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Erschienen in: International Urogynecology Journal 8/2007

01.08.2007 | Original Article

Histological features of the rectovaginal septum in elderly women and a proposal for posterior vaginal defect repair

verfasst von: Ichiro Nagata, Gen Murakami, Daisuke Suzuki, Kenichi Furuya, Masayasu Koyama, Aiji Ohtsuka

Erschienen in: International Urogynecology Journal | Ausgabe 8/2007

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Abstract

To get support from morphological findings to develop a novel surgical procedure for posterior vaginal defect repair, we histologically examined the rectum–vagina interface tissues obtained from 20 elderly female cadavers. The rectovaginal septum (RVS) was defined here as an elastic fiber-rich plate (EFRP) along the posterior vaginal wall. It lined the posterior surface of the vein-rich zone of the vaginal wall and extended between the bilateral paracolpiums. The septum was more evident in the lower half of the interface than in the upper half. The RVS was often thin and interrupted. Since the RVS was not so clearly demonstrated in the upper vagina histologically, augmentation using some implant is considered to be necessary for the enterocele and high rectocele. Since the thickness and tightness of the RVS vary with the case in the lower vagina, surgical procedures for low rectocele repair should be individualized, including implant-augmentation.
Literatur
1.
Zurück zum Zitat Richardson AC (1993) The rectovaginal septum revisited: its relationship to rectocele and its importance in rectocele repair. Clin Obstet Gynecol 36:976–983PubMedCrossRef Richardson AC (1993) The rectovaginal septum revisited: its relationship to rectocele and its importance in rectocele repair. Clin Obstet Gynecol 36:976–983PubMedCrossRef
2.
Zurück zum Zitat Singh K, Cortes E, Reid WM (2003) Evaluation of the fascial technique for surgical repair of isolated posterior vaginal wall prolapse. Obstet Gynecol 101:320–324PubMedCrossRef Singh K, Cortes E, Reid WM (2003) Evaluation of the fascial technique for surgical repair of isolated posterior vaginal wall prolapse. Obstet Gynecol 101:320–324PubMedCrossRef
3.
Zurück zum Zitat Abramov Y, Gandhi S, Goldberg RP, Botros SM, Kwon C, Sand PK (2005) Site-specific rectocele repair compared with standard posterior colporrhaphy. Obstet Gynecol 105:314–318PubMed Abramov Y, Gandhi S, Goldberg RP, Botros SM, Kwon C, Sand PK (2005) Site-specific rectocele repair compared with standard posterior colporrhaphy. Obstet Gynecol 105:314–318PubMed
4.
Zurück zum Zitat Miklos JR, Kohli N, Lucente V, Saye WB (1998) Site-specific fascial defects in the diagnosis and surgical management of enterocele. Am J Obstet Gynecol 179:1418–1423PubMedCrossRef Miklos JR, Kohli N, Lucente V, Saye WB (1998) Site-specific fascial defects in the diagnosis and surgical management of enterocele. Am J Obstet Gynecol 179:1418–1423PubMedCrossRef
5.
Zurück zum Zitat Shull BL, Bachofen C, Coates KW, Kuehl TJ (2000) A transvaginal approach to repair of apical and other associated sites of pelvic organ prolapse with uterosacral ligaments. Am J Obstet Gynecol 183:1365–1374PubMedCrossRef Shull BL, Bachofen C, Coates KW, Kuehl TJ (2000) A transvaginal approach to repair of apical and other associated sites of pelvic organ prolapse with uterosacral ligaments. Am J Obstet Gynecol 183:1365–1374PubMedCrossRef
6.
Zurück zum Zitat Krantz KE (1959) The gross and microscopic anatomy of the human vagina. Ann N Y Acad Sci 83:89–104PubMedCrossRef Krantz KE (1959) The gross and microscopic anatomy of the human vagina. Ann N Y Acad Sci 83:89–104PubMedCrossRef
7.
Zurück zum Zitat Ricci JV, Lisa JR, Thom CH, Kron WL (1947) The relationship of the vagina to adjacent organs in reconstructive surgery. A histologic study. Am J Surg 74:387–410CrossRef Ricci JV, Lisa JR, Thom CH, Kron WL (1947) The relationship of the vagina to adjacent organs in reconstructive surgery. A histologic study. Am J Surg 74:387–410CrossRef
8.
Zurück zum Zitat Milley PS, Nichols DH (1969) A correlative investigation of the human rectovaginal septum. Anat Rec 163:443–451PubMedCrossRef Milley PS, Nichols DH (1969) A correlative investigation of the human rectovaginal septum. Anat Rec 163:443–451PubMedCrossRef
9.
Zurück zum Zitat Sunami-Kataoka Y, Akagi H, Nishizaki K, Taguchi T, Murakami T, Ohtsuka A (2001) Chondroitin sulfate proteoglycan at the basal lamina beneath high endothelial cells in human palatine tonsils: a light and electron microscopic study using the cationic colloidal iron method. Arch Histol Cytol 64:535–543PubMedCrossRef Sunami-Kataoka Y, Akagi H, Nishizaki K, Taguchi T, Murakami T, Ohtsuka A (2001) Chondroitin sulfate proteoglycan at the basal lamina beneath high endothelial cells in human palatine tonsils: a light and electron microscopic study using the cationic colloidal iron method. Arch Histol Cytol 64:535–543PubMedCrossRef
