Explain: Pelvic relaxation syndrome

Content: Abdominal colposacropexy

 

Clinical Information:

The female patient had bearing down sensation, back soreness and lower abdominal pain for years. Palpable protruding prolapsed [[uterus, vaginal wall]] was noted.

ICS staging {{I, II, III, IV}}.

Urodynamic study {normal finding, GSI, D.I., mixed incontinence, not done}} was noted.

Pad test :        gm.

Menopause {{ +, -}}.

Hormone replacement therapy: {{yes, no}}

Urogynecologic ultrasonography {{ +, -}}.

Previous pelvic surgical history: [[no, Burch, Laparoscopic Burch, EBNS, Raz, Stamy, TVT, anterior colporraphy, posterior colporraphy, VTH, colposacropexy, S-S ligament suspension, others]]       

 

Operative Procedures:

Type of operation: Abdominal colposacropexy [[ATH, Sub-total hysterectomy, BSO, RSO, LSO, BS, Burch colposuspension, anterior colporraphy, posterior colporraphy, Appendectomy, Enterolysyis]].

1.          A {{low median incision, pfannestial incision}} about 8 cm in length was made and intraperitoneal cavity was exposed.

2.          A longitudinal incision was made through the peritoneum over the sacral promontory, and the incision was extended caudally for 5 to 6 cm below and posterior to the promontory.

3.          The midsacral artery and vein were identified and a clean area of periosteum over the promontory was able to access.

4.          A piece of {{Prolene mesh, Mersilene mesh}} was used to transfix the vaginal cuff with use of 1-0 Prolene.

5.          A {{longitudinal incision was made from promontory on the peritoneum across the posterolateral aspect of the right side of the cul-de-sac to the vaginal apex, subperitoneal tunnel that extends from the inferior edge of the incision cover the sacral promontory beneath the peritoneum across the posterolateral aspect of the right side of the cul-de-sac to the vaginal apex}}, the mesh was grasped with a Kelly clamp and drew to the promontory of the sacrum fixing on the periosteum of the promontory with stitches of 1-0 Prolene sutures.

6.          {{A, No}} drain was placed in the right pararectal space extraperitoneally.

7.          The incised peritoneum was approximated with chromic and abdominal wall was closed layer by layer.

{{1,2,3,}}

{{1,2,3,}}

{{1,2,3,4,5,6,7,8,}}

{{2.5,3.5,4.5,}}

{{1,2,3,}}

{{1,2,3,4,5,6,7,8,}}

{{1,2,3,}}

{{1,2,3,}}

{{1,2,3,4,5,6,7,8,}}

 
 
 


Operative Findings:

Cystocele grade {{ I, II, III }}

Rectocele {{ I, II, III }}

Enterocele{{ +, -}}

ICS staging {{I, II, III, IV}}.

{{Uterine prolapse, Vaginal cuff eversion}}: {{ I, II, III }}

 

Complication: [[massive bleeding, ureter injury, bladder injury, intestine injury, _______________]].

 

Dr:________________. Date: _______________.