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Chill HH, Martin LC, Chang C, Abramowitch SD, Rostaminia G. Pubococcygeal Line Versus H-line as MR Defecography Reference for Bladder Descent. Int Urogynecol J 2024; 35:537-544. [PMID: 38197952 DOI: 10.1007/s00192-023-05707-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/18/2023] [Indexed: 01/11/2024]
Abstract
INTRODUCTION AND HYPOTHESIS Magnetic resonance defecography imaging techniques have been used widely to study pelvic floor function and diagnose pelvic organ prolapse (POP). The aim of this study was to investigate the diagnostic accuracy of the H-line to detect bladder descent compared with the current landmark, the pubococcygeal line (PCL). METHODS In this retrospective cohort study, patients who underwent MR defecography in our medical center and were diagnosed with moderate to severe cystocele by radiological measurements were recruited. One rest image and one maximum evacuation image for each subject were used for the following measurements: bladder base perpendicular distance from the genital hiatus (GH), indicative of clinically significant bladder descent, PCL as the current radiological reference line, and the H-line, or minimal levator hiatus line, indicative of pelvic floor muscle and connective tissue support. Subjects were categorized as having clinically significant cystocele if the "bladder base" reached within 1 cm or lower of the GH (stage II or higher cystocele). A comparison was performed to assess differences and predictive capabilities of the reference lines relative to the GH measure. RESULTS Seventy subjects were included, 30 with clinically significant bladder descent based on distance to GH. Women with bladder descent were older (64.0 ± 11.8 vs 51.2 ± 15.6, p < 0.001), had increased parity (3 [1-7] vs 2 [0-5], p = 0.009), and had a bladder that descended lower than the H-line at rest (1.9 ± 0.5 vs 2.2 ± 0.4, p = 0.003) and evacuation (-2.4 ± 1.6 vs -0.7 ± 1.1, p < 0.001). Multivariate regression analysis confirmed that age, length of the H-line at evacuation, the perpendicular distances between the H-line and the lowest bladder point at rest, and the PCL to the lowest bladder point at evacuation significantly correlated with bladder descent. Receiver operating characteristic analysis was used to identify a measurement threshold to diagnose clinically significant cystocele for both measurements, bladder base to the H-line: -1.2 (80.0, 72.5) area under the curve (AUC) 0.82, and bladder base PCL: -3.3 (77.8, 79.5) AUC 0.86. CONCLUSION Our data support the application of using the minimal levator hiatus plane and specifically the H-line as a reliable landmark to diagnose bladder descent using MR defecography imaging.
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Affiliation(s)
- Henry H Chill
- Female Pelvic Medicine and Reconstructive Surgery (FPMRS), Division of Urogynecology, University of Chicago, Northshore University HealthSystem, 9650 Gross Point Road, Suite 3900, Skokie, IL, 60076, USA.
| | - Liam C Martin
- Translational Biomechanics Laboratory, Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Cecilia Chang
- NorthShore University HealthSystem Research Institute, Evanston, IL, USA
| | - Steven D Abramowitch
- Translational Biomechanics Laboratory, Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ghazaleh Rostaminia
- Female Pelvic Medicine and Reconstructive Surgery (FPMRS), Division of Urogynecology, University of Chicago, Northshore University HealthSystem, 9650 Gross Point Road, Suite 3900, Skokie, IL, 60076, USA
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Giri A, Hartmann KE, Aldrich MC, Ward RM, Wu JM, Park AJ, Graff M, Qi L, Nassir R, Wallace RB, O'Sullivan MJ, North KE, Velez Edwards DR, Edwards TL. Admixture mapping of pelvic organ prolapse in African Americans from the Women's Health Initiative Hormone Therapy trial. PLoS One 2017; 12:e0178839. [PMID: 28582460 PMCID: PMC5459562 DOI: 10.1371/journal.pone.0178839] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 05/19/2017] [Indexed: 12/27/2022] Open
Abstract
Evidence suggests European American (EA) women have two- to five-fold increased odds of having pelvic organ prolapse (POP) when compared with African American (AA) women. However, the role of genetic ancestry in relation to POP risk is not clear. Here we evaluate the association between genetic ancestry and POP in AA women from the Women’s Health Initiative Hormone Therapy trial. Women with grade 1 or higher classification, and grade 2 or higher classification for uterine prolapse, cystocele or rectocele at baseline or during follow-up were considered to have any POP (N = 805) and moderate/severe POP (N = 156), respectively. Women with at least two pelvic exams with no indication for POP served as controls (N = 344). We performed case-only, and case-control admixture-mapping analyses using multiple logistic regression while adjusting for age, BMI, parity and global ancestry. We evaluated the association between global ancestry and