Somatic and autonomic nerve density and distribution within the clitoris: an immunohistochemical study in adult female cadavers.

Introduction And Hypothesis: Knowledge of clitoral neuroanatomy is critical to vulvar surgery. We sought to characterize the density and distribution of autonomic and somatic nerves supplying the clitoris.

Methods: Pelvic tissue harvested from female cadavers was sectioned axially at three anatomic levels: the proximal aspect of the clitoral body (CB), the distal CB, and the glans.

Somatic and autonomic nerve density of the urethra, periurethral tissue, and anterior vaginal wall: an immunohistochemical study in adult female cadavers.

Introduction And Hypothesis: Retropubic procedures may disrupt nerves supplying the pelvic viscera; however, knowledge of pelvic neuroanatomy is limited. We sought to characterize somatic and autonomic nerve density within the urethra, periurethral tissue, and anterior vagina.

Methods: Axial sections were obtained from pelvic tissue harvested from female cadavers ≤24 h from death at three anatomical levels: the midurethra, proximal urethra, and upper trigone.

Surgical anatomy of the clitoris and surrounding vulvar structures.

Injury to the clitoris and its associated nerve supply has the potential to adversely impact sexual arousal and sexual response. Strategies to avoid such injuries during vulvar procedures are not well described, in part, because of the limited understanding of clitoral anatomy. In particular, resources demonstrating methods of periclitoral surgical dissection are rare.

Anatomic relationships of the clitoral body, bulbs of the vestibule, and urethra.

Background: Although recent studies have enhanced our understanding of the anatomy of the clitoris and its somatic innervation, less emphasis has been placed on the anatomic relationships of the clitoris to its surrounding structures.

Objective: This study aimed to further characterize the gross and histologic relationships of the clitoris, vestibular bulbs, and urethra.

Study Design: Detailed dissections were performed in 30 unembalmed female cadavers.

Robotic Burch colposuspension: anatomical and technical considerations.

Introduction And Hypothesis: Up to 13.6% of women will undergo surgical treatment for stress urinary incontinence during their lifetime. Midurethral slings are the mainstay of stress incontinence treatment; however, diversity of surgical options is needed to serve the large number of patients desiring treatment.

Recommended standardized anatomic terminology of the posterior female pelvis and vulva based on a structured medical literature review.

Background: Anatomic terminology in both written and verbal forms has been shown to be inaccurate and imprecise.

Objective: Here, we aimed to (1) review published anatomic terminology as it relates to the posterior female pelvis, posterior vagina, and vulva; (2) compare these terms to "Terminologia Anatomica," the internationally standardized terminology; and (3) compile standardized anatomic terms for improved communication and understanding.

Study Design: From inception of the study to April 6, 2018, MEDLINE database was used to search for 40 terms relevant to the posterior female pelvis and vulvar anatomy.

Needs Assessment for Lower Urinary Tract Injury Curriculum for FPMRS Fellowships.

Objective: The aim of this study was to determine the level and types of training Accreditation Council for Graduate Medical Education-accredited programs use for female pelvic medicine and reconstructive surgery (FPMRS) fellows' education on lower urinary tract injuries (LUTIs).

Methods: Two surveys were developed to assess the need for LUTI curriculum from both program director (PD) and fellow vantages through a multistage process, including review by knowledgeable colleagues, cognitive interviews, and pilot testing. Surveys were distributed in an electronic link via e-mail to graduating fellows and program directors from each of the 58 Accreditation Council for Graduate Medical Education-accredited FPMRS programs.

Standardized terminology of apical structures in the female pelvis based on a structured medical literature review.

The objectives of this study were to review the published literature and selected textbooks, to compare existing usage to that in Terminologia Anatomica, and to compile standardized anatomic nomenclature for the apical structures of the female pelvis. MEDLINE was searched from inception until May 30, 2017, based on 33 search terms generated by group consensus. Resulting abstracts were screened by 11 reviewers to identify pertinent studies reporting on apical female pelvic anatomy.

Anatomy, histology, and nerve density of clitoris and associated structures: clinical applications to vulvar surgery.

Background: A precise understanding of structures comprising the female external genitalia is essential in obstetric and gynecologic practice.

Objective: To further characterize the anatomy, histology, and nerve density of the clitoris and associated structures, and to provide clinical correlations to vulvar surgery.

Materials And Methods: Unembalmed female cadavers were examined.

Gross and Histologic Anatomy of the Pelvic Ureter: Clinical Applications to Pelvic Surgery.

Objective: To further evaluate relationships of the pelvic ureter to clinically relevant structures and to characterize the anatomy, histology, and nerve density of the distal ureter.

Methods: In this observational cadaveric study, 35 female cadavers were examined, 30 by gross dissections and five microscopically. Ureter length and segments of pelvic ureter were measured.

Posterior Vaginal Compartment Anatomy: Implications for Surgical Repair.

Objectives: To examine the gross and histologic anatomy of the proximal, mid, and distal posterior vaginal compartment and discuss implications for surgical repair.

Study Design: In this cadaver study, pelvic organs were resected en bloc, immersed in formalin solution, and transected in the mid sagittal plane. Measured distances included: posterior vaginal wall length, cervicovaginal junction or vaginal cuff to posterior peritoneal reflection, peritoneal reflection to proximal edge (apex) of perineal body, and perineal body apex to hymenal remnant (height).

Gross and histologic relationships of the retropubic urethra to lateral pelvic sidewall and anterior vaginal wall in female cadavers: clinical applications to retropubic surgery.

