浙江大学医学院：盆腔器官脱垂 Relaxation of Pelvic Supports（Pelvic Organ Prolapse，PPT讲稿）

Relaxation of Pelvic Supports (Pelvic Organ Prolapse) Womens Hospital, School of Medicine, Zhejiang University Jianhong Zhou 周坚红

Relaxation of Pelvic Supports (Pelvic Organ Prolapse) Women’s Hospital, School of Medicine, Zhejiang University Jianhong Zhou 周坚红

NTRODUCTION Pelvic organ prolapse(POP)is a common group of clinical conditions affecting millions of women ncluding anterior and posterior vaginal prolapse Uterine prolapse and enterocele

INTRODUCTION • Pelvic organ prolapse(POP) is a common group of clinical conditions affecting millions of women • Including – anterior and posterior vaginal prolapse –Uterine prolapse and enterocele

CLINICAL IMPORTANCE The prevalence of PoP increases with age The lifetime risk that a woman in the usa Mill have surgery for POP or urinary incontinence is 11%, with up to 1/3 of surgeries representing repeat procedures The direct cost of prolapse surgery is greater than $1 billion per year

CLINICAL IMPORTANCE • The prevalence of POP increases with age • The lifetime risk that a woman in the USA will have surgery for POP or urinary incontinence is 11%, with up to 1/3 of surgeries representing repeat procedures. • The direct cost of prolapse surgery is greater than $1 billion per year

CLINICAL IMPORTANCE Surgically treated prolapse represents the severe end of the clinical spectrum For the vast majority of asymptomatic women with physical findings of prolapse, no treatment is indicated

CLINICAL IMPORTANCE • Surgically treated prolapse represents the severe end of the clinical spectrum • For the vast majority of asymptomatic women with physical findings of prolapse, no treatment is indicated

Anatomy of pelvic floor To understand the pathophysiology of POP Some knowledge of normal vaginal support is needed

Anatomy of pelvic floor • To understand the pathophysiology of POP • Some knowledge of normal vaginal support is needed

CC. Maher&S.Francis Bladder Vagina Rectum Pelvic Floor Anal Sphincter The female pelvic floor serves to aid in the function of the lower urinary system, genital tract and rectum. The female pelvic floor is composed of voluntary muscle, fascia and condensations of fascia called ligaments that all work together to offer support and function to the organs that exit through the female pelvis

The female pelvic floor serves to aid in the function of the lower urinary system, genital tract and rectum. The female pelvic floor is composed of voluntary muscle, fascia and condensations of fascia called ligaments that all work together to offer support and function to the organs that exit through the female pelvis

⊙ C. Maher& s. Francis Pubic Bone Sacrum an empty pelvis looking from above. At the back is the sacrum(tailbone) and the front is the pubic bones

an empty pelvis looking from above. At the back is the sacrum (tailbone) and the front is the pubic bones

C Maher &S Francis Urethra Vagina Perineum Anu Exiting the female pelvis from the front to the back, is the urethra, vagina and anus The anus is surrounded by the anal sphincter which is connected to the sacrum behind and the perineum muscles in front The perineum stabilizes the lower pelvic floor. The perineum is stabilized to the pelvic side-wall by the transverse perineum muscles

• Exiting the female pelvis from the front to the back, is the urethra, vagina and anus. • The anus is surrounded by the anal sphincter which is connected to the sacrum behind and the perineum muscles in front. • The perineum stabilizes the lower pelvic floor. The perineum is stabilized to the pelvic side-wall by the transverse perineum muscles

C .Maher&S.Francis Anal Sphincter The urogenital diaphram offers further support to the lower urethra and vagina and is stabilized to the pubic bones and the perineum

The urogenital diaphram offers further support to the lower urethra and vagina and is stabilized to the pubic bones and the perineum