POP using multiple logistic regression. European ancestry at the individual level was not associated with POP risk. Case-only and case-control local ancestry analyses identified two ancestry-specific loci that may be associated with POP. One locus (Chromosome 15q26.2) achieved empirically-estimated statistical significance and was associated with decreased POP odds (considering grade ≥2 POP) with each unit increase in European ancestry (OR: 0.35; 95% CI: 0.30, 0.57; p-value = 1.48x10-5). This region includes RGMA, a potent regulator of the BMP family of genes. The second locus (Chromosome 1q42.1-q42.3) was associated with increased POP odds with each unit increase in European ancestry (Odds ratio [OR]: 1.69; 95% confidence interval [CI]: 1.28, 2.22; p-value = 1.93x10-4). Although this region did not reach statistical significance after considering multiple comparisons, it includes potentially relevant genes including TBCE, and ACTA1. Unique non-overlapping European and African ancestry-specific susceptibility loci may be associated with increased POP risk.
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Affiliation(s)
- Ayush Giri
- Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Katherine E. Hartmann
- Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Melinda C. Aldrich
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Renee M. Ward
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Jennifer M. Wu
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Amy J. Park
- Department of Obstetrics and Gynecology, Georgetown University School of Medicine, Washington, District of Columbia, United States of America
| | - Mariaelisa Graff
- Department of Epidemiology, Gillings School of Global Public health, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Lihong Qi
- Division of Biostatistics, Department of Public Health Sciences, School of Medicine, University of California, Davis, Davis, California, United States of America
| | - Rami Nassir
- Department of Biochemistry and Molecular Medicine, University of California, Davis, Davis, California, United States of America
- Department of Internal Medicine, University of California, Davis, Davis, California, United States of America
| | - Robert B. Wallace
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, United States of America
| | - Mary J. O'Sullivan
- Department of Obstetrics and Gynecology, Miller School of Medicine, Miami, Florida, United States of America
| | - Kari E. North
- Department of Epidemiology, Gillings School of Global Public health, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Digna R. Velez Edwards
- Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Todd L. Edwards
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- * E-mail:
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3
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Chanda A, Unnikrishnan V, Richter HE, Lockhart ME. A biofidelic computational model of the female pelvic system to understand effect of bladder fill and progressive vaginal tissue stiffening due to prolapse on anterior vaginal wall. Int J Numer Method Biomed Eng 2016; 32:e02767. [PMID: 26732347 DOI: 10.1002/cnm.2767] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 12/23/2015] [Accepted: 12/27/2015] [Indexed: 06/05/2023]
Abstract
Treatment of anterior vaginal prolapse (AVP), suffered by over 500,000 women in the USA, is a challenge in urogynecology because of the poorly understood mechanics of AVP. Recently, computational modeling combined with finite element method has been used to model AVP through the study of pelvic floor muscle and connective tissue impairments on the anterior vaginal wall (AVW). Also, the effects of pelvic organ displacements on the AVW were studied numerically. In our current work, an MRI-based full-scale biofidelic computational model of the female pelvic system composed of the urinary bladder, vaginal canal, and the uterus was developed, and a novel finite element method framework was employed to simulate vaginal tissue stiffening and also bladder filling due to expansion for the first time. A mesh convergence study was conducted to choose a computationally efficient mesh, and a non-linear hyperelastic Yeoh's material model was adopted for the study. The AVW displacements, mechanical stresses, and strains were estimated at varying degrees of bladder fills and vaginal tissue stiffening. Both bladder filling and vaginal stiffening were found to increase the stress concentration on the AVW with varying trends, which have been discussed in detail in the paper. To our knowledge, this study is the first to estimate the individual and combined effects of bladder filling and vaginal tissue stiffening due to prolapse on the AVW. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Arnab Chanda
- Department of Aerospace Engineering and Mechanics, University of Alabama, Tuscaloosa, 35487, AL, USA
| | - Vinu Unnikrishnan
- Department of Aerospace Engineering and Mechanics, University of Alabama, Tuscaloosa, 35487, AL, USA.
