MANAGEMENT OF

UTEROVAGINAL PROLAPSE

BY
DR DENNIS ALLAGOA
 MANAGEMENT
PREVENTION

EXPECTANT

SURGICAL
 PREVENTION
SPECIFIC MEASURES
-correct obesity
-treat chronic cough
-prevent premature bearing down during
delivery
- Avoid credes’ manoevre during delivery
of baby and placenta.
-repair of genital tract lacerations and
incisions
-Avoid forceful instrumental delivery
technique.
 Prevention cont
Avoid constipation in the
puerperium
Encourage postnatal exercise(Kegel’s
exercises)
Prevention of post hysterectomy
vault prolapse by apposition of the
cardinal and uterosacral ligament to
the vaginal vault.
Family planning.
 Expectant management
Physiotheraphy involving the pelvic
floor muscles.
-kegel’s exercises
-Faradism
-TENS (Trans-cutaneous Electric
Nerve Stimulation)
Applications of pessaries to the
vaginal vault.
Oestrogen replacement.
 Indications for expectant
management
 Physiotherapy
-prolapse discovered within six months of delivery
-minor degree of prolapse
 Pessaries
-Therapeutic test to determine if symptoms are really due
to prolapse.
-Prolapse discovered during pregnancy, puerperium and
throughout the period of lactation.
-Patients not fit for surgery.
-Those who refuse surgery
-Presence of decubitus ulcers to promote their healing
before surgery while awaiting surgery
-When family size is not complete

NOTE: Pessaries come in varieties: Ring, Stem, Hodge, Shelf,

Gehrung,gellhorn, Doughnut and inflatable pessaries.
 Complications of pessaries
Impaction of pessaries
Ulceration of vaginal wall
Stress incontinence
Infection
Carcinoma of vaginal wall (rarely)
Oestrogen replacement therapy
Postmenopausal women
Healing of decubitus ulcer
Mild degree of prolapse
 SURGICAL MANAGEMENT
PREOPERATIVE CARE
-Correction of anaemia and nutritional
deficiencies.
-Treatment of UTI, vaginitis and
cervicitis
-Treatment of decubitus ulcers via
-packing with acriflavine, normal
saline and estrogen creams.
-pessary insertion,ulcer heals in 2-
3wks
- Avoid smoking
 Pre –operations cont
Investigations
-Full blood count and ESR
-cervical smear for PAP Test
-urinalysis and urine culture
-vaginal and cervical cultures
-blood urea and electrolytes
-cystometry and cystoscopy when urinary
symptoms are overt.
-Electrocardiography with patient> 40yrs
-Chest X ray > 40 years or preexisting cardio
respiratory disease.
 TYPES OF SURGERY
Pelvic floor repair
- anterior colporrhaphy
-posterior colpoperineorrhapy
- combination of above
- enterocelectomy: Halban/ Moschowitz approach
Manchester or fothergill’s operation
-examination under anaesthesia and
dilatation and curettage
- Anterior colporrhaphy
-posterior colpoperineorrhapy
-amputation of the cervix
-shortening of the transverse cervical ligament
 Operations cont.

Vaginal hysterectomy, pelvic floor repair + shortening

of the cardinal ligament and obliterating the pouch of
Douglas by using the McCall’s culdoplasty

Vaginal colpocleisis: Le forte’s and complete colpocleisis.

Post hysterectomy vaginal vault prolapse

-vaginal approach
- uterosacral ligament suspension: plication of the
uterosacral ligament,McCall’s ,mayo’s ;modified
McCall’s culdoplasty.

- sacrospinous fixation

- iliococcygeal fixation ( prespinous colpopexy)

 Operations cont
Abdominal approach.
Uterosacral suspension
Sacrocolpopexy
Laparoscopic approach
Uterosacral suspension
Sacrocolpopexy
 Post operative care
Continous catherisation: 2-5days
foley’s or suprapubic
-if foley’s catheter is used it should be
secured firmly to the thigh to avoid pulling
on the bladder neck.
-after removal of catheter if residual urine
is less than 50mls then reinsert the
catheter.
-Culture urine at the removal of catheter.
 Postoperative care

Vaginal pack
-A pack soaked in antiseptic solution to
be removed after 24 hours
-Pack is useful in securing haemostasis
and prevention of adhesions.

ANTIBIOTICS
-used until removal of catheter.
Complications of the procedures
Haemorrhage
Urinary retension
Urinary incontinence
Vault infection
Thromboembolic phenomenon
Dyspareunia
Apareunia
Constipation
Recurrent Prolapse
Mesh erosion
Vaginal stenosis
Subfertility
Premature/precipitate labour and cervical dystocia
 Followup visits
The patient is seen at followup clinic at

Six weeks; then at three monthly

intervals for a minimum of three
years.
 CONCLUSION
Measures to reduce difficult
deliveries, grandmultiparity, post
operative morbidity and mortality, as
well as provision of basic maternity
services and empowerment of
women must be continually
advocated.
THANK YOU FOR LISTENING
2006 ON YOUR MARKS.