Pelvic architectural distortion is associated with pelvic organ prolapse.

The aim of this study was to determine whether there is an association between architectural distortion seen on magnetic resonance (MR) scans (lateral "spill" of the vagina and posterior extension of the space of Retzius) and pelvic organ prolapse. Secondary analysis of MR imaging scans from a case-control study of women with prolapse (maximum point > or = + 1 cm; N = 144) and normal controls (maximum point < or = -1 cm; N= 126) was done. Two independent investigators, blinded to prolapse status and previously established levator-defect scores, determined the presence of architectural distortion on axial MR scans.

Müllerian duct anomalies: comparison of MRI diagnosis and clinical diagnosis.

Objective: The objective of our study was to assess agreement between MRI and clinical diagnosis of müllerian duct anomalies and identify causes of discrepancy.

Materials And Methods: Images of 103 patients who underwent MRI for suspected müllerian duct anomaly were reviewed. Imaging included axial T1-weighted spin-echo (SE) (TR/TE, 500/10) and sagittal, long-uterine-axis, and short-uterine-axis T2-weighted fast SE (5,000/80) sequences.

Are persistent or recurrent symptoms of urinary incontinence after surgery associated with adverse effects on sexual activity or function?

We sought to determine if postoperative urinary incontinence (UI) symptoms are associated with (1) sexual activity status and (2) sexual function using validated health-related quality of life instruments. In this mailed cross-sectional survey of 687 women who underwent stress incontinence surgery, 437 (63.6%) completed a questionnaire protocol.

Symptoms of anal incontinence and difficult defecation among women with prolapse and a matched control cohort.

Objective: The purpose of this study was to quantify the risk for anal incontinence and difficult defecation among women with prolapse by comparing them with women without prolapse of similar age, body mass index, race, and hysterectomy status, and to determine whether there are characteristics or findings in women with prolapse that are associated with greater symptom severity.

Study Design: Women with primary pelvic organ prolapse (n = 151) were compared with women without prolapse (n = 135). All subjects underwent pelvic examination and completed symptom questionnaires regarding how frequently anal incontinence and difficult defecation were experienced.

Vaginal birth and de novo stress incontinence: relative contributions of urethral dysfunction and mobility.

Objective: To evaluate the relative contributions of urethral mobility and urethral function to stress incontinence.

Methods: This was a case-control study with group matching. Eighty primiparous women with self-reported new stress incontinence 9-12 months postpartum were compared with 80 primiparous continent controls to identify impairments specific to stress incontinence.

Age effects on internal anal sphincter thickness and diameter in nulliparous females.

Purpose: Age can affect the delicate physiologic balance of the internal anal sphincter diameters and pressure governed by Laplace's law. This study compares the effect of aging on the internal anal sphincter thickness and diameter in younger and older nulliparous females without symptoms of fecal incontinence undisturbed by an endoanal probe.

Methods: Magnetic resonance images were selected from a large database of nulliparous females to form two groups: "younger" females, aged 30 years and younger (n = 32), and "older" females, aged 50 years and older (n = 32).

Anterior vaginal wall length and degree of anterior compartment prolapse seen on dynamic MRI.

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).

Heterogeneity in anatomic outcome of sacrospinous ligament fixation for prolapse: a systematic review.

Objective: To explore why failure rates vary so much between published reports of sacrospinous ligament fixation to correct pelvic organ prolapse and what the potential sources of heterogeneity may be.

Data Sources: MEDLINE was queried for studies between 1966 and 2005 that included the term "sacrospinous."

Methods Of Study Selection: One-hundred eighty-seven studies were reviewed.

Functional anatomy of the female pelvic floor.

The anatomic structures in the female that prevent incontinence and genital organ prolapse on increases in abdominal pressure during daily activities include sphincteric and supportive systems. In the urethra, the action of the vesical neck and urethral sphincteric mechanisms maintains urethral closure pressure above bladder pressure. Decreases in the number of striated muscle fibers of the sphincter occur with age and parity.

