Three-dimensional magnetic resonance imaging assessment of levator ani morphologic features in different grades of prolapse

Singh, Kavita; Jakab, Marianna; Reid, Wendy; Berger, Leslie; Hoyte, Lennox

doi:10.1067/mob.2003.254

Cited by 125 publications

(100 citation statements)

References 18 publications

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“…However, additional studies have confirmed the anatomical correctness of the MR portrayal of the pubovisceral muscle, and validated the same defects by comparisons with expected clinical findings such as higher rates of defects in women with prolapse [Hoyte et al, 2001, Singh et al, 2003 Further work is suggested to determine if physical examination techniques in others' hands can achieve results that minimize the rate of false negatives that we obtained. Obstetricians and gynecologists examine many nulliparous women that provide a healthy sample of women for all interested clinicians to become familiar with the normal configuration of this muscle and become experienced in its assessment.…”

Section: Discussionsupporting

confidence: 60%

Interrater reliability and physical examination of the pubovisceral portion of the levator ani muscle, validity comparisons using MR imaging

Kearney

Miller

DeLancey

2005

Neurourology and Urodynamics

116

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Aims-Defects in the pubovisceral portion of the levator ani muscle are seen with MR imaging. This study aims to determine interrater reliability of physical examination in detecting these defects, and to validate findings from physical examination using comparisons with MR images Methods-Two examiners palpated the pubovisceral muscles of 29 women to assess for defects in this muscle. Each examiner was blinded to the others findings. MR scans were acquired on a further 24 women after structured clinical examination by one examiner. These images were read to determine pubovisceral muscle defects, blinded to patient identifiers. Agreement between raters and between MR imaging and clinical examination were calculated.Results-The two examiners had positive agreement (presence of a defect) of 72.7% and negative agreement (absence of a defect) of 83.3%. The positive agreement between physical examination and MR imaging was 27.3% and the negative agreement 86.5% Conclusion-The structured physical examination to detect defects in the pubovisceral portion of the levator ani muscle can be learned as shown by good interrater agreement. However, examination alone underestimates these defects compared with MR imaging.

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Section: Discussionsupporting

confidence: 60%

Interrater reliability and physical examination of the pubovisceral portion of the levator ani muscle, validity comparisons using MR imaging

Kearney

Miller

DeLancey

2005

Neurourology and Urodynamics

116

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show abstract

“…To define avulsion in any given slice, we use the term 'abnormal insertion' rather than 'absence of muscle' on ultrasound imaging since it is not uncommon to see scar tissue connecting the retracted muscle to the sidewall, lateral to the original insertion, which could be misinterpreted as 'attachment'. In doubtful cases, we utilise the 'levator urethra gap (LUG) measurement' [21], which is a sonographic equivalent to the 'levator symphysis gap' [22] used on MR imaging. An insertion is regarded as abnormal when the LUG is over 2.5 cm as illustrated in Fig.…”

Section: Methodsmentioning

confidence: 99%

Minimal criteria for the diagnosis of avulsion of the puborectalis muscle by tomographic ultrasound

et al. 2010

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Introduction and hypothesis Puborectalis avulsion is a likely etiological factor for female pelvic organ prolapse (FPOP). We performed a study to establish minimal sonographic criteria for the diagnosis of avulsion. Methods We analysed datasets of 764 women seen at a urogynecological service. Offline analysis of ultrasound datasets was performed blinded to patient data. Tomographic ultrasound imaging (TUI) was used to diagnose avulsion of the puborectalis muscle.

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“…The uterosacral ligaments have long been regarded as a part of the support system for the pelvic organs [10]. Nichols, in his book on vaginal surgery, expressed the widely held opinion that the uterosacral ligaments, together with the cardinal ligament, hold the upper vagina and cervix over the levator plate [11].…”

Section: Discussionmentioning

confidence: 99%

Robotic Assisted Laparoscopic Apical Suspension. Description of a 4 Points Technique (RALAS-4): First Case Reported

Davila¹,

Bruce²,

Goodman³

et al. 2017

OJOG

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The uterosacral ligaments (UTSL), together with the cardinal ligament (CL), hold the upper vagina and cervix over the levator plate. These 2 ligaments provided 4 points support at the apex. Here we describe our surgical technique of robotic assisted laparoscopic apical suspension (RALAS) using nonabsorbable sutures and describe a new 4 points technique (RALAS-4). 73-year-old Caucasian woman, gravida 5, para 4 had symptomatic pelvic organ prolapse (POP) apical/anterior stage III. At pelvic ultrasound evaluation the uterus was small and normal appearing of adnexa bilaterally. She failed pessaries and was sexually active. The most relevant complaints were vaginal bulging, pressure and urinary incontinence, mainly stress urinary incontinence; she is using 5 -7 pads/day. Robotic assisted laparoscopic hysterectomy, mid-urthral sling and apical suspension was successfully performed in 125 min. Once we finished with hysterectomy, we proceed with RALAS-4, we used V-Loc 3-0, CV-23 (Covidien) sutures (absorbable) on the right and left uterosacral ligaments (2 points) and theses were reinforced with Gore-Tex 2-0, CV-2 (non-absorbable, Gore Medical). On the right/left anterior apical support we used Gore-Tex 2-0 and these provided the 2 point suspension (UTLS = 2 and anterior vagina = 2). The 2 anterior apical support sutures are taken from the vagina to the transversalis fascia and the obliterated umbilical artery on the anterior abdominal wall. The tension of these anterior sutures was maintained with Hem-o-lock (TeleFlex) and LAPRA-TY (Ethicon). In our opinion RALAS-4 may represents an alternative to robotic or laparoscopic sacrocolpopexy. This new approach simulate the natural 4 points support given by uterosacral ligaments and cardinal ligament, with the additional benefit of

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Three-dimensional magnetic resonance imaging assessment of levator ani morphologic features in different grades of prolapse

Cited by 125 publications

References 18 publications

Interrater reliability and physical examination of the pubovisceral portion of the levator ani muscle, validity comparisons using MR imaging

Interrater reliability and physical examination of the pubovisceral portion of the levator ani muscle, validity comparisons using MR imaging

Minimal criteria for the diagnosis of avulsion of the puborectalis muscle by tomographic ultrasound

Robotic Assisted Laparoscopic Apical Suspension. Description of a 4 Points Technique (RALAS-4): First Case Reported

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