| | - Holly E Richter
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, 1720 2nd Ave S, Birmingham, AL, 35233, USA
| | - Mark E Lockhart
- Department of Radiology, University of Alabama at Birmingham, 1720 2nd Ave S, Birmingham, AL, 35233, USA
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Ni D, Ji X, Gao Y, Cheng JZ, Wang H, Qin J, Lei B, Wang T, Wu G, Shen D. Automatic Cystocele Severity Grading in Ultrasound by Spatio-Temporal Regression. Med Image Comput Comput Assist Interv 2016; 9901:247-255. [PMID: 28386607 PMCID: PMC5380365 DOI: 10.1007/978-3-319-46723-8_29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
Cystocele is a common disease in woman. Accurate assessment of cystocele severity is very important for treatment options. The transperineal ultrasound (US) has recently emerged as an alternative tool for cystocele grading. The cystocele severity is usually evaluated with the manual measurement of the maximal descent of the bladder (MDB) relative to the symphysis pubis (SP) during Valsalva maneuver. However, this process is time-consuming and operator-dependent. In this study, we propose an automatic scheme for csystocele grading from transperineal US video. A two-layer spatio-temporal regression model is proposed to identify the middle axis and lower tip of the SP, and segment the bladder, which are essential tasks for the measurement of the MDB. Both appearance and context features are extracted in the spatio-temporal domain to help the anatomy detection. Experimental results on 85 transperineal US videos show that our method significantly outperforms the state-of-the-art regression method.
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Affiliation(s)
- Dong Ni
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, School of Biomedical Engineering, Shenzhen University, Shenzhen, China
| | - Xing Ji
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, School of Biomedical Engineering, Shenzhen University, Shenzhen, China
| | - Yaozong Gao
- Department of Radiology and BRIC, UNC at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Jie-Zhi Cheng
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, School of Biomedical Engineering, Shenzhen University, Shenzhen, China
| | - Huifang Wang
- Department of Ultrasound, Shenzhen Second Peoples Hospital, Shenzhen, China
| | - Jing Qin
- School of Nursing, Centre for Smart Health, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Baiying Lei
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, School of Biomedical Engineering, Shenzhen University, Shenzhen, China
| | - Tianfu Wang
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, School of Biomedical Engineering, Shenzhen University, Shenzhen, China
| | - Guorong Wu
- Department of Radiology and BRIC, UNC at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Dinggang Shen
- Department of Radiology and BRIC, UNC at Chapel Hill, Chapel Hill, NC 27599, USA
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5
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Christmas AB, Honaker D. Incarcerated massive sliding hernia treated with bladder resection and mesh repair. Am Surg 2015; 81:E123-E124. [PMID: 25760189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- A Britton Christmas
- Division of Trauma/Surgical Critical Care, Department of General Surgery, Carolinas HealthCare System, Charlotte, North Carolina, USA
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6
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Yousuf A, Chen L, Larson K, Ashton-Miller JA, DeLancey JOL. The length of anterior vaginal wall exposed to external pressure on maximal straining MRI: relationship to urogenital hiatus diameter, and apical and bladder location. Int Urogynecol J 2014; 25:1349-56. [PMID: 24737299 DOI: 10.1007/s00192-014-2372-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 03/07/2014] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS In cystoceles, the distal anterior vaginal wall (AVW) bulges out through the introitus and is no longer in contact with the posterior vaginal wall or perineal body, exposing the pressure differential