Levator bowl volume during straining and its relationship to other levator measures

Nandikanti, Lahari; Sammarco, Anne G.; Chen, Luyun; Ashton‐Miller, James A.; DeLancey, John O.L.

doi:10.1007/s00192-019-04006-8

Cited by 13 publications

(8 citation statements)

References 13 publications

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“…We showed that the effect of increasing basin volume on increased Oxford grades was affected by age, prior vaginal delivery, and pelvic surgeries. Previous studies have correlated increased hiatus opening size and downward displacement of levator ani during straining with sagging of abdominal and pelvic organs (19). Our findings further substantiate this because we demonstrate that increased levator hiatus length (both at rest and straining) and its descent at simulated defecation contribute to increased Oxford grades.…”

Section: Discussionmentioning

confidence: 99%

“…The pivotal role of hiatal enlargement and descent in anterior compartment pelvic organ prolapse is well described in women (19)(20)(21). By contrast, the significance of levator hiatus laxity measured by levator hiatus enlargement and descent in posterior compartment prolapse has been less studied.…”

Section: Neshatian Et Almentioning

confidence: 99%

“…In anterior compartment prolapse, increased levator basin volume is believed to be caused at least in part by the prolapsing tissue (19). To assess the levator basin volume we calculated levator ani subtended volume, a validated measurement of levator basin volume (22), using a mathematical model including levator hiatus length, width, and descent in 2D MRDs (11).…”

Section: Neshatian Et Almentioning

confidence: 99%

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Increased Grades of Rectal Intussusception: Role of Decline in Pelvic Floor Integrity and Association With Dyssynergic Defecation

Neshatian,

Triadafilopoulos,

Wallace

et al. 2023

Am J Gastroenterol

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Background: The natural history of rectal intussusception (RI) is poorly understood. We hypothesized that decline in pelvic floor integrity and function leads to increasing RI grades. Methods: Retrospective analysis of a registry of patients with defecatory disorders with high-resolution anorectal manometry and MR defecography. Association of risk factors on increasing RI grades was assessed using logistic regression. Results: Analysis included a total of 238 women; 90 had no RI, 43 Oxford 1-2, 49 Oxford 3, and 56 Oxford 4-5. Age (p:0.017), vaginal delivery (p: 0.008), and prior pelvic surgery (p: 0.032) were associated with increased Oxford grades. Obstructive defecation symptoms and dyssynergic defecation were observed at relatively high rates across groups. Increased RI grades was associated with less anal relaxation at simulated defecation yet, higher rates of normal balloon expulsion (p<0.05), linked to diminished anal sphincter. Indeed, increased RI grades was associated with worsening fecal incontinence severity, attributed to higher rates of anal hypotension. Levator ani laxity, defined by increased levator hiatus length and its excessive descent at straining, was associated with increasing RI grades, independent of age, history of vaginal delivery, and pelvic surgeries and could independently predict increased RI grades. Concurrent anterior and posterior compartments, and visceral prolapse were associated with higher Oxford grades. Conclusion: Our data suggests that decline in pelvic floor integrity with abnormal levator ani laxity is associated with increased RI grades; a process that is independent of age, history of vaginal deliveries and/or pelvic surgeries, and perhaps related to dyssynergic defecation.

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Section: Discussionmentioning

confidence: 99%

Section: Neshatian Et Almentioning

confidence: 99%

Section: Neshatian Et Almentioning

confidence: 99%

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Increased Grades of Rectal Intussusception: Role of Decline in Pelvic Floor Integrity and Association With Dyssynergic Defecation

Neshatian,

Triadafilopoulos,

Wallace

et al. 2023

Am J Gastroenterol

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“…Nandikanti et al measured UGH and LH lengths to compare the volumes of the levator ani bowl at rest and during straining in women with and without POP 18 . They demonstrated that the average UGH and LH lengths during straining were 59 and 70 mm, respectively, in women with POP.…”

Section: Discussionmentioning

confidence: 99%

Magnetic resonance imaging evaluation of the effectiveness of FemiCushion in pelvic organ prolapse

