Role of the uterosacral ligaments in the causation of urinary and bowel dysfunction

Abendstein, Burghard; Petros, Peter

doi:10.1002/nau.21023

Cited by 12 publications

(20 citation statements)

References 2 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Multiple other studies performing USL slings for prolapse confirmed AI cure, with cure rates ranging from 65% to 88%. [4][5][6][7][8] These studies further confirmed the hypothesis that USL laxity was an important cause of AI. A new theory of anorectal function and dysfunction based on 12 original experimental studies evolved.…”

supporting

confidence: 64%

Anal sphincter damage may not be the prime cause of anal incontinence

Petros

2023

Neurourology and Urodynamics

View full text Add to dashboard Cite

supporting

confidence: 64%

Anal sphincter damage may not be the prime cause of anal incontinence

Petros

2023

Neurourology and Urodynamics

View full text Add to dashboard Cite

“…This technique was used to treat 48 patients with vaginal vault descent, rectocoele and defaecatory dysfunction and 94% of patients reported normalization of defaecatory difficulties with 89% of patients showing resolution of intussusception on postoperative proctography. 24 In our study, for enterocoele and intussusception, the link between levator plate damage and anatomical abnormalities was evident with integrated total PFUS but not DP. There are concerns that DP over diagnoses pathology but also changes in patient position and rectal contrast means that integrated total pelvic ultrasound and DP will not completely agree.…”

Section: Levator Plate Damage Is Only Weakly Associated With Patholog...contrasting

confidence: 47%

“…The Integral Theory proposes that evacuatory disorders are mainly caused by connective tissue damage to both the vagina and its’ suspensory ligaments 23,24 . Abendstein 24 and colleagues have shown that posterior sling to reinforce the uterosacral ligament and rebuild its’ attachment to the levator plate by way of a posterior infracoccygeal sacropexy, corrects rectocoele and intussusception by the suspension and stretching of the rectal wall.…”

Section: Discussionmentioning

confidence: 99%

“…22 The Integral Theory proposes that evacuatory disorders are mainly caused by connective tissue damage to both the vagina and its' suspensory ligaments. 23,24 Abendstein 24 and colleagues have shown that posterior sling to reinforce the uterosacral ligament and rebuild its' attachment to the levator plate by way of a posterior infracoccygeal sacropexy, corrects rectocoele and intussusception by the suspension and stretching of the rectal wall. This technique was used to treat 48 patients with vaginal vault descent, rectocoele and defaecatory dysfunction and 94% of patients reported normalization of defaecatory difficulties with 89% of patients showing resolution of intussusception on postoperative proctography.…”

Section: Levator Plate Damage Is Only Weakly Associated With Patholog...mentioning

confidence: 99%

See 1 more Smart Citation

The association between levator plate integrity and pelvic floor defaecatory dysfunction

Hainsworth

Solanki

Ferrari

et al. 2023

Neurourology and Urodynamics

View full text Add to dashboard Cite

Aims: Levator ani deficiency has been implicated in anterior pelvic floor pathology but its association with pelvic floor defaecatory dysfunction is less clear. The aim was to examine the relationship of levator ani deficiency with anatomical abnormalities (rectocoele, intussusception, enterocoele, perineal descent) and patient symptoms (bowel, vagina) in patients with pelvic floor defaecatory dysfunction. Methods: The prospective observational case series of 223 women presenting to a tertiary colorectal pelvic floor unit with defaecatory dysfunction. Each underwent assessment with symptom severity and quality of life (QoL) scores, integrated total pelvic floor ultrasound (PFUS) (transvaginal, transperineal) and defaecation proctography (DP). Rectocoele, intussusception, enterocoele and perineal descent were assessed on both. Levator ani deficiency was scored using endovaginal ultrasound (score 0-18; mild [0-6], moderate [>6-12], severe [>12-18]). Results:The proportion of patients with rectocoele, enterocoele, and intussusception increased with increasing levator ani damage (mild, moderate, severe). There was a weakly positive correlation between size of rectocoele and levator ani deficiency. On PFUS, there was a weakly positive correlation between severity of intussusception and enterocoele with levator ani deficiency. On DP, there was a weakly positive correlation between perineal descent and levator ani deficiency. There was no association between bowel symptom and QoL scores and levator ani deficiency. Vaginal symptoms were associated with levator ani deficiency. Conclusions: Anatomical abnormalities which are implicated in pelvic floor defaecatory dysfunction (rectocoele, intussusception, enterocoele, perineal descent) were associated with worsening levator ani deficiency. There was no association between bowel symptoms and levator ani deficiency. Vaginal symptoms were associated with levator ani deficiency.

show abstract

“…6 The same author published an article on the relationship between loose ligaments involved in POP and rectal intussusception. 7…”

Section: Introductionmentioning

confidence: 99%

Doppler Ultrasound Testing Suggests Hemorrhoids in Females may be a Consequence of Impaired Blood Flow Associated with Pelvic Organ Prolapse

Enache

Soare

2022

Journal of Coloproctology

View full text Add to dashboard Cite

Background It has been observed that there is a high incidence of hemorrhoids in female patients with pelvic organ prolapse. Also, in these patients, hemorrhoidal disease improves after the surgical correction of the pelvic organ prolapse. Objective Our hypothesis was that a cause-effect relationship between pelvic organ prolapse, and hemorrhoids might be the key. The objective of this study was to find an element which connects these two conditions. Study Design We conducted a pilot study which consisted of two parts. An initial part, in which we asked several patients with grades III and IV pelvic organ prolapse and hemorrhoids, who have undergone surgery for prolapse, to determine the impact of the surgical restoration of the prolapsed organs on their hemorrhoidal disease. For the second part, on several patients with uncorrected uterine prolapse grades III and IV, we determined the resistive index of the hemorrhoidal branches within the rectal wall before and after manual reduction of the prolapse. Results First, more than 50% of patients who underwent uterine prolapse correction described an improvement of their hemorrhoidal disease of over 50%. Second, the resistive index of the hemorrhoidal branches was significantly lower after manual reduction of the prolapse. We consider that obstructed veins due to pelvic organ prolapse might induce the dilation of the hemorrhoids. The direct measurement of the resistive index of the hemorrhoidal branches allows us to directly assess the increased resistance in the rectal vascular system. Conclusion Venous stasis and impaired vascular flow might be the pathophysiological explanation for the association between pelvic organ prolapse and hemorrhoids. In these patients, the pathogenic treatment should aim at the restoration of a normal blood flow (prolapse surgical cure) instead of focusing on hemorrhoids only.

show abstract

Role of the uterosacral ligaments in the causation of urinary and bowel dysfunction

Cited by 12 publications

References 2 publications

Anal sphincter damage may not be the prime cause of anal incontinence

Anal sphincter damage may not be the prime cause of anal incontinence

The association between levator plate integrity and pelvic floor defaecatory dysfunction

Doppler Ultrasound Testing Suggests Hemorrhoids in Females may be a Consequence of Impaired Blood Flow Associated with Pelvic Organ Prolapse

Contact Info

Product

Resources

About