between intra-abdominal pressure and atmospheric pressure. The goal of this study is to quantify the length of the exposed vaginal wall length and to investigate its relationship with other factors associated with the AVW support, such as most dependent bladder location, apical location, and hiatus diameter, demonstrating its key role in cystocele formation. METHODS Fifty women were selected to represent a full spectrum of AVW support. Each underwent supine, dynamic MR imaging. Most dependent bladder location and apical location were measured relative to the average normal position on the mid-sagittal plane using the Pelvic Inclination Correction System . The length of the exposed AVW and the hiatus diameter were measured as well. The relationship between exposed AVW and most dependent bladder location, apical location, and hiatus diameter were examined. RESULTS A bilinear relationship has been observed between exposed vaginal wall length and most dependent bladder location (R(2) = 0.91, P < 0.001). When the bladder descents up to the inflection point (about 4.4 cm away from its normal position), there is little change in the exposed AVW length. With further descent, the exposed vaginal wall length increases significantly, with a 2 cm increase in exposed AVW length for every additional 1 cm of drop bladder location. A similar but weaker bilinear relationship exists between exposed AVW and apical location. Exposed vaginal wall length is also highly correlated with hiatus diameter (R(2) = 0.85, P < 0.001). CONCLUSION A bilinear relationship exists between exposed vaginal wall length and most dependent bladder location and apical location. It is when the bladder descent is beyond the inflection point that exposed vaginal wall length increases significantly.
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Affiliation(s)
- Aisha Yousuf
- Department of Obstetrics and Gynecology (Pelvic Floor Research Group), University of Michigan Hospital, Ann Arbor, MI, 48109, USA
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7
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Paganotto MC, Amadori L, Di Donato N, Mauloni M, Busacchi P. Use of a preventive sling surgery for the simultaneous correction of latent stress urinary incontinence during the cystocele repair: two year follow-up. Minerva Ginecol 2013; 65:319-326. [PMID: 23689175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
AIM The aim of this paper was to assess the feasibility and utility of adding a preventive trans obturatory tape (TOT) during the same intervention for anterior prolapse repair, in patients with masked urinary incontinence and massive cystocele. METHODS A retrospective trial was conducted in a Tertiary care University Hospital. Ninety-nine women with a massive cystocele (Ba ≥2 cm of pelvic organ prolapse quantification) and an occult stress urinary incontinence were recruited from 2004 to 2010: 53 women were subjected to an anterior fascial reconstruction alone while 46 underwent the same intervention with the addition of TOT. Patients were also asked to rate their overall quality of life, using the International Consultation on Incontinence Modular Questionnaire-Lower Urinary Tract Symptoms Quality Of Life (ICIQ-LUTSqol). All patients were assessed at one, six, twelve and twenty-four months of follow-up. Statistical analysis was performed with SPSS 15.0 software; SPSS inc., Chicago IL, USA was performed using the Chi-square test with Fisher's post-hoc correction. RESULTS At 24 month follow-up the rate of appearance of stress urinary incontinence at the urogynecological examination, was higher in the group without TOT (81% vs. 19%, P=0.004). In terms of overall quality of life, significantly higher rates of satisfaction have been reported by the group treated with additional TOT (P=0.006). CONCLUSION The addition of TOT during the anterior prolapse correction seems to give a greater durability to the correction, resulting, in the long term, in a lower rate of urinary symptoms onset (first latency) and in a better quality of life compared to the traditional anterior colporrhaphy alone.
