Surgical anatomy of the vaginal vault

Haylen, Bernard T.; Vu, Dzung

doi:10.1002/nau.24963

Cited by 4 publications

(10 citation statements)

References 18 publications

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“…We suggest the posterior wall is also inverse trapezoid in shape, narrow close to the hymen, and gradually widening up to the border with the VV (Figure 3). We support the theory 12 that this proximal widening is due, in part, to the influence of the VV supports, the cardinal and uterosacral ligaments (CL and USL) 2,12 and in part to the bulk of the cervix pre-hysterectomy.…”

Section: Gross Anatomy Of the MVsupporting

confidence: 82%

“…(A) (Left) 1 cystocele seemingly without major uterine or vaginal vault descent 1 ; (B) (Far right) 2 cystocele largely related to vaginal vault descent (NB cuff scar) 1,2 …”

Section: Anterior Mid‐vaginal Pop Assessment120— Cystocele12mentioning

confidence: 99%

“…The initial conclusion (from Table 1) is that the MV defects (Level II) are the smallest defects, provided the VV is reduced to its undisplaced position. 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.…”

Section: Surgical Aspects Of Posterior Mid‐vaginal Defectsmentioning

confidence: 99%

“…The surgical anatomy of the MV has not been recently subject to a comprehensive examination and description. The MV commences posteriorly at the lower end of the vaginal vault (VV), that is, 2.5 cm down the posterior wall from the vaginal apex in the posterior fornix 1,2 . It ends at the posterior aspect of the hymen, the latter included in Level II.…”

Section: Introductionmentioning

confidence: 99%

“…AVL is on average 6.1± 1.3 cm in women with normal support and lengthened in women with a cystocele 5 . As around 1.0–1.5 cm of the upper anterior vagina is involved in the makeup of the anterior fornix, that is, Level I vagina (VV 2 ), the effective anterior mid‐vaginal length (AMVL) would be close to 5.0 cm, similar to the PMVL.…”

Section: Introductionmentioning

confidence: 99%

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Surgical anatomy of the mid‐vagina

Haylen

Wong

et al. 2022

Neurourology and Urodynamics

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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.

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Section: Gross Anatomy Of the MVsupporting

confidence: 82%

“…(A) (Left) 1 cystocele seemingly without major uterine or vaginal vault descent 1 ; (B) (Far right) 2 cystocele largely related to vaginal vault descent (NB cuff scar) 1,2 …”

Section: Anterior Mid‐vaginal Pop Assessment120— Cystocele12mentioning

confidence: 99%

Section: Surgical Aspects Of Posterior Mid‐vaginal Defectsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Surgical anatomy of the mid‐vagina

Haylen

Wong

et al. 2022

Neurourology and Urodynamics

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Surgical anatomy of the vaginal vault

Haylen

2022

Neurourology and Urodynamics

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Aim: Vaginal vault (VV) surgery should be a key part of surgery for a majority of pelvic organ prolapse (POP). The surgical anatomy of the VV, the upper most part of the vagina, has not been recently subject to a dedicated examination and description.Methods: Cadaver studies were performed in (i) 10 unembalmed cadaveric pelves (observation); (ii) 2 unembalmed cadaveric pelves (dissection); (iii) 5 formalinized hemipelves (dissection). The structural outline and ligamentous supports of the VV were determined. Further confirmation of observations in post-hysterectomy patients were from a separate study on 300 consecutive POP repairs, 46% of whom had undergone prior hysterectomy. Results: The VV is equivalent to the Level I section of the vagina, measured posteriorly from the top of the posterior vaginal wall (apex or highest part of the vagina) to 2.5 cm below this point. It comprises the anterior fornix (through which cervix protrudes or is removed at hysterectomy), posterior fornix and two lateral fornices. Before hysterectomy, the posterior aspects of the cervix and upper vagina are supported by the uterosacral (USL) and cardinal ligaments (CL), the distal segments of which fuse together to form a cardinal-uterosacral ligament complex (cardinal utero-sacral complex), around 2-3 cm long. Post---hysterectomy, there is some residual USL support to the anterior fornix but the posterior fornix has no ligamentous support and is thus more vulnerable to prolapse. Conclusion:Effective management of VV prolapse will need to be part of most POP repairs. Enhanced understanding of the surgical anatomy of the vaginal vault allows more effective planning of those POP surgeries.

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Unveiling novel regulatory mechanisms of miR-5195-3p in pelvic organ prolapse pathogenesis

Zhang,

Wang,

Dong

et al. 2024

Biology of Reproduction

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Pelvic organ prolapse (POP) is a condition that significantly affects women’s quality of life. The pathological mechanism of POP is not yet fully understood, and its pathogenesis is often caused by multiple factors, including the metabolic imbalance of the extracellular matrix (ECM). This study aims to investigate the role of miR-5195-3p, a microRNA, in the pathology of POP and its regulatory mechanism. Using various molecular biology techniques such as qRT-PCR, FISH, immunohistochemistry, and western blot, miR-5195-3p expression was examined in vaginal wall tissues obtained from POP patients. Results revealed an up-regulation of miR-5195-3p expression in these tissues, showing a negative correlation with the expression of ECM-related proteins. Further analysis using bioinformatics tools identified LOX as a potential target in POP. Dual luciferase reporter gene experiments confirmed LOX as a direct target of miR-5195-3p. Interestingly, regulating the expression of LOX also influenced the TGF-β1 signaling pathway and had an impact on ECM metabolism. This finding suggests that miR-5195-3p controls ECM metabolism by targeting LOX and modulating the TGF-β1 signaling pathway. In conclusion, this study unveils the involvement of miR-5195-3p in the pathological mechanism of POP by regulating ECM metabolism through the LOX/TGF-β1 axis. These findings reveal new mechanisms in the pathogenesis of pelvic POP, providing a theoretical foundation and therapeutic targets for further research on POP treatment.

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Surgical anatomy of the vaginal vault

Cited by 4 publications

References 18 publications

Surgical anatomy of the mid‐vagina

Surgical anatomy of the mid‐vagina

Surgical anatomy of the vaginal vault

Unveiling novel regulatory mechanisms of miR-5195-3p in pelvic organ prolapse pathogenesis

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