The variation in published failure rates after sacrospinous ligament fixation is, in part, accounted for by differences in how anatomical outcomes are evaluated and which compartment of vaginal support is being considered. Failure rates are highest in the anterior compartment.

This RCT shows significant improvement in patients' quality of life for conservative therapy of SUI. Differences between the three therapeutic options analyzed could not be found. Additional ES showed no benefit for patients with SUI, capable of voluntary pelvic floor contraction.

Due to a lack of well-designed prospective randomized trials, recommendations for using graft materials in vaginal reconstructive surgery cannot be made. At this time, grafts should have limited use in a carefully selected patient population.

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The aim of this study was to determine whether there is an association between architectural distortion seen on magnetic resonance (MR) scans (lateral "spill" of the vagina and posterior extension of the space of Retzius) and pelvic organ prolapse. Secondary analysis of MR imaging scans from a case-control study of women with prolapse (maximum point > or = + 1 cm; N = 144) and normal controls (maximum point < or = -1 cm; N= 126) was done. Two independent investigators, blinded to prolapse status and previously established levator-defect scores, determined the presence of architectural distortion on axial MR scans. Women were categorized into three groups based on levator defects and architectural distortion. Among the three groups, women with levator defects and architectural distortion have the highest proportion of prolapse (78%; p < 0.001). Among women with levator defects, those with prolapse had an odds ratio of 2.2 for the presence of architectural distortion (95% CI = 1.1-4.6). Pelvic organ prolapse is associated with the presence of visible architectural distortion on MR scans.

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OBJECTIVE-This project sought to identify and to describe the anatomical connections affected by levator ani defects involving the pubovisceral portion of the muscle.STUDY DESIGN-Fourteen magnetic resonance scans of women with unilateral levator defects were selected. The missing muscle mapping technique was used to characterize the absent muscle. Normal muscle was visualized and compared with the contralateral side. Using a three-dimensional slicer, the outline of the intact muscle was traced; models of this muscle and surrounding structures were generated. RESULTS-The missing muscle originates from the posterior pubic bone and extends laterally over the obturator internus muscle; it inserts into the vaginal wall, perineal body, and the intersphincteric space. Architectural distortion, with an asymmetric lateral spilling of the vagina was present in 50% of women. The defect was right sided in 71% of patients. CONCLUSION-The origin and insertion points of the damaged portion of the levator ani muscle were identified.Keywords levator ani defects; magnetic resonance; missing muscle mapping; pubovisceral Pelvic organ prolapse (POP) is a prevalent condition, with more than 200,000 inpatient procedures performed each year in the United States. 1 An association between abnormalities in the levator ani and prolapse has been established. 2 Recently it has become possible to visualize each component of the levator ani on magnetic resonance (MR) scans, 3 namely, the pubovisceral (further subdivided into pubovaginal, puboperineal, and puboanal), the puborectal, and the iliococcygeal subdivisions and their separate attachments. Each portion of this complex muscle has a unique origin-insertion pair that establishes its unique mechanical line of action. Damage to a specific portion of a muscle would be expected to result in loss of that force vector.Our objective in this project was to determine: (1) the specific subdivision of the levator ani muscle that is affected by damage and (2) to identify the origin and insertion points, as well as the medial and lateral points of attachment, of the damaged portion of the levator ani muscle. Materials and MethodsOur existing database of 676 pelvic MR scans was queried to select for all subjects with unilateral levator defects. Women with unilateral defects were chosen to study and compare normal and abnormal muscles in the same individual. The database consists of scans made of All women underwent magnetic resonance imaging (MRI) of the pelvic floor using proton density T-2-weighted scans; 2-dimensional fast spin proton density MR scans were performed at 5 mm intervals in the axial, sagittal, and coronal planes in the supine position using a 1.5 Tesla superconducting magnet (Signa; General Electric Medical Systems, Milwaukee, WI). In addition, a pelvic examination to evaluate prolapse and a multichannel urodynamic evaluation were performed. The mean age of the subjects in our database was 46.4 years (SD 15.4), mean body mass index (BMI) was 26.3 kg/m 2 (SD 5.5), and mean parit...

Objective To assess the repeatability of crown-rump length (CRL)