Comparison of the main body of the external anal sphincter muscle cross-sectional area between women with and without prolapse.

The aim of the study was to compare the main body of the external anal sphincter (EAS) cross-sectional area (CSA) of women with and without pelvic organ prolapse. Pelvic magnetic resonance imaging (MRI) scans of 40 women were selected for analysis. Of these women, 20 had pelvic organ prolapse and 20 had normal support.

Test-retest reliability of an instrumented speculum for measuring vaginal closure force.

Aims: The study aimed to: a) determine reliability of an instrumented speculum designed for measuring intravaginal closure pressure, and b) compare findings with a comparable device reported in the literature. The goal of these new devices is to reduce subjectivity, improve precision, and acknowledge reliability issues in quantifying levator ani closure force acting on the vagina.

Methods: The instrumented speculum consisted of two parallel aluminum bills, similar in size to a Peterson speculum.

Origin and insertion points involved in levator ani muscle defects.

Objective: This project sought to identify and to describe the anatomical connections affected by levator ani defects involving the pubovisceral portion of the muscle.

Study Design: Fourteen magnetic resonance scans of women with unilateral levator defects were selected. The missing muscle mapping technique was used to characterize the absent muscle.

Effects of aging on lower urinary tract and pelvic floor function in nulliparous women.

Objective: To evaluate the effects of aging, independent of parity, on pelvic organ and urethral support, urethral function, and levator function in a sample of nulliparous women.

Methods: A cohort of 82 nulliparous women, aged 21-70 years, were recruited from the community through advertisements. Subjects underwent pelvic examination using pelvic organ prolapse quantification, urethral angles by cotton-tipped swab, and multichannel urodynamics and uroflow.

Comparison of levator ani muscle defects and function in women with and without pelvic organ prolapse.

Background: To compare levator ani defects and pelvic floor function among women with prolapse and controls.

Methods: Levator ani structure and function were measured in a case-control study with group matching for age, race, and hysterectomy status among 151 women with prolapse (cases) and 135 controls with normal support (controls) determined by pelvic organ prolapse quantification examination. Magnetic resonance imaging was used to determine whether there were "major" (more than half missing), "minor" (less than half of the muscle missing), or no defects in the levator ani muscles.

Comparative analysis of urinary incontinence severity after autologous fascia pubovaginal sling, pubovaginal sling and tension-free vaginal tape.

Purpose: Autologous fascia, Pelvicol implant and polypropylene are common materials used in suburethral anti-incontinence procedures. We explored the relative effectiveness of the autologous fascia pubovaginal sling, Pelvicol pubovaginal sling and Gynecare TVT on self-reported postoperative urinary incontinence.

Materials And Methods: The study was a mailed cross-sectional survey of health related quality of life 1 to 3 years after suburethral anti-incontinence surgery performed at our institution.

Sexual function, quality of life, and severity of anal incontinence after anal sphincteroplasty.

Objective: The purpose of this study was to determine the severity of anal incontinence and its impact on quality of life and sexual function in women after anal sphincteroplasty.

Study Design: Eighty-six women who underwent anal sphincteroplasty during the years 1993 to 2004 were mailed validated survey instruments to evaluate continence status, health-related quality of life, and sexual functioning. Demographic and perioperative data were obtained from patient charts.

Interrater reliability of assessing levator ani muscle defects with magnetic resonance images.

The objective of this study is to determine interrater reliability of assessing pubovisceral levator ani muscle defects with magnetic resonance images. Normal pubovisceral muscle was assigned a grade of 0; PVM defects were graded as mild=1 (less than half missing), moderate=2 (more than half missing), and severe=3 (total or near total loss). Among six pairs of examiners, percent agreement and weighted kappa coefficients were calculated to determine agreement between pairs of examiners and among all examiners (i.

Quantification of levator ani cross-sectional area differences between women with and those without prolapse.

Objective: Compare levator ani cross-sectional area as a function of prolapse and muscle defect status.

