Effects of preoperative local estrogen in postmenopausal women with prolapse: a randomized trial.

Context: Pelvic organ prolapse (POP) increases in prevalence with age; recurrence after surgical repair is common.

Objective: The objective of the study was to determine the effects of local estrogen treatment on connective tissue synthesis and breakdown in the vaginal wall of postmenopausal women planning surgical repair of POP.

Design: This was a randomized trial.

Extracellular matrix proteases contribute to progression of pelvic organ prolapse in mice and humans.

Pelvic organ prolapse (POP) is a common condition affecting almost half of women over the age of 50. The molecular and cellular mechanisms underlying this condition, however, remain poorly understood. Here we have reported that fibulin-5, an integrin-binding matricellular protein that is essential for elastic fiber assembly, regulated the activity of MMP-9 to maintain integrity of the vaginal wall and prevented development of POP.

Anterior abdominal wall nerve and vessel anatomy: clinical implications for gynecologic surgery.

Objective: We sought to describe relationships of clinically relevant nerves and vessels of the anterior abdominal wall.

Study Design: The ilioinguinal and iliohypogastric nerves and inferior epigastric vessels were dissected in 11 unembalmed female cadavers. Distances from surface landmarks and common incision sites were recorded.

Pathophysiology of urinary incontinence, voiding dysfunction, and overactive bladder.

Urinary incontinence and voiding dysfunction are common forms of pelvic floor dysfunction affecting women. The complex interactions between the nervous system and lower urinary tract anatomy allow for the coordinated functions of urine storage and evacuation. A thorough understanding of these components and their interactions is the foundation for the diagnosis and treatment of pathologic conditions affecting urine storage or evacuation.

Failure of pelvic organ support in mice deficient in fibulin-3.

Fibulin-5 is crucial for normal elastic fiber synthesis in the vaginal wall; more than 90% of fibulin-5-knockout mice develop pelvic organ prolapse by 20 weeks of age. In contrast, fibulin-1 and -2 deficiencies do not result in similar pathologies, and fibulin-4-knockout mice die shortly after birth. EFEMP1 encodes fibulin-3, an extracellular matrix protein important in the maintenance of abdominal fascia.

Uterosacral ligament suspension sutures: Anatomic relationships in unembalmed female cadavers.

Objective: The objective of the study was to characterize anatomic relationships of uterosacral ligament suspension (USLS) sutures.

Study Design: The relationship of USLS sutures to the ureters, rectal lumen, and sidewall neurovascular structures was examined in 15 unembalmed female cadavers.

Results: The mean distance of the proximal sutures to the ureters and rectal lumen was 14 mm (range, 0-33) and 10 mm (range, 0-33), respectively.

Anatomic relationships of the distal third of the pelvic ureter, trigone, and urethra in unembalmed female cadavers.

Objective: The objective of the study was to examine the relationship of the ureter to paravaginal defect repair (PVDR) sutures and to evaluate the anatomy of distal ureter, trigone, and urethra relative to the anterior vaginal wall.

Study Design: Dissections of the retropubic space were performed in 24 unembalmed female cadavers following placement of PVDR sutures. Lengths of the vagina, urethra, and trigone were recorded.

Neurovascular anatomy of the sacrospinous ligament region in female cadavers: Implications in sacrospinous ligament fixation.

Objective: The objective of the study was to further characterize the anatomy of the coccygeus muscle-sacrospinous ligament (C-SSL) complex and to correlate the findings with sacrospinous ligament fixations (SSLF).

Study Design: Dissections were performed in 21 female cadavers.

Results: In all dissections, nerves originating from S3, S4, S5, or a combination passed over the anterior surface of the C-SSL at its midsegment, and either the pudendal or third sacral nerve coursed on the superior border of C-SSL at its midpoint.

Posterior division of the internal iliac artery: Anatomic variations and clinical applications.

Objective: The objective of the study was to characterize the anatomy of the internal iliac artery (IIA) and its posterior division branches and to correlate these findings to IIA ligation.

Study Design: Dissections were performed in 54 female cadavers.

Results: Average length of IIA was 27.

Does supracervical hysterectomy provide more support to the vaginal apex than total abdominal hysterectomy?

Objective: The objective of the study was to assess whether cervical preservation at the time of hysterectomy may help prevent subsequent apical vaginal vault prolapse.

Study Design: Supracervical hysterectomies were performed in 12 unembalmed cadavers. Successive hanging weights of 1, 2, 3, and 4 kg were loaded against the cervical stump and distances moved were recorded.