Surgical anatomy of the vaginal introitus

Haylen, Bernard T.; Vu, Dzung; Wong, Audris

doi:10.1002/nau.24961

Cited by 8 publications

(12 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The MV (Level II) here is the same area, a mean of 5 cm in length, as the proposed combined Levels II and III in an earlier description. 36 Level III currently refers to the vaginal introitus, below the hymen, incorporating anterior and posterior vestibules and perineum 1,4 (Figure 1).…”

Section: Discussionmentioning

confidence: 99%

“…An understanding of the surgical anatomy can assist anterior and posterior colporrhaphy. In particular, if VV (Level I) support is employed and suitable perineorrhaphy 4 performed (Level III), the Level II component of a posterior repair should be relatively small.…”

Section: Discussionmentioning

confidence: 99%

“…The VV (Level I) defects (posterior vaginal vault descent [PVVD] 1,2 —6 cm, Point C—minus 0.9 cm) are the largest defects. The Level III defects (perineal gap [PG] 1,4 —2.9 cm, genital hiatus [GH] 1,4 —3.7 cm) are the next largest. The Level II defects (MVL—1.3 cm, RVFL—1.1 cm, Ap—1.0 cm, Bp—1.0 cm) are relatively small, again provided the VV descent is reduced.…”

Section: Surgical Aspects Of Posterior Mid‐vaginal Defectsmentioning

confidence: 99%

See 2 more Smart Citations

Surgical anatomy of the mid‐vagina

Haylen

Wong

et al. 2022

Neurourology and Urodynamics

Self Cite

View full text Add to dashboard Cite

Aim The mid‐vagina (MV) represents Level II of the vagina. The surgical anatomy of the MV has not been recently subject to a comprehensive examination and description. MV surgery involving anterior and posterior colporrhaphy represents a key part of surgery for a majority of pelvic organ prolapse (POP). Methods Literature review and surgical observations of many aspects of the MV were performed including MV length and width; MV shape; immediate relationships; histological analysis; anterior and posterior MV prolapse assessment and anterior MV surgical aspects. Unpublished pre‐ and postoperative quantitative data on 300 women undergoing posterior vaginal compartment repairs are presented. Results The MV runs from the lower limit of the vaginal vault (VV) to the hymen. Its length is a mean of 5 cm. Its shape in section overall is a compressed rectangle. Its longitudinal shape is created by its anterior and posterior walls being inverse trapezoid in shape. Histology comprises three layers: (i) mucosa; (ii) muscularis; (iii) adventitia. MV prolapse staging uses pelvic organ prolapse quantification (POP‐Q). Anterior MV prolapse can be quantitatively assessed using POP‐Q while posterior MV prolapse can be assessed with POP‐Q or PR‐Q. Around 50% of both cystocele and rectocele are due to VV defects. POP will increase anterior MV width and length. Native tissue anterior colporrhaphy is the current conventional repair with mesh disadvantages outweighing advantages. Posteriorly, Level II (MV) defects are far smaller (mean 1.3 cm) than Level I (mean 6.0 cm) and Level III (mean 2.9 cm). Conclusion An understanding of the surgical anatomy of the MV can assist anterior and posterior colporrhaphy. In particular, if VV support is employed, the Level II component of a posterior repair should be relatively small.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Surgical Aspects Of Posterior Mid‐vaginal Defectsmentioning

confidence: 99%

See 1 more Smart Citation

Surgical anatomy of the mid‐vagina

Haylen

Wong

et al. 2022

Neurourology and Urodynamics

Self Cite

View full text Add to dashboard Cite

show abstract

“…Furthermore, there are several reports in the medical literature about gynecological entities that are specifically related to the vaginal outlet, such as "vulvar outlet stenosis" (vaginal stenosis), which is recognized as causing superficial dyspareunia. [6][7][8] Those authors postulated that the vulvar outlet participates in the pelvic organ prolapse; therefore, it should be evaluated when the posterior-distal vaginal wall relaxation is present. However, they did not present the gross, topographic, or surgical anatomy.…”

