上海产科临床医学中心建设规划

UterineProlapse

-Uterineprolapse("droppeduterus")isaconditioninwhichawoman'suterus(womb)sagsorslipsoutofitsnormalposition.Theuterusmayslipenoughthatitdropspartiallyintothevagina(thebirthcanal),creatingaperceptiblelumporbulge.Thisiscalledincompleteprolapse.Inamoreseverecase—knownascompleteprolapse—theuterusslipstosuchadegreethatsomeofthetissuedropsoutsideofthevagina.2UterineProlapse-ProlapseDefinitionProlapseliterallymeans"tofalloutofplace."Inmedicine,prolapseisaconditionwhereorgans,suchastheuterus,falldownorslipoutofplace.Itisgenerallyreservedfororgansprotrudingthroughthevagina,orforthemisalignmentofthevalvesoftheheart.3UterineProlapse-AnatomyoftheVagina-Thevaginalvaulthasthreecompartments:ananteriorcompartment(consistingoftheanteriorvaginalwall),amiddlecompartment(cervix),andaposteriorcompartment(posteriorvaginalwall).Uterineprolapseinvolvesthecervix.4UterineProlapseSigns&Symptoms-Womenwithmildcasesofuterineprolapsemayhavenoobvioussymptoms.However,astheslippeduterusfallsfurtheroutofposition,itcanplacepressureonotherpelvicorgans—suchasthebladderorbowel—causingavarietyofsymptoms,including:Pelvicpressure:afeelingofheavinessorpressureinthepelvisPelvicpain:discomfortinthepelvis,abdomenorlowerbackPainduringintercourseAprotrusionoftissuefromtheopeningofthevaginaRecurrentbladderinfections5UterineProlapseUnusualorexcessivedischargefromthevaginaConstipationDifficultywithurination,includinginvoluntary-lossofurine(femaleincontinence),orurinaryfrequencyorurgency

1Symptomsmaybeworsenedbyprolongedstandingorwalking,duetoaddedpressureplacedonthepelvicmusclesbygravity.6UterineProlapseCausesofUterineProlapse-Traumaincurredduringthebirthingprocess,particularlywithlargebabiesorafteradifficultlaboranddelivery,isoneofthemaincausesofthemuscleweaknessthatleadstouterineprolapse.Reducedmuscletonefromaging,aswellasloweredamountsofcirculatingestrogenaftermenopause,mayalsoformcontributingfactorsinpelvicorganprolapses.Inrarecircumstances,uterineprolapsemaybecausedbyatumorinthepelviccavity.7UterineProlapseGeneticsalsomayplayarole;womenofNorthernEuropeandescentexperienceahigherincidenceofuterineprolapsethandowomenofAsianandAfricanheritage.Finally,increasedintra-abdominalpressure,stemmingfromsuchdiverseconditionsasobesity,chroniclungdiseaseandasthma,canbecontributingfactorsinuterineprolapse.

8UterineProlapseRiskFactorsOneormorepregnanciesandvaginalbirthsGivingbirthtoalargebabyIncreasingageFrequentheavyliftingChroniccoughingFrequentstrainingduringbowelmovements

9UterineProlapse-StagesofUterineProlapseFourstagesofuterineprolapsearecommonlydefined:StagingDefinitionsEversion:

Aturningoutwardorturninginsideout

Procidentia:

Aprolapseorfallingdown10UterineProlapseStageIofuterineprolapseisdefinedasdescentoftheuterustoanypointinthevaginaabovethehymen(orhymenalremnants).StageIIofuterineprolapseisdefinedasdescenttothehymen.StageIIIofuterineprolapseisdefinedasdescentbeyondthehymen.StageIVofuterineprolapseisdefinedastotaleversionorprocidentia.6-Uterineprolapsealwaysisaccompaniedbysomedegreeofvaginalvaultprolapse.11UterineProlapse12UterineProlapseTreatment-Losingweight,stoppingsmokingandgettingpropertreatmentforcontributingmedicalproblems,suchaslungdisease,mayslowtheprogressionofuterineprolapse.-Ifyouhaveverymilduterineprolapse,eitherwithoutsymptomsorwithsymptomsthataren'thighlybothersome,notreatmentisnecessary.However,withouttreatment,youmaycontinuetoloseuterinesupport,whichcouldrequirefuturetreatment.13UterineProlapseNon-SurgicalOptionsSurgicalOptionsHysterectomy

isawayoftreatingproblemsthataffecttheuterus.Manyconditionscanbecuredwithhysterectomy.Becauseitismajorsurgery,youmaywanttoexploreothertreatmentoptionsfirst.Forconditionsthathavenotrespondedtoothertreatments,ahysterectomymaybethebestchoice.Youshouldbefullyinformedofalloptionsbeforeyoudecide.14UterineProlapseThispamphletexplainsreasonsforhavingahysterectomyhowhysterectomyisperformedrisksofhysterectomyrecoveryaftersurgeryReasonsforHysterectomy-Hysterectomyisthesurgicalremovaloftheuterus.Itisthesecondmostcommontypeofmajorsurgeryperformedonwomenofchildbearingage(themostcommonis

cesareandelivery).Hysterectomymaybedonetotreatmanyconditionsthataffecttheuterus:15UterineProlapseUterine

fibroidsEndometriosisPelvicsupportproblems(suchas

uterineprolapsed)AbnormaluterinebleedingCancerChronicpelvicpain16UterineProlapse17UterineProlapse18UterineProlapse19UterineProlapse-Hysterectomyismajorsurgery,andaswithanymajorsurgery,itcarriesrisks.Formanyoftheproblemslistedpreviously,othertreatmentscanbetriedfirst.Afterhysterectomy,younolongerareabletobecomepregnant.Discussallofthetreatmentoptionsforyourspecificconditionwithyourhealthcareprovider.Thereareseveralkindsofhysterectomy:20UterineProlapseTotalhysterectomy—Theentireuterus,includingthecervix,isremoved.Inatotalradicalhysterectomy,theentireuterusandsupportstructuresaroundtheuterusareremoved.Itoftenisdonetotreatcertaintypesofcancer.Supracervical(alsocalledsubtotalorpartial)hysterectomy—Theupperpartoftheuterusisremovedbutthecervixisleftinplace.Hysterectomywithremovalofthe

fallopiantubes

andovaries—Ahysterectomydoesnotincluderemovaloftheovariesandfallopiantubes.Surgerytoremovetheovariesiscalledanoophorectomy.Surgerytoremovethefallopiantubesiscalledasalpingectomy.Oneorbothoftheseprocedurescanbedoneatthesametimeasahysterectomy.Sometimes,onlyoneovaryortubeisremoved.21UterineProlapseHowHysterectomyIsPerformedAhysterectomycanbedoneindifferentways.Thewayahysterectomyisperformeddependsonthereasonforthesurgeryandotherfactors,includingyourgeneralhealth.YouandyourdoctorwilldecidewhichrouteissafestandbestforyoursituationSometimesitisnotpossibletoknowbeforethesurgeryhowthehysterectomywillbeperformed.Inthesecases,thedecisionismadeafterthesurgerybeginsandthesurgeonisabletoseewhetherotherproblemsarepresent.22UterineProlapseVaginalHysterectomyInavaginalhysterectomy,theuterusisremovedthroughthe

vagina.Withthistypeofsurgery,youwillnothaveanincision(cut)onyourabdomen.Becausetheincisionisinsidethevagina,thehealingtimemaybeshorterthanwithabdominalsurgery.Theremaybelesspainduringrecovery.Vaginalhysterectomycausesfewercomplicationsthantheothertypesofhysterectomyandisaverysafewaytoremovetheuterus.Italsoisassociatedwithashorterhospitalstayandafasterreturntonormalactivitiesthanabdominalhysterectomy.23UterineProlapseAvaginalhysterectomyisnotalwayspossible.Forexample,womenwhohave