Background: Knowledge of the retropubic space anatomy is essential for safe entry and surgical applications within this space.

Objective: The objectives of this study were to examine the gross and histologic anatomy of the retropubic urethra, paraurethral tissue, and urethrovaginal space and to correlate findings to retropubic procedures.

Study Design: Anatomic relationships of the retropubic urethra were examined grossly in unembalmed female cadavers.

Medial Thigh Anatomy in Female Cadavers: Clinical Applications to the Transobturator Midurethral Sling.

Background: Mesh resection for refractory pain after transobturator midurethral sling may require exploration of structures different than those involved in insertion. Our objective was to describe the muscular and neurovascular anatomy of the medial thigh compartment.

Methods: Dissections were performed in unembalmed female cadavers.

Recommended standardized terminology of the anterior female pelvis based on a structured medical literature review.

Background: The use of imprecise and inaccurate terms leads to confusion amongst anatomists and medical professionals.

Objective: We sought to create recommended standardized terminology to describe anatomic structures of the anterior female pelvis based on a structured review of published literature and selected text books.

Study Design: We searched MEDLINE from its inception until May 2, 2016, using 11 medical subject heading terms to identify studies reporting on anterior female pelvic anatomy; any study type published in English was accepted.

Long-Term Outcomes After Overlapping Sphincteroplasty for Cloacal-Like Deformities.

Objective: The aim of this study was to report subjective, long-term outcomes and describe patient demographics, presenting symptoms, perioperative management, and complications after overlapping sphincteroplasty repair for chronic fourth-degree lacerations (cloacal-like deformities).

Methods: In this retrospective study, hospital records were reviewed for women who underwent overlapping anal sphincteroplasty for a cloacal-like deformity of the perineum at a single institution from 1996 to 2013. Details including patient demographics, presenting symptoms, perioperative management, and complications were abstracted from the medical record.

First sacral nerve and anterior longitudinal ligament anatomy: clinical applications during sacrocolpopexy.

Background: The recommended location of graft attachment during sacrocolpopexy is at or below the sacral promontory on the anterior surface of the first sacral vertebra. Graft fixation below the sacral promontory may potentially involve the first sacral nerve.

Objective: The objectives of this study were to examine the anatomy of the right first sacral nerve relative to the midpoint of the sacral promontory and to evaluate the thickness and ultrastructural composition of the anterior longitudinal ligament at the sacral promontory level.

Anatomic relationships of the pelvic autonomic nervous system in female cadavers: clinical applications to pelvic surgery.

Background: The integrity of the pelvic autonomic nervous system is essential for proper bowel, bladder, and sexual function.

Objective: The purpose of this study was to characterize the anatomic path of the pelvic autonomic system and to examine relationships to clinically useful landmarks.

Study Design: Detailed dissections were performed in 17 female cadavers.

Inferior gluteal and other nerves associated with sacrospinous ligament: a cadaver study.

Background: Reported rates of gluteal pain after sacrospinous ligament fixation range from 12-55% in the immediate postoperative period and from 4-15% 4-6 weeks postoperatively. The source of gluteal pain often is attributed to injury to the nerve to levator ani or pudendal nerve. The inferior gluteal nerve and other sacral nerve branches have not been examined thoroughly as potential sources of gluteal pain.

Distance From Cervicovaginal Junction to Anterior Peritoneal Reflection Measured During Vaginal Hysterectomy.

Objective: To quantify the distance of the dissection plane from the cervicovaginal junction to the anterior peritoneal reflection for vaginal hysterectomy.

Methods: This is a descriptive study examining the dissection plane for anterior colpotomy in 22 surgical patients undergoing vaginal hysterectomy and in nine cadaver specimens. Intraoperatively, the distance from the vaginal incision to the anterior peritoneal reflection was measured on the uterus after removal.

Anatomic variations of pudendal nerve within pelvis and pudendal canal: clinical applications.

Objective: The objective of the study was to examine the anatomic variation of the pudendal nerve in the pelvis, on the dorsal surface of the sacrospinous ligament, and in the pudendal canal.

Study Design: Detailed dissections of the pudendal nerve were performed in unembalmed female cadavers. Pelvic measurements included the distance from the origin of the pudendal nerve to the tip of ischial spine and the nerve width at its origin.

Symptom improvement in women after fecal incontinence treatments: a multicenter cohort study of the pelvic floor disorders network.

Objectives: The study aims were to characterize women with fecal incontinence (FI) and measure changes in FI severity and quality of life 3 and 12 months after treatment.

Methods: This study is a secondary analysis of a multicenter study measuring adaptive behaviors among women with FI. Women included had a primary complaint of at least monthly FI over 3 consecutive months and planned FI treatment.

Anatomic relationships of psoas muscle: clinical applications to psoas hitch ureteral reimplantation.

Objective: The objective of the study was to examine the anatomic relationship of the genitofemoral and femoral nerves to the psoas major muscle.

Study Design: Dissections were performed in 17 unembalmed female cadavers. Point A was used as the approximate location for placement of psoas hitch sutures and as the reference point from which all measurements were taken.

Pneumomediastinum after robotic sacrocolpopexy.

Background: Pneumomediastinum is a rare but potential complication of laparoscopy that is related to insufflation with carbon dioxide gas and may lead to life-threatening complications.

Case: A 76-year-old woman underwent robotic sacrocolpopexy to repair posthysterectomy prolapse without any apparent intraoperative complications. Postoperatively, she developed shortness of breath and tachycardia and was found to have subcutaneous emphysema and pneumomediastinum.