Nomura

Okada

Nakagawa

et al. 2022

J of Obstet and Gynaecol

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Aims FemiCushion (FC) is a supportive device for pelvic organ prolapse (POP), but its effectiveness has not been evaluated with imaging studies. This study utilized magnetic resonance imaging (MRI) to evaluate the anatomic changes induced by FC use in patients with severe POP. Methods This prospective study examined patients with stage 3 or 4 POP who underwent treatment with FC and received a diagnostic MRI. Measurements were made in the midsagittal plane at rest and during straining with and without FC. The vertical distances from the lowest points of the anterior and posterior vaginal wall (A; P), uterine cervix or vaginal stump (C), and perineal body (PB) to the Pelvic Inclination Correction System line were measured, along with the lengths of the urogenital (UGH) and levator hiatus (LH). Results Twelve patients were included in the study. The median age was 72 (range, 56–84) years. All reference points were positioned significantly higher with the FC than without the FC (median ΔA: 11 mm, p = 0.005; ΔC: 14 mm, p = 0.011; ΔP: 6 mm, p = 0.008; ΔPB: 7 mm, p = 0.002). Median UGH and LH lengths during straining were significantly shorter with the FC than without the FC (UGH: 44 mm vs. 53 mm, p = 0.002; LH: 60 vs. 65 mm, p = 0.021). Conclusions This is the first report on the use of MRI to measure the performance of FC. Our study demonstrates that FC effectively repositioned the organs involved in POP.

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“…Однако УЗИ и МРТ мышц промежности подтвердили повреждение мышечной ткани (скрытые травмы промежнос ти) [24]. При помощи УЗИ тазового дна и перинеометрии N.O.…”

Section: Introductionunclassified

Morphology of the Levator Ani in Patients with Genital Prolapse

Lologaeva¹,

Toktar²,

Оразов³

et al. 2020

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Цель исследования: расширение представлений о патогенезе пролапса гениталий и несостоятельности мышц тазового дна (НMТД) с оценкой стандартных морфологических изменений m. levator ani. Дизайн: многоцентровое ретроспективное клинико-морфологическое исследование. Материалы и методы. Исследование проводилось в 2018-2019 гг. В выборку входили 40 пациенток с верифицированным диагнозом «недостаточность мышц тазового дна» (N81.8), осложненным впервые диагностированным передним, апикальным и задним пролапсом в разных сочетаниях. Выполняли биопсию m. levator ani справа и слева от centrum tendineum во время оперативного вмешательства, а также материала в области рубца на промежности вследствие акушерской травмы (при наличии) с микроскопическим исследованием, подсчетом площади фиброза. Результаты. Обнаружено фиброзирование m. levator ani справа и слева от сentrum tendineum у всех пациенток с НМТД и пролапсом тазовых органов (ПТО) вне зависимости от наличия или отсутствия посттравматического рубца на промежности. Не выявлено статистически значимых различий групп по площади фиброза (p > 0,05) и площадей фиброза m. levator ani слева и справа (p > 0,05), корреляции между возрастом и площадью фиброза во всех локализациях по коэффициенту Спирмена. Заключение. Подтверждено наличие дефекта мышечной ткани при НМТД и ПТО даже в отсутствие посттравматического рубца от акушерской травмы промежности. Последняя лишь запускает деградацию, а декомпенсационным атрофическим изменениям подвергается весь мышечный пласт тазового дна. Развитие тотальной деградации мышц промежности является процессом симметричного формирования грыжевых ворот-продрома манифестированного ПТО. Ключевые слова: пролапс тазовых органов, несостоятельность мышц тазового дна, m. levator ani, фиброз мышечной ткани.

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Levator bowl volume during straining and its relationship to other levator measures

Cited by 13 publications

References 13 publications

Increased Grades of Rectal Intussusception: Role of Decline in Pelvic Floor Integrity and Association With Dyssynergic Defecation

Increased Grades of Rectal Intussusception: Role of Decline in Pelvic Floor Integrity and Association With Dyssynergic Defecation

Magnetic resonance imaging evaluation of the effectiveness of FemiCushion in pelvic organ prolapse

Morphology of the Levator Ani in Patients with Genital Prolapse

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