PFD Management

Obstetrics & Gynecology Hospital
Fudan University
Pelvic Floor Dysfunction
Fudan University
Pelvic Organ Prolapse
Lower Urinary Tract disorder
Anorectal Disorder
Fudan University
Not life threatening

But life quality worsening
Fudan University
Pelvic Floor
Fudan University
Pelvic Floor
Pelvic diaphragm
Funnel-shaped
fibromuscular partition
Forms the primary
supporting structure for
the pelvic contents
Composition
Levator ani
Coccygeus muscles
their superior and inferior fasciae
Forms the ceiling of the
ischiorectal fossa

Fudan University
Fudan University
Pelvic Organ Prolapse
Fudan University
Pelvic Organ Prolapse (POP)
bulge or protrusion of pelvic organs and
their associated vaginal segments into or
through the vagina
Incidence increases with aging
anterior pelvic organ prolapse 34.3%
posterior wall prolapse 18.6%
uterine prolapse in 14.3%
Vaginal delivery as a significant risk factor
history of hysterectomy; obesity ; history
of previous prolapse operations; race
Optical surgical treatment remains elusive

Fudan University
Pathophysiology

attenuation of the
supportive structures
endopelvic connective
tissue
levator ani muscular
support
by actual tears or
breaks
by neuromuscular
dysfunction

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Definitions
Rectocele
Enterocele
Cystocele
Uterine prolapse
Procidentia

Fudan University
Definitions
Fudan University
Symptoms
Pelvic organ prolapse
Symptoms of voiding dysfunction
Urinary incontinence
Obstructive voiding symptoms
Urinary urgency and frequency
Urinary retention and upper renal compromise
Defecatory problems (e.g., constipation,
diarrhea, tenesmus, fecal incontinence)
Pelvic pain
Back and flank pain
Overall pelvic discomfort
Dyspareunia

Fudan University
Symptoms
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Physical examination
Divide the pelvis into compartments
Apical compartment ---- Graves speculum or
Baden retractor
The anterior and posterior compartments ----
univalve or Sims' speculum
Rectovaginal examination ---- distinguish a
posterior vaginal wall defect from a dissecting
apical enterocele
Anterior lateral detachment defect----Baden
retractor
Valsalva is encouraged
standing straining examination

Fudan University
Pelvic Organ Prolapse Quantitation System

Fudan University
Fudan University
Fudan University
Pelvic Muscle Function Assessment
Bladder Evaluation

Fudan University
Treatment
Nonsurgical Therapy
Mild to moderate prolapse
Desire future childbearing
Not suitable or desire surgery

Fudan University
Conservative Management
pelvic floor muscle training (PFMT)
Lifestyle intervention
weight loss
reduction of activities that increase intraabdominal
pressure
Mechanical Devices

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Surgical Management

OPTIONAL!!!
relieve symptoms
restore vaginal anatomy
vaginal, abdominal, and laparoscopic
routes
involve a combination of repairs
directed to the anterior vagina, vaginal
apex, posterior vagina, and perineum
None is perfect

Fudan University
Surgical Management
Procedures
Restorative: use the patient's
endogenous support structures
Compensatory: replace deficient
support with permanent graft material
Obliterative: close or partially close the
vagina.

Fudan University
Fudan University
Lower Urinary Tract Disorders

Fudan University
Normal Urethral Closure

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Stress Urinary Incontinence
Most common type of urinary continence in
women
Leaking when sneezing, coughing, or exercise
Urethral sphincter defect and/or urethral
hypermobility
Urge Urinary Incontinence and
Overactive Bladder
most common form of incontinence in older
women
involuntary leakage of urine accompanied by or
immediately preceded by urgency
may or may not be caused by detrusor
overactivity

Fudan University
Mixed Incontinence

have symptoms of both stress and urge urinary
incontinence
in older women mixed and urge incontinence is
predominate

Fudan University
Evaluation
Qtip test
Voiding Diary
Urinalysis
Postvoid Residual Volume
Cough Stress Test
Pad Tests
Urodynamics

Fudan University
Nonsurgical treatment
Lifestyle Changes
Weight loss
Postural change
Decrease caffeine intake
Physical Therapy
pelvic floor muscle training
Behavioral Therapy and Bladder Training

Fudan University
Vaginal and Urethral Devices
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Medications
Stress incontinence
adrenergic activity

Urge Incontinence and Overactive
Bladder
anticholinergic agents

Fudan University
Surgical Treatment for Stress incontinence

TVT/SPARC

Fudan University
TVT/SPARC

Fudan University
Key Points
Fudan University
Thank you !

PFD Management

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Obstetrics & Gynecology Hospital

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