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Pelvic organ prolapse

Pelvic organ prolapse. POP. Rectocele. Rectocele. COCHRIAN REWIEW 50 % of women with history of delivery have pelvic organ prolapse. RECTOCELE ASSOCIATED WITH : SI. 30% Rectal prolapse. 33% Anismus . 10% Enterocele 2%.

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Pelvic organ prolapse

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  1. Pelvic organ prolapse

  2. POP

  3. Rectocele

  4. Rectocele

  5. COCHRIAN REWIEW 50% of women with history of delivery have pelvic organ prolapse

  6. RECTOCELE ASSOCIATED WITH: • SI. 30% • Rectal prolapse. 33% • Anismus. 10% • Enterocele2%

  7. 42% of gynecologist's elective operations are RECTOCE • BUT • 16% of these patients are evaluated correctly • 85% of patients who are candidate for surgery by • proctologists ,have systematic evaluations

  8. 30% of pop have occult SI

  9. Bowel Bladder Sexual The effect of pop surgery on Function UNPREDICTABLE

  10. Definition of cure in surgical treatment • No anatomic prolapse • No functional symptoms • Patient satisfaction • Avoidance of complication

  11. In upper vaginal vault prolapse which option is preferred? -Abdominal approach(sacrocolpopexy) -Vaginal approach(sacrospinousfixation&post.colporraphy)

  12. Sacrocolpopexy

  13. Uterine or vaginal vault prolapse Abdominal sacrocolpopexy is better than vaginal sacrospinousfixation

  14. In abdominal approach: -laparascopic -open. hysterectomy or Levatormyorraphy With&without

  15. Hysterectomy +abdominal sacrocolpopexy

  16. Comprehension of abdominal sacrocolpopexy&vaginalsacrospinousfixation: Abdominal approach has lower recurrence Less Dysparunia Longer operating time Longer recovery time Higher cost

  17. In post.vaginal wall prolapse which approach has low recurrence ? Post.colporraphy with or without graft Transanal repair √Abdominal post.repair

  18. In rectocele, vaginal approach is superior to transanal approach.

  19. In post.colporraphy: -traditional colporraphy -mesh

  20. NOT enough evidence about the use of mesh

  21. Use of graft: Yes or No?

  22. What kind of graft? -synthetic -Biologic. (autologous,alloplastic,cadave)

  23. Use of absorbable or nonabsorbable graft in cystocele repair: Reduce the risk of recurrent cystocele on examination The effect of graft in patient's satisfaction & QOL is uncertain

  24. In continent women, concomitant continence surgery don't reduce the rate of post.op SI In occult SI, concomitant continence surgery : 20% prevent of post op SI 60% will have unnecessary procedure For balance between cost&side effect more investigation must be done

  25. Rectocele&ant,compartment prolapse: -Traditional ant.repair -Burch operation -Mesh

  26. What kind of suture? -Absorbable -Non absorbable

  27. It is referred to surgeon's preferred.

  28. Rectocele + enterocele ?

  29. Small enterocele : transperineal Large enterocele: transabdominal

  30. Rectocele & vault prolapse & previous hysterectomy?

  31. Abdominosacrocolpopexy

  32. Rectocele + fecal incontinence?

  33. Transperineal. If there is gap in Endoanalsono:+ Sphincteroplasty If there is no gap: + Levatoroplasty

  34. Rectocele + Animus?

  35. Biofeedback & conservative

  36. Rectocele + Anorectalproblem?

  37. Transanal

  38. Rectocele + Severe dyspaurunia?

  39. Transanal

  40. Rectocele&(no anismus , no anorectal problem , no severe dyspaurunia , no fecal incontinence): Transvaginal & site specific repair

  41. Comprehension of surgical repair with conservative management of pop: There is no any research .

  42. Comprehension of surgical repair with mechanical device There is no any research .

  43. Figure 1. Commonly used pessaries: (A) Smith; (B) Hodge; (C) Hodge with support; (D) Gehrung; (E) Risser; (F) Ring with diaphragm; (G) Ring; (H) Cube; (I) Shaatz; (J) Rigid Gellhorn; (K) Flexible Gellhorn; (L) Incontinence ring; (M) Inflatoball; (N) Donut. Image courtesy of CooperSurgical, Inc., Trumbull, CT.

  44. Pessary Insertion

  45. Indication of STARR : Rectocele with&withoutIRP

  46. STARR

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