal wall prolapse – bladder
prolapse, urinary incontinence
– midline defects – loss of rugae
– para-vaginal defects – rugae OK
• Posterior vaginal wall prolapse – rectal
prolapse, loaded faecal matter
• Urethral caruncle – red inflamed tumour

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Uterine prolapse Vaginal prolapse
Conservative treatment • Cystocele, urethrocele
– observation or pessary treatment – Anterior vaginal wall repair, “mesh” repair
– pelvic floor exercise
• Rectocele
(young, women wanting pregnancy, pregnancy,
– Posterior vaginal wall repair, posterior
against surgical intervention, pessary test) perineorrhaphy
Surgical treatment – Enterocele repair
- uterus conserved – Manchester repair,
uterosacroplexy, ischiospinous • Genuine stress incontinence
colposuspension, sacrocolpopexy – Tensionless vaginal tape procedure, other sling
- uterus removed – vaginal hysterectomy procedures, laparoscopic colposuspension, Burch
colposuspension