Old and new procedures in the treatment of prolapse

Abstract

TN THE virgin state the uterus is flattened anterooosteriorlv and is pyriform 1 in shape, ;ith the apex directed downward and ~backward. It lies~ between the bladder in front and the pelvic or sigmoid colon and rectum behind, completely within the pelvis. The typical position of the uterus with the bladder and rectum empty is maintained by the attachment of the cervix to the vaginal wall; to a small extent by the smooth muscles and connective tissue in the round ligaments; by the fairly strong uterosacral ligaments; and to a large degree by the smooth muscle and fibrous tissue, the ligament of Mackenrodt, which lies between the layers of the broad ligaments. Inferiorly, the uterus is maintained at its horizontal level by the muscular pelvic diaphragm of which the levator ani is the chief support. The position of the uterus in the adult may vary considera:bly under different conditions. For example, with the bladder and rectum empty the body of the uterus is nearly horizontal when the individual is standing. The fundus is about 2 em. behind the symphysis pubis; the body and cervix are at an angle of about 90 degrees to each other. As the bladder fills the uterus is bent back toward the sacrum. With the overdistended rectum the uterus is pushed forward. Factors Leading to Prolapse