Methods: Thirty women with prolapse and 30 women with normal pelvic support were selected from an ongoing case-control study of prolapse. For each of the two groups, 10 women were selected from three categories of levator defect severity: none, minor, and major identified on supine magnetic resonance scans.

Revisiting reliability of quantified perineal ultrasound: Bland and Altman analysis of a new protocol for the rectangular coordinate method.

Aims: This study tested the reliability of a new protocol for the rectangular coordinate method of quantifying perineal ultrasound.

Methods: Representative scans of healthy primiparous females were quantified by positioning a pubic bone template, drawn onto an acetate sheet containing x-y axes, over scans, by aligning the x-axis with the pubic bone central axis. Values for x (D(x)) and y (D(y)) located the urethrovesical junction (UVJ) at Rest, and at maximal Valsalva and Kegel.

Interaction among apical support, levator ani impairment, and anterior vaginal wall prolapse.

Objective: To use a biomechanical model to explore how impairment of the pubovisceral portion of the levator ani muscle, the apical vaginal suspension complex, or both might interact to affect anterior vaginal wall prolapse severity.

Methods: A biomechanical model of the anterior vaginal wall and its support system was developed and implemented. The anterior vaginal wall and its main muscular and connective tissue support elements, namely the levator plate, pubovisceral muscle, and cardinal and uterosacral ligaments were included, and their geometry was based on midsagittal plane magnetic resonance scans.

Appearance of the levator ani muscle subdivisions in magnetic resonance images.

Objective: Identify and describe the separate appearance of 5 levator ani muscle subdivisions seen in axial, coronal, and sagittal magnetic resonance imaging (MRI) scan planes.

Methods: Magnetic resonance scans of 80 nulliparous women with normal pelvic support were evaluated. Characteristic features of each Terminologia Anatomica-listed levator ani component were determined for each scan plane.

Urinary incontinence symptoms during and after pregnancy in continent and incontinent primiparas.

Objective: Examine patterns of urinary incontinence during and after pregnancy, as recalled by incontinent and continent primiparas.

Study Design: Primiparous women reporting no pre-pregnancy incontinence, were recruited 6 to 9 months postpartum. Those reporting current continence and demonstrating a negative stress test were considered "Primiparous Continent" (PC, n=64).

Levator plate angle in women with pelvic organ prolapse compared to women with normal support using dynamic MR imaging.

Objective: The purpose of this study was to determine whether the levator plate is (1) horizontal in women with normal support, (2) different between women with and without prolapse, (3) related to levator hiatus and perineal body descent.

Study Design: Cohorts of cases with prolapse at least 1 cm below the hymen and normal controls with all points 1 cm or more above the hymen were prospectively enrolled in a study of pelvic organ support to be of similar age, race, and parity. Subjects underwent supine midsagittal dynamic magnetic resonance imaging (MRI) during Valsalva.

Childbirth and pelvic floor dysfunction: an epidemiologic approach to the assessment of prevention opportunities at delivery.

Female pelvic floor dysfunction is integral to the woman's role in the reproductive process, largely because of the unique anatomic features that facilitate vaginal birth and also because of the trauma that can occur during that event. Interventions such as primary elective cesarean delivery have been discussed for the primary prevention of pelvic floor dysfunction; however, existing data about potentially causal factors limit our ability to evaluate such strategies critically. Here we consider the conceptual principles of epidemiologic function and the availability of data that are necessary to make informed recommendations about prevention opportunities for pelvic floor dysfunction at delivery.

The relationship between anterior and apical compartment support.

Objective: The purpose of this study was to determine whether the degree of anterior compartment (bladder) and apical compartment (cervix) prolapse are correlated, and whether 2 anterior compartment elements (urethra and bladder) are related at maximal Valsalva.

Study Design: Women with a complete spectrum of pelvic support were recruited for a pelvic support study. Dynamic magnetic resonance scans were taken during Valsalva.