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Erschienen in: International Urogynecology Journal 9/2010

01.09.2010 | Original Article

Magnetic resonance imaging-based three-dimensional model of anterior vaginal wall position at rest and maximal strain in women with and without prolapse

verfasst von: Kindra A. Larson, Yvonne Hsu, Luyun Chen, James A. Ashton-Miller, John O. L. DeLancey

Erschienen in: International Urogynecology Journal | Ausgabe 9/2010

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Abstract

Introduction and hypothesis

Two-dimensional magnetic resonance imaging (MRI) demonstrates apical support and vaginal length contribute to anterior wall prolapse (AWP). This paper describes a novel three-dimensional technique to examine the vagina and its relationship to pelvic sidewalls at rest and Valsalva.

Methods

Twenty women (10 with AWP and 10 with normal support) underwent pelvic magnetic resonance imaging at rest and Valsalva. Three-dimensional reconstructions of the pelvic bones and anterior vaginal wall were created to assess morphologic changes occurring in prolapse.

Results

In women with AWP, Valsalva caused downward translation of the vagina along its length. A transition point separated a proximal region supported by levator muscles and a distal, unsupported region no longer in contact with the perineal body. In this latter region, sagittal and frontal plane “cupping” occurs. The distal vagina rotated inferiorly along an arc centered on the inferior pubis.

