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International Urogynecology Journal

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01.01.2013 | Original Article

Cardinal and deep uterosacral ligament lines of action: MRI based 3D technique development and preliminary findings in normal women

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

Erschienen in: International Urogynecology Journal | Ausgabe 1/2013

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Abstract

Introduction and hypothesis

The cardinal ligament (CL) and deep uterosacral ligament (US) play a critical role in utero-vaginal support. This study aims to quantify their geometrical relationships in living women using a MRI-based 3D technique.

Methods

The angles between ligaments, the ligaments length and curvature were assessed on 3D models constructed from twenty MRIs of volunteers with normal support. How angle variation theoretically affects ligament tension was investigated using a simplified biomechanical model.

Results

The CLs are 18.1 ° ± 6.8 °(SD) from the cephalic-caudal body axis , and the USs are dorsally directed and 92.5 ° ± 13.5 from the body axis. The CLs are longer and more curved than US. The theoretical calculated tension on CL is 52 % larger than that on US.

Conclusions

The CL is relatively parallel to the body axis while the US is dorsally directed. The tensions on these ligaments are affected by their orientations.

Jelovsek JE, Barber MD (2006) Women seeking treatment for advanced pelvic organ prolapse have decreased body image and quality of life. Am J Obstet Gynecol 194:1455–61PubMedCrossRef

Swift S, Woodman O, O’Boyle A, Kahn M, Valley M, Bland D, Wang W, Schaffer J (2005) Pelvic Orgn Support Study (POSST): the distribution, clinical definition, and epidemiologic condition of pelvic organ support defects. Am J Obstet Gynecol 192:796–806CrossRef

Jelovsek JE, Maher C, Barber MD (2007) Pelvic organ prolapse. Lancet 369(9566):1027–1038PubMedCrossRef

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

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):1837–40PubMedCrossRef

Summers A, Winkel LA, Hussain HK, DeLancey JO (2006) The relationship between anterior and apical compartment support. Am J Obstet Gynecol 194(5):1438–43PubMedCrossRef

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):324–32PubMedCrossRef

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(10):1371–7PubMedCrossRef

DeLancey JOL. Anatomic aspects of vaginal aversion after hysterectomy. American Journal of Obstetrics & Gynecology. (1992)166: t

10.

Blaisdell FE (1917) The anatomy of the sacro-uterine ligaments. Anat Rec 12:1–42CrossRef

11.

Campbell RM (1950) The anatomy and histology of the sacrouterine ligaments. Am J Obstet Gynecol 59:1PubMed

12.

Range RL, Woodburne RT (1964) The gross and microscopic anatomy of the transverse cervical ligaments. Am J Obstet Gynecol 90:460PubMed

13.

Larson KA, Hsu Y, Chen L, Ashton-Miller JA, DeLancey JO (2010) Magnetic resonance imaging-based three-dimensional model of anterior vaginal wall position at rest and maximal strain in women with and without prolapse. Int Urogynecol J Pelvic Floor Dysfunct 21(9):1103–9CrossRef

14.

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.e1–548.e6CrossRef

15.

Umek WH, Morgan DM, Ashton-Miller JA, DeLancey JO (2004) Quantitative analysis of uterosacral ligament origin and insertion points by magnetic resonance imaging. Obstet Gynecol 103(3):447–51PubMedCrossRef

16.

Butler-Manuel SA, Buttery LD, A'Hern RP, Polak JM, Barton DP (2000) Pelvic nerve plexus trauma at radical hysterectomy and simple hysterectomy: the nerve content of the uterine supporting ligaments. Cancer 89(4):834–41PubMedCrossRef

17.

Tunn R, DeLancey JO, Quint EE (2001) Visibility of pelvic organ support system structures in magnetic resonance images without an endovaginal coil. Am J Obstet Gynecol 184:1156–63PubMedCrossRef

18.

Hsu Y, Summers A, Hussain HK, Guire KE, Delancey JO (2006) Levator plate angle in women with pelvic organ prolapse compared to women with normal support using dynamic MR imaging. Am J Obstet Gynecol 194(5):1427–33PubMedCrossRef

19.

Vu D, Haylen BT, Tse K, Farnsworth A (2010) Surgical anatomy of the uterosacral ligament. Int Urogynecol J 21:1123–28PubMedCrossRef

20.

Bartscht KD, DeLancey JOL (1988) A technique to study the passive supports of the uterus. Obstet Gynecol 72:940–3PubMed

21.

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):1607–10PubMed

22.

Bertschinger KM, Hetzer FH, Roos JE, Treiber K, 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):501–8PubMedCrossRef

23.

Shafik A, Doss S, Asaad S (2003) Etiology of the resting myoelectric activity of the levator ani muscle: physioanatomic study with a new theory. World J Surg 27(3):309–14PubMedCrossRef

24.

Tumbarello JA, Hsu Y, Lewicky-Gaupp C, Rohrer S, Delancey JO. (2010) Do repetitive Valsalva maneuvers change maximum prolapse on dynamic MRI? Int Urogynecol J Pelvic Floor Dysfunct. Jun 11

25.

Alexander RM (2003) Modelling approaches in biomechanics. Phil Trans Roy Soc Lond B Biol Sci 358(1437):1429–35CrossRef

Titel: Cardinal and deep uterosacral ligament lines of action: MRI based 3D technique development and preliminary findings in normal women
verfasst von: Luyun Chen
Rajeev Ramanah
Yvonne Hsu
James A. Ashton-Miller
John O. L. DeLancey
Publikationsdatum: 01.01.2013
Verlag: Springer-Verlag
Erschienen in: International Urogynecology Journal / Ausgabe 1/2013
Print ISSN: 0937-3462
Elektronische ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-012-1801-4

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Springer Medizin

Cardinal and deep uterosacral ligament lines of action: MRI based 3D technique development and preliminary findings in normal women

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

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Springer Medizin

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

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