Most common genital prolapse is :
Ans. is a i.e. Cystocoele Genital prolapse : refers to protusion of the pelvic organ into or out of the vaginal wall. Classification of prolapse Anterior vaginal wall : upper two thirds - cystocoele Cytourethrocoele lower one third - urethrocoele Posterior vaginal wall : upper one third - enterocoele (pouch of Douglas Hernia) Grade I = Descent halfway to the hymen Grade II = Descent to the hymen Grade IIt = Descent halfway past the hymen Grade IV = Maximum possible descent for site Bader walker Halfway system : 11, Grade 0 = Normal postion for each reproesentative site Uterine descent : Shaw's classification (old classification) : 1deg- descent of the cervix to the vagina 2deg - descent of the cervix to the introitus 3deg - descent of the cervix outside the introitus. Procidentia : all of the uterus outside the introitus. Utero vaginal Prolapse : It is the commonest type of prolapse. Cystocoele occurs first followed by traction on the cervix causing retroversion of the uterus and then uterus is pushed into the vagina. Vault prolapse : it follows vaginal or abdominal hysterectomy, symptoms are-coital difficulty and difficulty in walking. Congenital Prolapse : There is no cystocoele. "Data from Women's Health Initiative revealed anterior pelvic organ prolapse in 34.3%, posterior wall prolapse in 18.6% and uterine prolapse in 14.3% of women in the study." Therefore, from the above data it is clear that cystocele (anterior organ prolapse) is the most common type of prolapse. Friends, according to latest trends, prolapse is not classified as above, but compamental classification is done. (It might be asked in fohcoming PGME exams). Newer classification Prolapse Uterine Prolapse Vaginal prolapse 10 descent of the uterus but the cervix remains within the introitus. 2o degree Descent to the extent that the cervix projects through the vulva, when the woman is straining or standing 3o degree i.e. complete Procidentia. Anterior compamentdefectLeads to cystocoeleUrethrocele of vagina Middle compamentdefectLeads to Enterocele& massive eversion Posterior compamentdefectRectocoele and Perinealbody descent Note:Sometimes the term apical prolapse is used - It includes : Uterine prolapse Vaginal vault prolapse (post hysterectomy) Enterocele
Cystocoele
Procidentia
Rectocoele
Enterocoele