Conclusion

Downward translation, cupping, and distal rotation are three novel characteristics of AWP demonstrated by this three-dimensional technique.
Literatur
1.
Zurück zum Zitat Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL (1997) Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol 89(4):501–506CrossRefPubMed Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL (1997) Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol 89(4):501–506CrossRefPubMed
2.
3.
Zurück zum Zitat He W, Sengupta M, Velkoff V, DeBarros K (2005) 65± in the US: 2005, current population report, special studies. United States Government Printing Office, Washington DC. December 2005. Available from: www.census.gov He W, Sengupta M, Velkoff V, DeBarros K (2005) 65± in the US: 2005, current population report, special studies. United States Government Printing Office, Washington DC. December 2005. Available from: www.​census.​gov
4.
Zurück zum Zitat Benson JT, Lucente V, McClellan E (1996) Vaginal versus abdominal reconstructive surgery for the treatment of pelvic support defects: a prospective randomized study with long-term outcome evaluation. Am J Obstet Gynecol 175(6):1418–1421, discussion 1421–1422CrossRefPubMed Benson JT, Lucente V, McClellan E (1996) Vaginal versus abdominal reconstructive surgery for the treatment of pelvic support defects: a prospective randomized study with long-term outcome evaluation. Am J Obstet Gynecol 175(6):1418–1421, discussion 1421–1422CrossRefPubMed
5.
Zurück zum Zitat Nguyen JN, Burchette RJ (2008) Outcome after anterior vaginal prolapse repair: a randomized controlled trial. Obstet Gynecol 111(4):891–898PubMed Nguyen JN, Burchette RJ (2008) Outcome after anterior vaginal prolapse repair: a randomized controlled trial. Obstet Gynecol 111(4):891–898PubMed
6.
Zurück zum Zitat Nguyen JK (2001) Current concepts in the diagnosis and surgical repair of anterior vaginal prolapse due to paravaginal defects. Obstet Gynecol Surv 56(4):239–246CrossRefPubMed Nguyen JK (2001) Current concepts in the diagnosis and surgical repair of anterior vaginal prolapse due to paravaginal defects. Obstet Gynecol Surv 56(4):239–246CrossRefPubMed
7.
Zurück zum Zitat Maher C, Baessler K (2006) Surgical management of anterior vaginal wall prolapse: an evidencebased literature review. Int Urogynecol J Pelvic Floor Dysfunct 17(2):195–201CrossRefPubMed Maher C, Baessler K (2006) Surgical management of anterior vaginal wall prolapse: an evidencebased literature review. Int Urogynecol J Pelvic Floor Dysfunct 17(2):195–201CrossRefPubMed
8.
Zurück zum Zitat Maher CF, Murray CJ, Carey MP, Dwyer PL, Ugoni AM (2001) Iliococcygeus or sacrospinous fixation for vaginal vault prolapse. Obstet Gynecol 98(1):40–44CrossRefPubMed Maher CF, Murray CJ, Carey MP, Dwyer PL, Ugoni AM (2001) Iliococcygeus or sacrospinous fixation for vaginal vault prolapse. Obstet Gynecol 98(1):40–44CrossRefPubMed
9.
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(6):1365–1373, discussion 1373–1374CrossRefPubMed 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(6):1365–1373, discussion 1373–1374CrossRefPubMed
10.
Zurück zum Zitat Hsu Y, Chen L, Summers A, Ashton-Miller JA, DeLancey JO (2008) Anterior vaginal wall length and degree of anterior compartment prolapse seen on dynamic MRI. Int Urogynecol J Pelvic Floor Dysfunct 19(1):137–142PubMed Hsu Y, Chen L, Summers A, Ashton-Miller JA, DeLancey JO (2008) Anterior vaginal wall length and degree of anterior compartment prolapse seen on dynamic MRI. Int Urogynecol J Pelvic Floor Dysfunct 19(1):137–142PubMed
11.
Zurück zum Zitat Rooney K, Kenton K, Mueller ER, FitzGerald MP, Brubaker L (2006) Advanced anterior vaginal wall prolapse is highly correlated with apical prolapse. Am J Obstet Gynecol 195(6):1837–1840CrossRefPubMed Rooney K, Kenton K, Mueller ER, FitzGerald MP, Brubaker L (2006) Advanced anterior vaginal wall prolapse is highly correlated with apical prolapse. Am J Obstet Gynecol 195(6):1837–1840CrossRefPubMed
12.
Zurück zum Zitat Summers A, Winkel LA, Hussain HK, DeLancey JO (2006) The relationship between anterior and apical compartment support. Am J Obstet Gynecol 194(5):1438–1443CrossRefPubMed Summers A, Winkel LA, Hussain HK, DeLancey JO (2006) The relationship between anterior and apical compartment support. Am J Obstet Gynecol 194(5):1438–1443CrossRefPubMed
13.
Zurück zum Zitat Delancey JO (2002) Fascial and muscular abnormalities in women with urethral hypermobility and anterior vaginal wall prolapse. Am J Obstet Gynecol 187(1):93–98CrossRefPubMed Delancey JO (2002) Fascial and muscular abnormalities in women with urethral hypermobility and anterior vaginal wall prolapse. Am J Obstet Gynecol 187(1):93–98CrossRefPubMed