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Affiliation(s)
- M C Paganotto
- Department of Gynecology and Pathophysiology of Human Reproduction, Policlinico S. Orsola-Malpighi University Hospital, Alma Mater Studiorum-University of Bologna, Bologna, Italy
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Tasali N, Cubuk R, Sinanoğlu O, Sahin K, Saydam B. MRI in stress urinary incontinence: endovaginal MRI with an intracavitary coil and dynamic pelvic MRI. Urol J 2012; 9:397-404. [PMID: 22395838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
PURPOSE To evaluate both morphology of the urethra and its supporting structures using endovaginal magnetic resonance imaging (EV-MRI) and the grade of the bladder neck prolapsus using dynamic pelvic MRI (DP-MRI) in women with stress urinary incontinence (SUI). MATERIALS AND METHODS We compared 25 women with SUI and 8 controls according to the different layers of the urethra, the degree of distortion in the periurethral, paraurethral, and pubourethral ligaments, the vesicourethral angle, the retropubic space, and the thickness of the puborectal muscle. The SUI group was also evaluated according to the number of deliveries and degree of the bladder neck prolapsus. RESULTS Significant differences were found in the thickness of each three layers of the urethra between the two groups (P < .05). There was a significantly higher pubourethral ligament distortion (P = .024) and larger vesicourethral angle (P = .000) in women with SUI. In women with SUI, there was no significant relationship between the number of deliveries and the degree of the bladder neck prolapsus (P > .05). CONCLUSION The combined usage of the EV-MRI and DP-MRI can provide complementary information concerning certain structural abnormalities with specific dysfunction, such as vesicourethral angle increase and pubourethral ligament distortion in patients with SUI.
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Affiliation(s)
- Nuri Tasali
- Department of Urology, Maltepe University, Istanbul, Turkey
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Jadhav J, Koukoura O, Joarder R, Edmonds S. Urethral diverticulum mimicking anterior vaginal wall prolapse: case report. J Minim Invasive Gynecol 2010; 17:390-2. [PMID: 20417434 DOI: 10.1016/j.jmig.2010.01.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2009] [Revised: 01/12/2010] [Accepted: 01/14/2010] [Indexed: 11/19/2022]
Abstract
Unfamiliar cystic formations may develop in the anterior vaginal wall. In view of the close proximity of the anterior vagina to the urethra and bladder, it is important that management of such masses is carefully planned after detailed examination and investigation. Herein, we present the case of an unusual painful swelling in the anterior vaginal wall that was first diagnosed as vaginal wall prolapse. Despite thorough preoperative investigations, the origin of the mass as a urethral diverticulum was confirmed only at pathologic analysis.
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Valencić M, Maricić A, Oguić R, Rahelić D, Sotosek S, Grsković A. Modified extensive anterior vaginal wall repair for cystocoele. Coll Antropol 2010; 34 Suppl 2:191-194. [PMID: 21302721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
We describe a new transvaginal technique for cystocoele repair. We prospectively evaluated patients with moderate and high-grade cystocoele who underwent repair with the new transvaginal repair between 2000 and June 2009. Preoperative evaluation included history and physical examination using the Pelvic Organ Prolapse Quantification, urine culture, residual urine measurement, urodinamycs and cystoscopy. We performed the repair in 76 patients with a mean age of 65.24 years (range, 36 to 84 years), wit anatomical cure in 72 (95%) patients. Four (5%) patients had recurrent cystocoele, 3 (4%) patients claimed residual sensory urgency and 4 (5%) stress urinary incontinence (SUI) after the operation. The operation is safe, simple, and provides good anatomic results with minimal complications.
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Affiliation(s)
- Maksim Valencić
- Department of Urology, University Hospital of Rijeka, Rijeka, Croatia.
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11
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Kdous M, Zhioua F. [Transobturator subvesical mesh: Tolerance and mild-term results. A prospective study]. ACTA ACUST UNITED AC 2008; 37:758-69. [PMID: 18980812 DOI: 10.1016/j.jgyn.2008.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2008] [Revised: 09/04/2008] [Accepted: 09/15/2008] [Indexed: 11/18/2022]
Abstract
AIM To evaluate midterm results, tolerance and efficiency of interposition of a transobturator subvesical mesh for the repair of cystoceles. PATIENTS AND METHODS We report the results of a total of 45 consecutive transobturator mesh fixation between March 1, 2005 and March 1, 2007. We used a transvaginal polypropylen tension-free mesh (Prolène, Ethicon, Johnson & Johnson, France) fixed through the obturator foramen. RESULTS Before surgery, all patients had cystocele of more or equal than grade II, according to Baden and Walker classification. Five had grade II cystocele (11%), 36 had grade III (80%) and four grade IV (9%). Thirty-nine women had associated median and/or posterior prolapse (86%). Eleven women had urinary incontinence (24%). The procedure was performed in all cases. Duration of a cystocele cure procedure was 25minutes+/-3.2 (12-32). Mean follow-up was 18 months+/-4.2 (13-29). Vaginal erosion ratio was 6%. There was no mesh infection. The objective success rate was 93%. The satisfaction index was 70%. CONCLUSION Transobturator mesh is a safe and efficient method for anterior segment prolapse repair. This procedure is simple, mini-invasive, reproducible and efficient with low morbidity and good tolerance.
