Definition and Classification

*A prolapse is a downward or forward displacement of one of the pelvic organs from its normal location.

*A variety of terms are used to describe female genital prolapse.

*A cystocele is a downward displacement of the bladder.

*A cystourethrocele is a cystocele that imcludes the urethra as part of the prolapsing organ complex.

*A uterine prolapse is a descent of the uterus and cervix down the vaginal canal toward the vaginal introitus.

*rectocele

*enterocele

Symptoms of Prolapse

*feeling of pressure

*something is protruding from the vagina

*stress urinary incontinence

*voiding difficulty

*inefficient rectal emptying

Stage 0 No prolapse is demonstrated

Stage 1 >1cm above the level of the hymen

Stage 2 the plane of the hymen

Stage 3 >1cm below the plane of the hymen

Stage 4 nearly complete eversion of the vagina

*all aspects of vaginal support should be carefully surveyed.

*examining patients in the standing position as well as in the standard dorsal lithotomy position.

Examination

Treatment

*Asymptomatic prolapse

*to undergo surgical bladder neck suspension

Surgery

*Vaginal Hysterectomy

*Manchester Operation

*Uteropexy

*Paravaginal Defect Repair Operation

*Posterior Colporrhaphy

*Colpectomy and Colpocleisis

*Colpopexy