adhesions

fromprevioussurgeryorwhohaveaverylargeuterusmaynotbeabletohavethistypeofsurgery.24UterineProlapseAbdominalHysterectomyInanabdominalhysterectomy,thedoctormakesanincisionthroughtheskinandtissueinthelowerabdomentoreachtheuterus.Theincisionmaybeverticalorhorizontal.Thistypeofhysterectomygivesthesurgeonagoodviewoftheuterusandotherorgansduringtheoperation.Thisproceduremaybechosenifyouhavelargetumorsorifcancermaybepresent.Abdominalhysterectomymayrequirealongerhealingtimethanvaginalorlaparoscopicsurgery,anditusuallyrequiresalongerhospitalstay.25UterineProlapseLaparoscopicHysterectomyInalaparoscopichysterectomy,laparoscope

isusedtoguidethesurgery.Alaparoscopeisathin,lightedtubewithacamerathatisinsertedintotheabdomenthroughasmallincisioninoraroundthenavel.Itallowsthesurgeontoseethepelvicorgansonascreen.Additionalsmallincisionsaremadeintheabdomenforotherinstrumentsusedinthesurgery.26UterineProlapse27UterineProlapse28UterineProlapseTherearethreekindsoflaparoscopichysterectomy:Totallaparoscopichysterectomy—Asmallincisionismadeinthenavelforthelaparoscope,andoneormoresmallincisionsaremadeintheabdomenforotherinstruments.Theuterusisdetachedfrominsidethebody.Itthenisremovedinsmallpiecesthroughtheincisions,orthepiecesarepassedoutofthebodythroughthevagina.Ifonlytheuterusisremovedandthecervixisleftinplace,itiscalledasupracervicallaparoscopichysterectomy.29UterineProlapseLaparoscopicallyassistedvaginalhysterectomy(LAVH)—Avaginalhysterectomyisdonewithlaparoscopicassistance.Forexample,theovariesandfallopiantubesmaybedetachedusinglaparoscopy,andthentheuterusisdetachedandalloftheorgansareremovedthroughthevagina.Robot-assistedlaparoscopichysterectomy—Somesurgeonsusearobotattachedtothelaparoscopicinstrumentstohelpperformthesurgery.Experienceusingthistechnologyislimited.Moreinformationisneededtoseeifroboticsurgeryhasaddedbenefitsovertheothermethods.30UterineProlapseLaparoscopicsurgeryhassomebenefitsoverabdominalsurgery:Theincisionsaresmaller,andtheremaybelesspain.Thehospitalstayafterlaparoscopicsurgerymaybeshorter.Youmaybeabletoreturntoyournormalactivitiessooner.Theriskofinfectionislower.31UterineProlapse-Therealsoaredisadvantages.Itoftentakeslongertoperformlaparoscopicsurgerycomparedwithabdominalorvaginalsurgery.Thelongeryouareunder

generalanesthesia,thegreatertherisksforcertaincomplications.Also,thereisanincreasedriskforbladderinjuryinthistypeofsurgery.32UterineProlapse33UterineProlapseAneedleisplacedinyourarm,wrist,orhand.Itisattachedtoatubecalledanintravenous(IV)linethatwillsupplyyourbodywithfluids,medication,orblood.Youwillbegivenan

antibiotic

topreventinfection.Specialstockingsordevicesmaybeplacedonyourlowerlegstoprevent

deepveinthrombosis(DVT).Thisconditionisariskwithanysurgery.WomenathighriskofDVTmaybegivenadrugtopreventbloodclotsfromforminginthelegs.34UterineProlapseMonitorswillbeattachedtoyourbodybeforeanesthesiaisgiven.Youmaybegivengeneralanesthesia,whichputsyoutosleep,or