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Affiliation(s)
- M Kdous
- Service de gynécologie obstétrique et de médecine de la reproduction, hôpital Aziza-Othmana de Tunis, La Kasba, 1008 Tunis, Tunisie.
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12
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Health Practitioners Disciplinary Tribunal--not guilty (Med07/72D). N Z Med J 2008; 121:117-20. [PMID: 18846732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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13
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Valencić M, Spanjol J, Maricić A, Markić D, Fuckar D, Bobinac M. Cystocoele and sensory urgency--our experience. Coll Antropol 2008; 32 Suppl 2:207-209. [PMID: 19138026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Sensory urgency appears mostly in patients with a specific or non specific cystitis, interstitial cystitis, intravesical foreign bodies, bladder carcinoma and carcinoma of the prostate, infravesical obstruction, estrogen deficiency and in some neurologic and psychiatric diseases. The aim of this study was to analyze and explain the relation between vaginal vault prolapse and sensory urgency. Clinical courses of 64 patients with cystocoele, which between 1999 and January 2006 have been treated on the Clinic of urology, University Hospital, Rijeka, Croatia, were analyzed retrospectively. On physical examination, using the International Society for Continence staging system we found that 4 (0.6%) had grade II, 29 (45.3%) had grade III, and 31 (48.4%) had grade IV cystocoele. Forty-seven (73.4%) women had urgency, for minimally 6 months to many years before the vaginal vault prolapse manifestation. In all but 3 (4.6%) an extended anterior vaginal colporaphy has been done, with only 1 (1.6%) recurrence of cystocele. It seems that sensory urgency may in fact be a predictor of cystocele.
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Affiliation(s)
- Maksim Valencić
- Clinic of Urology, University Hospital Rijeka, Rijeka, Croatia.
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14
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Zenteno G. [Abdominal-pelvic imbalance and genital prolapse. Surgical treatment in three different aspects. 1953]. Ginecol Obstet Mex 2008; 76:187-194. [PMID: 18798416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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15
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Misrai V, Almeras C, Roupret M, Chartier-Kastler E, Richard F. [Laparoscopic repair of urogenital prolapse without paravaginal repair: medium-term anatomical results]. Prog Urol 2007; 17:846-9. [PMID: 17633999 DOI: 10.1016/s1166-7087(07)92305-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To evaluate the medium-term anatomical results of laparoscopic repair of urogenital prolapse by sacral colpopexy without associated paravaginal repair (PVR). MATERIAL AND METHODS The medical records of 97 patients operated in a single centre between 1997 and 2005 by laparoscopic sacral colpopexy without PVR were retrospectively reviewed. The primary endpoint for evaluation of the functional results was anatomical relapse, defined by the appearance of prolapse greater than or equal to grade 2 according to the Baden and Walker classification. RESULTS Eighty two patients were reviewed with a mean follow-up of 14.3 months (range: 1-62.9). Nine patients (11%) presented an anatomical relapse with a mean follow-up of 26 months [range : 6-63]. One early relapse (< 6 months) was due to avulsion of the posterior tape and 8 late relapses presented with cystocele or isolated distal rectocele. CONCLUSION Laparoscopic sacral colpopexy allows good anatomical correction, especially of cystocele.
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Affiliation(s)
- Vincent Misrai
- Service d'Urologie et de transplantation rénale et pancréatique, Hôpital de la Pitié, Paris, France.
