Does levator ani injury affect cystocele type? (original) (raw)
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Cystocele and functional anatomy of the pelvic floor: review and update of the various theories
International Urogynecology Journal, 2015
Introduction and hypothesis We updated anatomic theories of pelvic organ support to determine pathophysiology in various forms of cystocele. Methods PubMed/MEDLINE, ScienceDirect, Cochrane Library, and Web of Science databases were searched using the terms pelvic floor, cystocele, anatomy, connective tissue, endopelvic fascia, and pelvic mobility. We retrieved 612 articles, of which 61 matched our topic and thus were selected. Anatomic structures of bladder support and their roles in cystocele onset were determined on the international anatomic classification; the various anatomic theories of pelvic organ support were reviewed and a synthesis was made of theories of cystocele pathophysiology. Results Anterior vaginal support structures comprise pubocervical fascia, tendinous arcs, endopelvic fascia, and levator ani muscle. DeLancey's theory was based on anatomic models and, later, magnetic resonance imaging (MRI), establishing a three-level anatomopathologic definition of prolapse. Petros's integral theory demonstrated interdependence between pelvic organ support systems, linking ligament-fascia lesions, and clinical expression. Apical cystocele is induced by failure of the pubocervical fascia and insertion of its cervical ring; lower cystocele is induced by pubocervical fascia (medial cystocele) or endopelvic fascia failure at its arcus tendineus fasciae pelvis attachment (lateral cystocele). Conclusions Improved anatomic knowledge of vaginal wall support mechanisms will improve understanding of cystocele pathophysiology, diagnosis of the various types, and surgical techniques. The two most relevant theories, DeLancey's and Petros's, are complementary, enriching knowledge of pelvic functional anatomy, but differ in mechanism. Threedimensional digital models could integrate and assess the mechanical properties of each anatomic structure.
Medicina
Background and objectives: As pelvic floor disorders are often difficult to assess thoroughly based on clinical examination alone, the use of imaging as a complementary technique is helpful. This study’s aim was to investigate by transperineal ultrasound (US) if there was any significant difference in the mobility of the bladder neck in women with stress urinary incontinence (SUI) without a cystocele and in those with SUI and an associated cystocele. The study also investigated whether the number of vaginal births and/or the heaviest newborn’s birth weight was correlated with the bladder neck mobility. Materials and Methods: A total of 71 women suffering from SUI were included in the study and divided into two groups based on the presence of a cystocele. Their bladder neck mobility was evaluated by transperineal US, calculating the distance from the inferior margin of the symphysis pubis to the bladder neck (SPBN), and the dorsocaudal linear movement (DLM), term used to illustrate t...
Levator ani morphology and function in women who have sustained obstetric anal sphincter injuries
Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, 2018
To estimate the prevalence and explore risk factors of levator ani muscle injury in women with clinically diagnosed obstetric anal sphincter injuries (OASIs). Secondly, we aimed to assess the association between levator injury and pelvic floor muscle contraction, anal incontinence (AI) and urinary incontinence (UI) in women with OASIs. Cross-sectional study of 250 women with OASIs, recruited from 2013 until 2015 in a tertiary referral centre at Croydon University Hospital, UK. AI symptoms were assessed using the modified St Mark's Incontinence Score and UI using the International Consultation on Incontinence modular Questionnaire for Urinary Incontinence - Short Form. All women underwent 3D/4D transperineal ultrasound at rest and at maximum pelvic floor contraction. Major levator injury was defined as a uni-or bilateral defect in all three central slices using tomographic ultrasound imaging. Muscle contraction was assessed using the Modified Oxford Scale (MOS) and measured on ul...
Journal of SAFOMS, 2018
Objective: • To determine the incidence of urinary tract injuries during gynecological surgeries. • To explore the role of universal cystourethroscopy to detect lower urinary tract injuries during gynecological operations to reduce postoperative morbidity and its sequelae. Study design: A prospective observational study. Settings: A tertiary care center. Materials and methods: This was an observational study conducted in 163 women who underwent gynecological surgery at our department during August 2014 to May 2017. Results: Data are classified according to demography, type, and indication of surgery performed in 163 consecutive subjects. History of previous pelvic surgery, if any, was taken into account to correlate with incidence of lower urinary tract injury intraoperatively. The ureteric and bladder injuries detected by routine intraoperative cystourethroscopy were tabulated. Intraoperatively detected rates of silent ureteric and bladder injury by cystourethroscopy are higher than obvious visually inspected injuries. We obtained intraoperatively ureteric injury rate of 0.61% and a bladder injury rate of 4.29% detected by cystourethroscopy. In two patients (1.23%), in spite of bloodstained urine in urobag, we could not detect any lower urinary tract injury. On long-term follow-up, two subjects (1.23%) attended outpatient department with ureterovaginal fistula and one subject (0.61%) developed vesicovaginal fistula. Conclusion: Use of intraoperative universal cystourethroscopy during gynecological operations should be considered routinely to detect unsuspected lower urinary tract injuries and immediate management to prevent its long-term sequelae.