10.
Zurück zum Zitat Fujita T (1959) Histological studies on the neuro-insular complex in the pancreas of some mammals. Z Zellforsch 50:94–109CrossRef Fujita T (1959) Histological studies on the neuro-insular complex in the pancreas of some mammals. Z Zellforsch 50:94–109CrossRef
11.
Zurück zum Zitat DeLancey JO (1999) Structural anatomy of the posterior pelvic compartment as it relates to rectocele. Am J Obstet Gynecol 180:815–823PubMedCrossRef DeLancey JO (1999) Structural anatomy of the posterior pelvic compartment as it relates to rectocele. Am J Obstet Gynecol 180:815–823PubMedCrossRef
12.
Zurück zum Zitat Uhlenhuth E, Wolfe WM, Smith EM, Middleton EB (1948) The rectogenital septum. Surg Gynecol Obstet 86:148–163 Uhlenhuth E, Wolfe WM, Smith EM, Middleton EB (1948) The rectogenital septum. Surg Gynecol Obstet 86:148–163
13.
Zurück zum Zitat Arakawa T, Murakami G, Nakajima F, Matsubara A, Ohtsuka A, Goto T, Teramoto T (2004) Morphologies of the interfaces between the levator ani muscle and pelvic viscera, with special reference to muscle insertion into the anorectum in elderly Japanese. Anat Sci Int 79:72–81PubMedCrossRef Arakawa T, Murakami G, Nakajima F, Matsubara A, Ohtsuka A, Goto T, Teramoto T (2004) Morphologies of the interfaces between the levator ani muscle and pelvic viscera, with special reference to muscle insertion into the anorectum in elderly Japanese. Anat Sci Int 79:72–81PubMedCrossRef
14.
Zurück zum Zitat Zimmerman CW (2003) Surgical correction of defects in pelvic support. A: pelvic organ prolapse. In: Rock JA, Jones HW III (eds) Te Linde’s operative gynecology, 9th edn. Lippincott Williams and Wilkins, Philadelphia, pp 927–948 Zimmerman CW (2003) Surgical correction of defects in pelvic support. A: pelvic organ prolapse. In: Rock JA, Jones HW III (eds) Te Linde’s operative gynecology, 9th edn. Lippincott Williams and Wilkins, Philadelphia, pp 927–948
15.
Zurück zum Zitat Shull BL, Bachofen CG (1999) Enterocele and rectocele. In: Walters MD, Karram MM (eds) Urogynecology and reconstructive pelvic surgery, 2nd edn. Mosby, St. Louis, pp 221–234 Shull BL, Bachofen CG (1999) Enterocele and rectocele. In: Walters MD, Karram MM (eds) Urogynecology and reconstructive pelvic surgery, 2nd edn. Mosby, St. Louis, pp 221–234
16.
Zurück zum Zitat Cundiff GW, Harris RL, Coates KW, Low VH, Bump RC, Addison WA (1997) Abdominal sacral colpoperineopexy: a new approach for correction of posterior compartment defects and perineal descent associated with vaginal vault prolapse. Am J Obstet Gynecol 177:1345–1355PubMedCrossRef Cundiff GW, Harris RL, Coates KW, Low VH, Bump RC, Addison WA (1997) Abdominal sacral colpoperineopexy: a new approach for correction of posterior compartment defects and perineal descent associated with vaginal vault prolapse. Am J Obstet Gynecol 177:1345–1355PubMedCrossRef
17.
Zurück zum Zitat Altman D, Mellgren A, Zetterstrom J (2005) Rectocele repair using biomaterial augmentation: current documentation and clinical experience. Obstet Gynecol Surv 60:753–760PubMedCrossRef Altman D, Mellgren A, Zetterstrom J (2005) Rectocele repair using biomaterial augmentation: current documentation and clinical experience. Obstet Gynecol Surv 60:753–760PubMedCrossRef
18.
Zurück zum Zitat Kohli N, Miklos JR (2003) Dermal graft-augmented rectocele repair. Int Urogynecol J Pelvic Floor Dysfunct 14:146–149PubMedCrossRef Kohli N, Miklos JR (2003) Dermal graft-augmented rectocele repair. Int Urogynecol J Pelvic Floor Dysfunct 14:146–149PubMedCrossRef
19.
Zurück zum Zitat Dell J, O’Kelley KR (2004) PelviSoft BioMesh augmentation of rectocele repair: the initial clinical experience in 35 patients. Int Urogynecol J Pelvic Floor Dysfunct 16:44–47PubMed Dell J, O’Kelley KR (2004) PelviSoft BioMesh augmentation of rectocele repair: the initial clinical experience in 35 patients. Int Urogynecol J Pelvic Floor Dysfunct 16:44–47PubMed
20.
Zurück zum Zitat Lyons TL, Winer WK (1997) Laparoscopic rectocele repair using polyglactin mesh. J Am Assoc Gynecol Laparosc 4:381–384PubMedCrossRef Lyons TL, Winer WK (1997) Laparoscopic rectocele repair using polyglactin mesh. J Am Assoc Gynecol Laparosc 4:381–384PubMedCrossRef
Metadaten
Titel
Histological features of the rectovaginal septum in elderly women and a proposal for posterior vaginal defect repair
verfasst von
Ichiro Nagata
Gen Murakami
Daisuke Suzuki
Kenichi Furuya
Masayasu Koyama
Aiji Ohtsuka
Publikationsdatum
01.08.2007
Verlag
Springer-Verlag
Erschienen in
International Urogynecology Journal / Ausgabe 8/2007
Print ISSN: 0937-3462
Elektronische ISSN: 1433-3023
DOI
https://doi.org/10.1007/s00192-006-0249-9

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