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Genital Prolapse: Dr. Isameldin Elamin MD DOWH MBBS Assistant Professor Obstetrics & Gynaecology Department
Genital Prolapse: Dr. Isameldin Elamin MD DOWH MBBS Assistant Professor Obstetrics & Gynaecology Department
o Nerve supply.
Procidentia:
o Third-degree uterine prolapse.
Clinical features
History:
o Enquire about aetiological factors.
o Ask about symptoms:
o Non-specific symptoms:
Lump.
Local discomfort.
Backache.
Bleeding/infection.
Dyspareunia or apareunia.
Renal failure.
Clinical features…CONT.
Specific symptoms:
Cystourethrocele:
o Urinary frequency and urgency.
o Voiding difficulty.
o Urinary tract infection.
o Stress incontinence.
Rectocele:
o Incomplete bowel emptying.
o Passive anal incontinence.
Clinical features…CONT.
Abdominal examination for:
o Organomegaly or abdominopelvic mass.
Vaginal examination:
o Examine the patient in the dorsal position.
o Look for:
Prolapse
Ulceration.
Atrophy.
Clinical features…CONT.
Vaginal pelvic examination for:
o Pelvic mass.
o Assess vaginal walls.
o Assess cervical descent.
o Put patient in left lateral position.
o Ask him to strain.
Use a Sims speculum.
Do rectal and vaginal examination to
differentiate rectocele from enterocele
Differential diagnosis:
For anterior wall prolapse:
o Dermoid vaginal cyst.
o Urethral diverticulum.
Coital
function is determinant factor to
choose the type and operation.
Surgical teartment …CONT.
Cystourethrocele:
o Anterior repair (colporrhaphy) is the most
commonly performed surgical procedure.
o Should be avoided if there is concurrent
stress incontinence.
Procedure:
o Incision made.
o Defect identified and closed.
o Redundant tissue removed.
Surgical teartment …CONT.
Rectocele:
o Procedure is posterior repair
(colporrhaphy).
Enterocele:
o Peritoneal sac excised.
o Pouch of Douglas is closed.
Surgical teartment …CONT.
Uterovaginal prolapse:
Uterine preserving surgery when:
o Woman wishes to preserve her uterus.
o Woman wants further children.
Vaginal hysterectomy.