Levator defects are associated with prolapse after pelvic floor surgery.
Summary of "Levator defects are associated with prolapse after pelvic floor surgery."
OBJECTIVES:
Pelvic organ prolapse recurrence after pelvic floor surgery is a common problem. This study was designed to assess whether avulsion defects of the puborectalis muscle are associated with recurrent pelvic organ prolapse and its symptoms. STUDY
DESIGN:
We retrospectively evaluated 737 data sets of patients who had presented to a tertiary urogynaecology unit with symptoms of pelvic floor dysfunction. All underwent a standardised interview including a surgical history, a clinical examination and 4D pelvic floor ultrasound. Avulsion injury was diagnosed on tomographic ultrasound. The prevalence of pelvic organ prolapse and its symptoms was calculated for patients with previous hysterectomy and previous anti-incontinence and prolapse surgery, with and without confirmed avulsion injury.
RESULTS:
Out of 737 patients, 248 (33.6%) reported a previous hysterectomy, 165 patients (22.4%) had undergone incontinence or prolapse procedures, 106 (14.4%) reported a previous anterior colporrhaphy, and 45 patients (6.1%) had undergone a colposuspension in the past. In all four groups avulsion injury was significantly associated with objective prolapse (relative risks between 2.3 and 3.3, odds ratios between 3.4 and 6). Symptoms of prolapse were significantly associated with avulsion injury post hysterectomy, incontinence or prolapse procedures and after anterior colporrhaphy.
CONCLUSIONS:
Avulsion injury of the puborectalis muscle is associated with prolapse in women with previous pelvic floor surgery.
Affiliation
Nepean Clinical School, University of Sydney, Penrith, Australia.
Journal Details
This article was published in the following journal.
Name: European journal of obstetrics, gynecology, and reproductive biology
ISSN: 1872-7654
Pages:
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/20832929
- DOI: http://dx.doi.org/10.1016/j.ejogrb.2010.07.046
Medical and Biotech [MESH] Definitions
Pelvic Floor
Soft tissue formed mainly by the pelvic diaphragm, which is composed of the two levator ani and two coccygeus muscles. The pelvic diaphragm lies just below the pelvic aperture (outlet) and separates the pelvic cavity from the PERINEUM. It extends between the PUBIC BONE anteriorly and the COCCYX posteriorly.
Pelvic Organ Prolapse
Abnormal descent of a pelvic organ resulting in the protrusion of the organ beyond its normal anatomical confines. Symptoms often include vaginal discomfort, DYSPAREUNIA; URINARY STRESS INCONTINENCE; and FECAL INCONTINENCE.
Parametritis
Inflammation of the parametrium, the connective tissue of the pelvic floor, extending from the subserous coat of the uterus laterally between the layers of the BROAD LIGAMENT.
Visceral Prolapse
The prolapse or downward displacement of the VISCERA.
Lesser Pelvis
The part of the pelvis, inferior to the pelvic brim, that comprises both the pelvic cavity and the part of the PERINEUM lying inferior to the PELVIC DIAPHRAGM.
PubMed Articles
Moment of inertia as a means to evaluate the biomechanical impact of pelvic organ prolapse.
OBJECTIVES: To present an alternative measure (moment of inertia) to describe the anatomical features of the pelvic organ prolapse. METHODS: A total of 30 women (21 diagnosed as having pelvic organ pr...
INTRODUCTION AND HYPOTHESIS: This pilot study aimed to investigate the effectiveness of pelvic floor muscle training (PFMT) for the treatment of pelvic organ prolapse. METHODS: Thirty-seven women with...
INTRODUCTION AND HYPOTHESIS: The aim of the study was to evaluate the association of avulsion and postnatal hiatal dimensions with delivery mode. These anatomical changes on pelvic floor muscle may be...
Knowledge of functional anatomy is a prerequisite for the safe and targeted reconstructive therapy of incontinence and the prolapse syndrome of the female pelvic floor. We illustrate the interaction o...
Urethral closure pressures among primiparous women with and without levator ani muscle defects.
INTRODUCTION AND HYPOTHESIS: Vaginal birth is an established risk factor for levator ani (LA) defects and incontinence. We hypothesized an association between urethral pressure profiles and LA defects...
Clinical Trials
Does Doing Pelvic Floor Exercise Ease Symptoms for Women Living With Prolapse?
The purpose of this study is to investigate the feasibility of undertaking a multi-centre randomised controlled trial of the effectiveness of a pelvic floor muscle training (PFMT) interven...
Effects of Age on the Levator Ani Muscle of Nulliparous Women
The purpose of the study is to characterize the levator ani structures (pubovaginalis, puboperinealis, puboanalis, puborectalis, and the iliococcygeous) using 3-D ultrasonography in nullip...
Prenatal Pelvic Floor Prevention (3PN)
Objective: Compare pelvic floor disorders (urinary incontinence, anal incontinence, genital prolapse, perineal pain, sexual troubles) 12 month after a first delivery between a group of wom...
GYNECARE PROSIMA* Pelvic Floor Repair System for Pelvic Organ Prolapse
The purpose of this study is to is to evaluate the success of the GYNECARE PROSIMA* system in women with symptoms for pelvic organ prolapse (POP) requiring surgical correction of POP. (*T...
Pelvic Floor Repair Systems for Prolapse Repair
1. This is a prospective, single arm, multi-center, post market study, which will be conducted under a common protocol. 2. The primary objective of the study is to evaluate long-te...
