1、Uterine Prolapse,DI WEN M.D., Ph.D., Professor & Chairman Department Of Obstetrics & GynecologyRenji Hospital Affiliated to SJTU School of Medicine,Uterine Prolapse,2,The uterus gradually descends in the axis of the vagina taking the vaginal wall with it. It may present clinically at any level, but
2、is usually classified as one of three degrees.,Definition,Uterine Prolapse,3,Uterine Prolapse,4,Uterine Prolapse,5,Uterine Prolapse,6,Uterine Prolapse,7,Causes,1. The stretching of muscle and fibrous tissue 2. Increased intra-abdominal pressure 3. A constitutional predisposition to stretching of the
3、 ligaments as a response presumably to years in the erect position,Uterine Prolapse,8,Uterine Prolapse,9,Uterine Prolapse,10,In recent years,the incidence of prolapse is greatly reduced. The more liberal use of caesarean section and the elimination of labours are probably the two most important fact
4、ors.,Uterine Prolapse,11,Symptoms,Something coming down Backache Increased frequency of micturition A bearing down sensation Stress incontinence Coital problems Difficulty in voiding urine,Uterine Prolapse,12,Uterine Prolapse,13,Uterine Prolapse,14,Uterine Prolapse,15,Uterine Prolapse,16,Uterine Pro
5、lapse,17,Uterine Prolapse,18,Degrees of uterine prolapse,First degree: cervix still inside vagina,Uterine Prolapse,19,Degrees of uterine prolapse,Second degree: the cervix appears outside the vulva. The cervical lips may become congested and ulcerated,Uterine Prolapse,20,Degrees of uterine prolapse,
6、Third degree: complete prolapse.In the picture the uterus is retroflexed,and the outline of bladder can be seen.This is sometimes called complete procidentia.,Uterine Prolapse,21,Diagnosis,A pelvic examination reveals protrusion of the cervix into the lower part of the vagina (mild prolapse), past t
7、he vaginal introitus/opening (moderate prolapse), or protrusion of the entire uterus past the vaginal introitus/opening (severe prolapse).,Uterine Prolapse,22,Treatment,Pessary treatmentIndications:Patient prefers a pessary.Pelvic surgery unaviodable risksProlapse amenable to pessaryThe patient is n
8、ot fit for surgeryPatient wishes to delay operation,Uterine Prolapse,23,Uterine Prolapse,24,Uterine Prolapse,25,Uterine Prolapse,26,Uterine Prolapse,27,* Anterior colporrhaphy(and repair of cystocele)* Posterior colpoperineorrhaphy(including repair of rectocele)* Manchester repair* Vaginal hysterect
9、omy,Surgery,Uterine Prolapse,28,Uterine Prolapse,29,Uterine Prolapse,30,Uterine Prolapse,31,Uterine Prolapse,32,Uterine Prolapse,33,DI WEN M.D., Ph.D.Professor & ChairmanDepartment of Obstetrics & GynecologyRenji Hospital Affiliated to SJTU School of Medicine,Thanks for Your Attention,DI WEN M.D., Ph.D.Professor & ChairmanDepartment of Obstetrics & GynecologyRenji Hospital Affiliated to SJTU School of Medicine,Thanks for Your Attention,