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Karam JA, Vazquez DV, Lin VK, Zimmern PE. Elastin expression and elastic fibre width in the anterior vaginal wall of postmenopausal women with and without prolapse. BJU Int 2007; 100:346-50. [PMID: 17532852 DOI: 10.1111/j.1464-410x.2007.06998.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To compare elastin expression and elastic fibre width in the anterior vaginal wall of postmenopausal women with and with no bladder prolapse. PATIENTS AND METHODS Full-thickness specimens were obtained from the upper lateral anterior vaginal wall of women having a large cystocele repaired (stage III or IV; prolapse group, 33) and the same location in patients with no prolapse having radical cystectomy (control group, 10). The percentage of elastin-positive tissue and elastic fibre width were measured by immunohistochemistry on 6 microm thick tissue sections from 10 random field readings per sample using image analysis software. The examiner was unaware of sample identity and the patients' clinical history. RESULTS The age was comparable between the control and prolapse groups (median 70.5 years), and the parity, vaginal deliveries, hormone replacement use, cigarette smokers and body mass index were no different between the groups. Immunohistochemical staining and morphometric analysis indicated that elastin expression in the prolapse group was 10.6%, vs 14.4% in the control group (P = 0.049). The median width of elastic fibres was 0.9 microm in the prolapse and 1.8 microm in the control groups (P < 0.001). Elastin expression and elastic fibre width appeared to be stable with increasing age in the prolapse group. CONCLUSIONS In this case-control study investigating elastin changes in postmenopausal women with prolapse, the elastin expression and fibre width were significantly lower in the vaginal wall of patients with a large cystocele than in controls of a similar age.
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Affiliation(s)
- Jose A Karam
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX 75390-9110, USA
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Hsu Y, Chen L, Summers A, Ashton-Miller JA, DeLancey JOL, DeLancey JOL. Anterior vaginal wall length and degree of anterior compartment prolapse seen on dynamic MRI. Int Urogynecol J 2007; 19:137-42. [PMID: 17579801 PMCID: PMC2289388 DOI: 10.1007/s00192-007-0405-x] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2007] [Accepted: 05/10/2007] [Indexed: 01/04/2023]
Abstract
The objective of the study was to determine the relationship between midsagittal vaginal wall geometric parameters and the degree of anterior vaginal prolapse. We have previously presented data indicating that about half of anterior wall descent can be explained by the degree of apical descent present (Summers et al., Am J Obstet Gynecol, 194:1438-1443, 2006). This led us to examine whether other midsagittal vaginal geometric parameters are associated with anterior wall descent. Magnetic resonance (MR) scans of 145 women from the prior study were suitable for analysis after eight were excluded because of inadequate visibility of the anterior vaginal wall. Subjects had been selected from a study of pelvic organ prolapse that included women with and without prolapse. All patients underwent supine dynamic MR scans in the midsagittal plane. Anterior vaginal wall length, location of distal vaginal wall point, and the area under the midsagittal profile of the anterior vaginal wall were measured during maximal Valsalva. A linear regression model was used to examine how much of the variance in cystocele size could be explained by these vaginal parameters. When both apical descent and vaginal length were considered in the linear regression model, 77% (R (2) = 0.77, p < 0.001) of the variation in anterior wall descent was explained. Distal vaginal point and a measure anterior wall shape, the area under the profile of the anterior vaginal wall, added little to the model. Increasing vaginal length was positively correlated with greater degrees of anterior vaginal prolapse during maximal Valsalva (R (2) = 0.30, p < 0.01) determining 30% of the variation in anterior wall decent. Greater degrees of anterior vaginal prolapse are associated with a longer vaginal wall. Linear regression modeling suggests that 77% of anterior wall descent can be explained by apical descent and midsagittal anterior vaginal wall length.
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Affiliation(s)
- Yvonne Hsu
- Department of Obstetrics and Gynecology, L4000 Women's Hospital, 1500 E Medical Center Drive, Ann Arbor, MI 48109-0276, USA.
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