14.
Zurück zum Zitat Larson KA, Hsu Y, DeLancey JO (2009) The relationship between superior attachment points for anterior wall mesh operations and the upper vagina using a 3-dimensional magnetic resonance model in women with normal support. Am J Obstet Gynecol 200(5):554.e1–554.e6CrossRef Larson KA, Hsu Y, DeLancey JO (2009) The relationship between superior attachment points for anterior wall mesh operations and the upper vagina using a 3-dimensional magnetic resonance model in women with normal support. Am J Obstet Gynecol 200(5):554.e1–554.e6CrossRef
15.
Zurück zum Zitat Chen L, Ashton-Miller JA, Hsu Y, DeLancey JO (2006) Interaction among apical support, levator ani impairment, and anterior vaginal wall prolapse. Obstet Gynecol 108(2):324–332PubMed Chen L, Ashton-Miller JA, Hsu Y, DeLancey JO (2006) Interaction among apical support, levator ani impairment, and anterior vaginal wall prolapse. Obstet Gynecol 108(2):324–332PubMed
16.
Zurück zum Zitat Chen L, Ashton-Miller JA, Delancey JO (2009) A 3D finite element model of anterior vaginal wall support to evaluate mechanisms underlying cystocele formation. J Biomech 42:1371–1277CrossRefPubMed Chen L, Ashton-Miller JA, Delancey JO (2009) A 3D finite element model of anterior vaginal wall support to evaluate mechanisms underlying cystocele formation. J Biomech 42:1371–1277CrossRefPubMed
17.
Zurück zum Zitat Bertschinger KM, Hetzer FH, Roos JE, Treiber K, Marincek B, Hilfiker PR (2002) Dynamic MR imaging of the pelvic floor performed with patient sitting in an open-magnet unit versus with patient supine in a closed-magnet unit. Radiology 223(2):501–508CrossRefPubMed Bertschinger KM, Hetzer FH, Roos JE, Treiber K, Marincek B, Hilfiker PR (2002) Dynamic MR imaging of the pelvic floor performed with patient sitting in an open-magnet unit versus with patient supine in a closed-magnet unit. Radiology 223(2):501–508CrossRefPubMed
18.
Zurück zum Zitat Fielding JR, Griffiths DJ, Versi E, Mulkern RV, Lee ML, Jolesz FA (1998) MR imaging of pelvic floor continence mechanisms in the supine and sitting positions. AJR Am J Roentgenol 171(6):1607–1610PubMed Fielding JR, Griffiths DJ, Versi E, Mulkern RV, Lee ML, Jolesz FA (1998) MR imaging of pelvic floor continence mechanisms in the supine and sitting positions. AJR Am J Roentgenol 171(6):1607–1610PubMed
19.
Zurück zum Zitat Barber MD, Brubaker L, Nygaard I, Wheeler TL 2nd, Schaffer J, Chen Z, Spino C (2009) Defining success after surgery for pelvic organ prolapse. Obstet Gynecol 114(3):600–609CrossRefPubMed Barber MD, Brubaker L, Nygaard I, Wheeler TL 2nd, Schaffer J, Chen Z, Spino C (2009) Defining success after surgery for pelvic organ prolapse. Obstet Gynecol 114(3):600–609CrossRefPubMed
20.
Zurück zum Zitat Trowbridge ER, Fultz NH, Patel DA, DeLancey JO, Fenner DE (2008) Distribution of pelvic organ support measures in a population-based sample of middle-aged, community-dwelling African American and white women in southeastern Michigan. Am J Obstet Gynecol 198(5):548.e1-6CrossRefPubMed Trowbridge ER, Fultz NH, Patel DA, DeLancey JO, Fenner DE (2008) Distribution of pelvic organ support measures in a population-based sample of middle-aged, community-dwelling African American and white women in southeastern Michigan. Am J Obstet Gynecol 198(5):548.e1-6CrossRefPubMed
21.
Zurück zum Zitat Swift S, Woodman P, O'Boyle A, Kahn M, Valley M, Bland D, Wang W, Schaffer J (2005) Pelvic Organ Support Study (POSST): the distribution, clinical definition, and epidemiologic condition of pelvic organ support defects. Am J Obstet Gynecol 192(3):795–806CrossRefPubMed Swift S, Woodman P, O'Boyle A, Kahn M, Valley M, Bland D, Wang W, Schaffer J (2005) Pelvic Organ Support Study (POSST): the distribution, clinical definition, and epidemiologic condition of pelvic organ support defects. Am J Obstet Gynecol 192(3):795–806CrossRefPubMed
Metadaten
Titel
Magnetic resonance imaging-based three-dimensional model of anterior vaginal wall position at rest and maximal strain in women with and without prolapse
verfasst von
Kindra A. Larson
Yvonne Hsu
Luyun Chen
James A. Ashton-Miller
John O. L. DeLancey
Publikationsdatum
01.09.2010
Verlag
Springer-Verlag
Erschienen in
International Urogynecology Journal / Ausgabe 9/2010
Print ISSN: 0937-3462
Elektronische ISSN: 1433-3023
DOI
https://doi.org/10.1007/s00192-010-1161-x

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