Urinary Bladder Injuries during Gynaecological Surgeries: ARetrospective 10 Years Analysis.
IOSR Journals , 2019
Aim and Objective: To study the Urinary Bladder injuries during gynaecological surgeries. Material and Method: This was a study retrospective at GRMC Gwalior a analysis from Jan2017to Dec 2018were carried out for VH,TAH,NDVH,Radicalhysterectomy,myomectomy,vault prolapse, laparotomy (for cystectomy,salpingectomy,ectopic pregnancy),LSCS,and caesarean hysterectomy. As minor surgeries like MTP, encirclage, d&c carry minimal risk therefore they were excluded. Results: As previously noted bladder injuries have higher prevalence than ureteric injuries. Conclusion: Bladder injuries remain commoner than ureteric injuries. Careful counselling and consent should be made with good knowledge of genitourinary tract. Caution while Dissection, asepsis adherence, early detection of injuries to improve postoperative care.
Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 2018
To evaluate the association between pelvic organ prolapse (POP) types and levator-urethra gap (LUG) as measured by 3-dimensional transperineal tomographic ultrasound. A retrospective study was carried out on 98 women with symptomatic POP. Three-dimensional transperineal tomographic ultrasound images and POP quantification coordinates were reviewed. Each vaginal compartment was staged for the degree of prolapse, and total number of involved compartments identified. LUG was measured on 3-dimensional tomographic sonograms as the distance between the center of the urethra and the levator insertion bilaterally. Based on prior studies, an abnormal LUG of 25 mm or greater indicated levator avulsion. The LUG and the presence or absence of unilateral/bilateral avulsions was analyzed with reference to the clinical diagnosis of prolapse (single versus multicompartment, and mild [stage II] versus severe [stage III-IV]). Generalized logit models were used to evaluate the association between avul...
Pelvic floor dysfunction after levator trauma 1-year postpartum: a prospective case–control study
International Urogynecology Journal, 2014
Introduction and hypothesis The aim of this study was to evaluate pelvic floor dysfunction and anatomical signs of pelvic organ prolapse (POP) in patients with levator ani muscle (LAM) trauma compared with patients with an intact LAM 1 year postpartum. Methods In a prospective case-control study, primiparous women after vaginal delivery, with LAM trauma diagnosed on 3D ultrasound, were included in the case group. Controls consisted of patients who fulfilled the same inclusion criteria but had an intact levator. All women were investigated 1 year postpartum in respect of bladder, bowel, prolapse, and sexual function using the Australian Pelvic Floor Questionnaire. POP was assessed according to the Pelvic Organ Prolapse Quantification (POP-Q) system and pelvic floor muscle strength using the Oxford Grading Scale. Results Forty patients were included: 20 with and 20 without levator trauma. Urinary symptoms were significantly more frequent in women with LAM trauma compared with controls (p=0.01). The two groups were comparable in respect of bowel, sexual, and prolapse symptoms (p=0.24, p=0.60, p= 0.99 respectively). Unlike POP stages II and III, POP stage I was significantly more common in LAM trauma patients (n= 19, 95 %) than in controls (n=10, 50 %) (p=0.003). A positive association was noted between POP stage I and LAM trauma (RR=7.2). The involvement of multiple compartments was significantly more frequent in cases than in controls (p= 0.003). Conclusions Except for urinary symptoms, LAM trauma was asymptomatic in nearly all patients 1 year postpartum. However, POP stage I involving multiple compartments occurred more frequently in LAM trauma patients than in controls. Keywords Levator ani trauma. Pelvic floor dysfunction. Three-dimensional ultrasound Abbreviations LAM Levator ani muscle POP Pelvic organ prolapse POP-Q Pelvic organ prolapse quantification TUI Tomographic ultrasound imaging This study was presented as an oral poster presentation at the 41st Meeting of the