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Management of Prolapse: Preventive Conservative Surgery
Management of Prolapse: Preventive Conservative Surgery
Preventive
Conservative
Surgery
Preventive
General measures
Antenatal
&intranatal care Postnatal care
* Avoid strenuous
* Encourage early activities, chr.
* To avoid injury to
cough, constipation
the supporting ambulation
& heavy weight
structures during * Encourage pelvic lifting
time of vaginal
floor exercise by * Avoid future
delivery either
sspontaneous or
squeezing the pelvic pregnancy too soon
instrumental floor muscles in the & too many by
puerperium contraceptive
practise
Conservative: Pessary treatment
Limitations
It is never curative and only be palliative
It can cause vaginitis
Pessary needs to be changed every 3 months
The wearing of pessary is not comfortable to some
women and may cause dyspareunia
If the vaginal orifice is very patulous, the pessary is
often not retained.
A forgotten pessary can be the cause of ulcer, rarely
carcinoma of vagina and a vesicovaginal fistula
A pessary does not cure urinary stress incontinence
Indications:
A young woman planning a pregnancy
During early pregnancy
Puerperium
Temporary use while clearing infection and decubitus ulcer
A woman unfit for surgery
In case a woman refuses for surgery
Ring pessary is made of soft plastic polyvinyl chloride &
available in different sizes.
Surgery
Complications:
Hemorrhage
Sepsis
Anaesthesia risks
UTI
Rarely trauma to bladderand rectum.
Vault prolapse as late sequela
Dyspareunia caused by short vagina
Le Fort’s repair
Reserved for the very elderly menopausal ptwith advanced
prolapse or for those considered unfit for any major surgical
procedure.
Pap smear & pelvic sonography to r/o pelvic pathology prior to
procedure
Procedure can be performed under sedation & LA or EA.
Flaps of vagina from ant & post vaginal walls are excised, the raw
areas apposed with catgut sutures
Wide area of adhesion is created in the midline prevents uterus
from prolapsing, small tunnels on either side permitting drainage
of discharge.
Operation limits marital function, not to be advised to women with
active married life.
Contraindicated in menstruating woman,a woman with diseased
cervix and uterus.
Abdominal Sling operations