regionalanesthesia,whichblocksoutfeelinginthelowerpartofyourbody..Beforeyouaregivenanesthesia,youlikelywillbeaskedtostateyourname,thetypeofsurgeryyouarehaving,orotherinformation.Thisstandardprocedure,calleda“time-out,”isdonetoensurethattherightsurgeryisbeingdoneontherightpatient.Athintubecalledacatheterwillbeplacedinyourbladder.Thecatheterwilldrainurinefromyourbladderduringthesurgery.35UterineProlapseRisksHysterectomyisoneofthesafestsurgicalprocedures.Butaswithanysurgery,problemscanoccur:InfectionBleedingduringoraftersurgeryInjurytotheurinarytractornearbyorgansBloodclotsintheveinsorlungsProblemsrelatedtoanesthesiaDeath36UterineProlapse37UterineProlapseYourRecovery-Ifyouhaveahysterectomy,youmayneedtostayinthehospitalforafewdays.Thelengthofyourhospitalstaywilldependonthetypeofhysterectomyyouhadandhowitwasperformed.-Youwillbeurgedtowalkaroundassoonaspossibleafteryoursurgery.Walkingwillhelppreventbloodclotsinyourlegs.Youalsomayreceivemedicineorothercaretohelppreventbloodclots.38UterineProlapse-Youcanexpecttohavesomepainforthefirstfewdaysafterthesurgery.Youwillbegivenmedicationtorelievepain.Youwillhavebleedinganddischargefromyourvaginaforseveralweeks.Sanitarypadscanbeusedafterthesurgery.-Duringtherecoveryperiod,itisimportanttofollowyourhealthcareprovider’sinstructions.Besuretogetlotsofrest,anddonotliftheavyobjectsuntilyourdoctorsaysyoucan.Donotputanythinginyourvaginaduringthefirst6weeks.Thatincludesdouching,havingsex,andusingtampons.39UterineProlapse40UterineProlapseEffectsofHysterectomy-Hysterectomycanhavebothphysicalandemotionaleffects.Somelastashorttime.Othersmaylastalongtime.Youshouldbeawareoftheseeffectsbeforehavingthesurgery.-Theovariesaretheglandsthatproduce

estrogen,a

hormone

thataffectsthebodyinmanyways.Dependingonyourage,ifyourovariesareremovedduringhysterectomy,youwillhavesignsandsymptomscausedbyalackofestrogen41UterineProlapsePhysicalEffect-Afterhysterectomy,yourperiodswillstop.Iftheovariesareleftinplaceandyouhavenotyetgonethrough

menopause,theywillstillproduceestrogenandwillcontinuetodosountiltheystopfunctioningnaturally.42UterineProlapseEmotionalEffects-Itisnotuncommontohaveanemotionalresponsetohysterectomy.Howyouwillfeelafterthesurgerydependsonanumberoffactorsanddiffersforeachwoman.-Somewomenfeeldepressedbecausetheycannolongerhavechildren.Ifdepressionlastslongerthanafewweeks,seeyourhealthcareprovider.Otherwomenmayfeelrelievedbecausethesymptomstheywerehavinghavenowstopped.43UterineProlapseSexualEffects-Somewomennoticeachangeintheirsexualresponseafterahysterectomy.Becausetheuterushasbeenremoved,uterinecontractionsthatmayhavebeenfeltduringorgasmwillnolongeroccur.-Somewomenfeelmoresexualpleasureafterhysterectomy.Thismaybebecausetheynolongerhavetoworryaboutgettingpregnant.Italsomaybebecausetheynolongerhavethediscomfortorheavybleedingcausedbytheproblemleadingtohysterectomy.44UterineProlapse-Somewomenwishtohaveasupracervicalhysterectomybecausetheythinkitwillhavelessofanimpactontheirsexualrespo