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PELVIC FLOOR AND FUNCTIONAL ANATOMY PowerPoint Presentation
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PELVIC FLOOR AND FUNCTIONAL ANATOMY

PELVIC FLOOR AND FUNCTIONAL ANATOMY

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PELVIC FLOOR AND FUNCTIONAL ANATOMY

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  1. PELVIC FLOOR AND FUNCTIONAL ANATOMY Assoc. Prof. Gazi YILDIRIM, M.D. Yeditepe University, Medical Faculty Dept of Ob&Gyn

  2. Objectives • To define • Pelvic organ prolapsus • Tolearn • Risk factorsforPelvic organ prolapsus • Diagnosis of theprolapsus • Tomanage • A womanwho has pelvicorgan prolapsus

  3. Functions of Pelvic Floor 1.Supportive function Pelvic viscera 2.Sphincteric function Vagina, Urethra, Rectum 3.Sexual function Proprioseptive sensation

  4. Elements comprising the Pelvis • Bones • Ilium, ischium and pubis fusion • Ligaments • Muscles • Obturator internis muscle • Arcus tendineus levator ani or white line • Levator ani muscles • Urethral and anal sphincter muscles

  5. “Ligaments and Fascia” Cardinal/Uterosacral Complex (Delancy level I) Paracervical Ring Arcus Tendineus Fascia Pelvis ATFP Pubocervical “fascia” Rectovaginal “fascia”

  6. Perineal Body Superficial Transverse perineus Pyramidal Fibrous Body Internal Anal Sphincter External Anal Sphincter Perineal Membrane Bulbocavernosis (urethrovaginal sphincter) Cleveland Clinic Foundation Burnett Novack’s Gynecology 2004

  7. Sphincter urethrae externus • Bulbospongiosus • Ischiocavernosus • Transversus perinei profundus • Transversus perinei superficialis

  8. Lets ‘create’ a woman pelvis…

  9. Bony structures of a pelvis

  10. Perineal muscles Urethra Vagina M. ischiocavernosus M. bulbospongiosus M. transversus perinei superficialis M. sphincter ani externus

  11. Urogenital fascia Urethra Vagina M. transversus perinei profundus M. transversus perinei superficialis M. sphincter ani externus

  12. Pelvic floor ATFP

  13. Add rectum

  14. Rectal connections

  15. Vaginal connections

  16. Urethra Bladder Cervix

  17. lig.cardinale

  18. Lig. sacrouterina Lig. cardinale

  19. DeLancey’s three levels of vaginal support • Apical suspension • Upper paracolpium suspends apex to pelvic walls and sacrum • Damage results in prolapse of vaginal apex • Midvaginal lateral attachment • Vaginal attachment to arcus tendineus fascia and levator ani muscle fascia • Pubocervical and rectovaginal fasciae support bladder and anterior rectum • Avulsion results in cystocele or rectocele • Distal perineal fusion • Fusion of vagina to perineal membrane, body and levators • Damage results in deficient perineal body or urethrocele

  20. De Lancey’s LevelsI. Uterosacral cardinal ligament II. ATFP III. Perineal membrane and perineal body

  21. Factors associated with pelvic floor prolapse • age • parity • big babies • menopause • obesity • occupation • home delivery • family history

  22. Pathogenesis • childbirth • connective tissue disorders • menopause • chronic intra-abdominal pressure • iatrogenic (hysterectomy)

  23. Factors promoting prolapse • Erect posture causes increased stress on muscles, nerves and connective tissue • Acute and chronic trauma of vaginal delivery • Aging • Estrogen deprivation • Intrinsic collagen abnormalities • Chronic increase in intraabdominal pressure • heavy lifting • coughing • constipation

  24. Pelvic Organ Prolapse

  25. POP-Q(Pelvic Organ Prolapse Quantitation) • International Continence Society • American Urogynecologic Society • Society of Gynecologic Surgeons • Pelvic Organ Prolapse • Definicition • Quantitation • Staging • Objective • Defect specific Bump RC. Am J Obstet Gynecol, 1996

  26. Pelvic Organ Prolapse Quantitation Symptomatic Prolapse Stage I Stage II Stage III Stage IV 1 cm 1cm tvl – 1 cm Hymen

  27. Pelvic Relaxation • Cystocele • Stress urinary incontinence • Rectocele • Enterocele • Uterine and vaginal prolapse • Result of weakness or defect in supporting tissues - endopelvic fascia and neuromuscular damage

  28. Apical Prolapse (Uterus)

  29. Apical Prolapse (Uterus)

  30. Apical Prolapse (Uterus)

  31. Apical Prolapse (Uterus)

  32. Apical Prolapse (Uterus)

  33. Apical Prolapse (Uterus)

  34. Complete Uterovaginal procidentia

  35. Anterior Prolapse

  36. Anterior Prolapse

  37. Anterior Prolapse

  38. Anterior Prolapse

  39. Anterior Prolapse

  40. Anterior Prolapse

  41. Anterior Prolapse

  42. Anterior Compartment:Abdominal Approach Bladder Ureter ATFP Paravaginal defect A Cullen Richardson

  43. Vajen ön duvar prolapsusuAyırıcı tanı

  44. Posterior Prolapse

  45. Posterior Prolapse

  46. Posterior Prolapse