Section: Interpretation Anatomymentioning

confidence: 99%

“…However, they did not present the gross, topographic, or surgical anatomy. [6][7][8] Histology Histology of the excised vaginal outlet biopsy showed no perineal skeletal muscle present in the excised specimens and verified three distinctive layers: the hymeneal membrane, ring, and plate, Fig. 1C.…”

Section: Interpretation Anatomymentioning

confidence: 99%

The vaginal outlet wall anatomy: A prospective case series study

Ostrzenski¹

2022

Preprint

View full text Add to dashboard Cite

The vaginal outlet wall anatomy: A prospective case series study Abstract Objectives To describe and document the anatomical and histological architecture of the vaginal outlet wall. Design A prospective observational case series study. Setting International centers. Population Twelve fresh human female cadavers. Methods Female corpses were subjected to stratum-by-stratum, macro-, and micro-anatomical dissections in sagittal, transverse, and coronal planes. The multiple excisional biopsies were obtained from the vaginal outlet wall at 12, 3, 6, and 9 o’clock locations for histological examination. Digital photograms documented the anatomical and histological features. Primary Outcome measures Gross, topographic anatomy, and characteristic histologic features of the vaginal outlet wall. Results The vaginal outlet wall (VOW) was positioned in the vertical orientation and fused with horizontally located the vaginal wall at the hymeneal plate level. The hymeneal membrane and ring were not attached directly to the vaginal wall. VOW had three identifiable anatomical-histological layers a) the hymeneal membrane, b) the hymeneal ring (cartilage) with different anatomy and histology than the vaginal wall, and c) the hymeneal plate (the deep level of VOW), which connects to the vaginal wall. Conclusions The vaginal outlet wall is an anatomical structure consisting of the hymeneal membrane, hymeneal ring (cartilage), and hymeneal plate. This structure is in vertical topographic orientation. Anatomically and histologically, it differs from the vaginal wall, which fuses with the deep layer of the hymeneal plate.

show abstract

Surgical anatomy of the vaginal introitus

Haylen

Wong

2022

Neurourology and Urodynamics

Self Cite

View full text Add to dashboard Cite

Aim The vaginal introitus is the entrance to the vagina, encompassing the anterior and posterior vestibules and the perineum. The surgical anatomy of the vaginal introitus, the lowest level of the vagina, has not been subject to a recent comprehensive examination and description. Vaginal introital surgery (perineorrhaphy) should be a key part of surgery for a majority of pelvic organ prolapse. Methods Cadaver studies were performed on the anterior and posterior vestibules and the perineum. Histological studies were performed on the excised perineal specimens of a cohort of 50 women undergoing perineorrhaphy. Included are pre‐ and postoperative studies which were performed on 50 women to determine the anatomical and histological changes achieved with a simple (anterior) perineorrhaphy. Results The vaginal introitus is equivalent to the Level III section of the vagina, measured posteriorly from the clitoris to the anterior perineum then down the perineum to the anal verge. The anterior and posterior vestibules, with nonkeratinizing epithelium, extend laterally to the keratinized epithelium of the labia minora (Hart's line). The anterior vestibule has six anatomical layers while the posterior vestibule has three. The perineum has an inverse trapezoid shape. Perineorrhaphy specimens were a mean 2.9 cm wide and 1.6 cm deep. They show squamous epithelium with loose underlying connective tissue. There were no important structures seen histologically, for example, ligaments or muscles. Microscopically, only 6 (12%) were completely normal with 44 (88%) showing minor changes including inflammation and scarring. Considerable anatomical benefits were achieved with such a perineorrhaphy including a 27.6% increase in the perineal length and a 30.8% reduction in the genital hiatus. Conclusion An understanding of the anatomy and histology of the vaginal introitus can assist with performing a simple and effective perineorrhaphy, the main surgical intervention at the vaginal introitus.

show abstract

Surgical anatomy of the vaginal introitus

Cited by 8 publications

References 17 publications

Surgical anatomy of the mid‐vagina

Surgical anatomy of the mid‐vagina

The vaginal outlet wall anatomy: A prospective case series study

Surgical anatomy of the vaginal introitus

Contact Info

Product

Resources

About