A Novel Concept for the Surgical Anatomy of the Perineal Body

Shafik, Ahmed; Sibai, Olfat El; Shafik, Ali A.; Shafik, Ismail A.

doi:10.1007/s10350-007-9064-8

Cited by 64 publications

(43 citation statements)

References 8 publications

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“…It is commonly subjected to trauma during vaginal childbirth and may also be affected by increased intra-abdominal pressure [4]. To date, this structure has attracted very limited attention [1,4], mostly through dissection of cadaveric specimens which do not allow dynamic evaluation. Advanced dynamic imaging is needed to assess movement and function of this structure in live women.…”

Section: Discussionmentioning

confidence: 99%

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Mobility of the perineal body and anorectal junction before and after childbirth

2012

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Section: Discussionmentioning

confidence: 99%

“…It is commonly the site of maternal trauma in childbirth [2], with up to 80% of nulliparae suffering some damage, at least to overlying perineal skin. In addition, chronic increased intra-abdominal pressure is said to affect the perineal muscles and lead to overstretch, subluxation, and sagging of the perineal body [3,4].…”

Section: Introductionmentioning

confidence: 99%

Mobility of the perineal body and anorectal junction before and after childbirth

2012

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“…The perineal muscles are composed of the superficial transverse perineal and bulbospongiosus muscles, both of which connect midline at the central perineal body, 38,39 and the small, fleshy muscle bundles of the perineal muscles, which occur on either side of the perineal body. 39 The perineal muscles are classically described as part of the perineum, rather than as part of the PFMs. 38 However, because they apply tension to the connecting fascia and ligaments to support the pelvic organs and maintain the closing pressure of the bowel and bladder sphincters, they are considered functionally to be part of the PFMs.…”

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confidence: 99%

Myotonometry Reliably Measures Muscle Stiffness in the Thenar and Perineal Muscles

Davidson¹,

Bryant

Bower

et al. 2017

Physiotherapy Canada

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Purpose: The authors investigated the reliability of myotonometry-measured muscle tone in the thenar and perineal muscles. Methods: Participants were women aged 18-50 years who were asymptomatic for thumb and pelvic floor dysfunction (interrater study n ¼ 20; intrarater study n ¼ 43) or who were symptomatic for vulvodynia (interrater study n ¼ 14; intrarater study n ¼ 32). Mechanical properties (stiffness, frequency, decrement, relaxation time, and creep) of the muscles were measured using a myotonometer (MyotonPRO) while the muscles were in a relaxed state. Measures were performed twice by two assessors. Intra-and interrater reliability were determined using intra-class correlation coefficients (ICCs) and absolute reliability using the standard error of measurement and a minimum detectable change. Results: The primary property of interest, muscle stiffness, showed very good interrater (ICC 0.85-0.86) and intrarater (ICC 0.82-0.88) reliability in the thenar eminence. In the perineal muscles, reliability results ranged from good to very good for interrater (ICC 0.70-0.86) and intrarater (ICC 0.80-0.91) reliability for muscle stiffness. Absolute reliability was confirmed, with all measures showing minimal variance. Conclusions: Muscle stiffness of the smaller muscles of the body can be reliably measured using the MyotonPRO. The device could be used as a reference standard in the development of a digital palpation scale that would facilitate accurate diagnosis of muscle tone.Key Words: muscle; perineum; reproducibility of results; thumb. RÉ SUMÉObjectif : é tudier la fiabilité de la raideur musculaire mesuré e par myotonomé trie dans les muscles de l'é minence thé nar et du pé riné e. Mé thodologie : Les participantes é taient des femmes â gé es de 18 à 50 ans ne pré sentant aucun symptô me de dysfonctionnement du pouce ni du plancher pelvien (é tude interé valuateur n ¼ 20; é tude intra-é valuateur n ¼ 43) ou pré sentant des symptô mes de vulvodynie (é tude interé valuateur n ¼ 14; é tude intra-é valuateur n ¼ 32). Les proprié té s mé caniques (raideur, fré quence, dé cré ment, temps de relaxation et fluage) des muscles au repos ont é té mesuré es à l'aide d'un myotonomè tre (MyotonPRO). Les mesures ont é té prises deux fois par deux é valuateurs. La fiabilité intra-é valuateur et interé valuateur a é té dé terminé e à l'aide des coefficients de corré lation intraclasse (CCI) et la fiabilité absolue à l'aide de l'é cart type de mesure et du changement minimal dé tectable. Ré sultats : la proprié té d'inté rê t principal, la raideur musculaire, a montré une trè s bonne fiabilité interé valuateur (CCI 0,85-0,86) et intra-é valuateur (CCI 0,82-0,88) pour l'é minence thé nar. Concernant les muscles du pé riné e, les ré sultats de fiabilité variaient de bons à trè s bons pour la fiabilité interé valuateur (CCI 0,70-0,86) et intra-é valuateur (CCI 0,80-0,91) pour la raideur musculaire. La fiabilité absolue a é té confirmé e, toutes les mesures montrant une variabilité minimale. Conclusions : la raideur musculair...

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“…The only change noted was an improvement in the sphincter asymmetry index, and this finding may be related to the integral theory of the pelvic floor. This theory states that the involvement of anterior, medium and posterior pelvic floor compartments and the interrelation of its structures and organs with the pelvic fascia and ligaments are important in anal continence 31-33…”

Section: Discussionmentioning

confidence: 99%

Influence of perineal prostatectomy on anal continence

Guilger

Jorge

Costa

et al. 2011

Clinics

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OBJECTIVE:Perineal prostatectomy has been proposed as a less invasive and safe procedure, but the risk of anal incontinence has been studied. This study aimed to evaluate the effects of perineal access on anal continence mechanisms after perineal prostatectomy.METHODS:From August 2008 to May 2009, twenty three patients underwent perineal prostatectomy. These patients were evaluated before surgery and eight months postoperatively using the Cleveland Clinic Anal Incontinence Score, the Fecal Incontinence Quality of Life Score, and anorectal manometry.RESULTS:The mean age of the subjects was 65 (range, 54-72) years, and the mean prostate weight was 34.5 (range, 24-54) grams. Gleason scores ranged from 6-7, and the mean Cleveland Clinic Anal Incontinence Score (mean±standard deviation) values were 0.9±1.9 and 0.7±1.2 (p>0.05) before and after surgery, respectively. The Fecal Incontinence Quality of Life Score did not change significantly after surgery. The mean values for anal manometric parameters before and after surgery were, respectively: Resting Pressures of 64±23 mmHg and 65±17 mmHg (p = 0.763), Maximum Squeezing Pressures of 130±41 mmHg and 117±40 mmHg (p = 0.259), High Pressure Zones of 3.0±0.9 cm and 2.7±0.8 cm (p = 0.398), Rectal Sensory Thresholds of 76±25 ml and 71±35 ml (p = 0.539), Maximum Tolerated Rectal Volumes of 157±48 ml and 156±56 ml (p = 0.836), and Sphincter Asymmetry Indexes 22.4±9% and 14.4±5% (p = 0.003).CONCLUSION:There was a significant decrease in the sphincter symmetry index after perineal prostatectomy. With the exception of the sphincter asymmetry index, perineal prostatectomy did not affect anal continence parameters.

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A Novel Concept for the Surgical Anatomy of the Perineal Body

Cited by 64 publications

References 8 publications

Mobility of the perineal body and anorectal junction before and after childbirth

Mobility of the perineal body and anorectal junction before and after childbirth

Myotonometry Reliably Measures Muscle Stiffness in the Thenar and Perineal Muscles

Influence of perineal prostatectomy on anal continence

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