3D analysis of cystoceles using magnetic resonance imaging assessing midline, paravaginal, and apical defects

Larson, Kindra; Luo, Jiajia; Guire, Kenneth E.; Chen, Luyun; Ashton‐Miller, James A.; DeLancey, John O.L.

doi:10.1007/s00192-011-1586-x

Cited by 55 publications

(34 citation statements)

References 24 publications

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“…This reduces the forces placed on the pelvic supportive tissues and can improve anterior vaginal wall support. The fact that the exposed vaginal wall is subjected to forces that in a normal position it is not exposed to may help to explain why the vaginal wall is somewhat wider and longer than normal [19, 27]. The degree to which this occurs may be related to variations that exist in the mechanical properties of the vaginal wall [28, 29].…”

Section: Discussionmentioning

confidence: 99%

The length of anterior vaginal wall exposed to external pressure on maximal straining MRI: relationship to urogenital hiatus diameter, and apical and bladder location

et al. 2014

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Introduction and hypothesis In cystoceles, the distal anterior vaginal wall (AVW) bulges out through the introitus and is no longer in contact with the posterior vaginal wall or perineal body, exposing the pressure differential between intra-abdominal pressure and atmospheric pressure. The goal of this study is to quantify the length of the exposed vaginal wall length and to investigate its relationship with other factors associated with the AVW support, such as most dependent bladder location, apical location, and hiatus diameter, demonstrating its key role in cystocele formation. Methods Fifty women were selected to represent a full spectrum of AVW support. Each underwent supine, dynamic MR imaging. Most dependent bladder location and apical location were measured relative to the average normal position on the mid-sagittal plane using the Pelvic Inclination Correction System . The length of the exposed AVW and the hiatus diameter were measured as well. The relationship between exposed AVW and most dependent bladder location, apical location, and hiatus diameter were examined. Results A bilinear relationship has been observed between exposed vaginal wall length and most dependent bladder location (R2=0.91, P<0.001). When the bladder descents up to the inflection point (about 4.4 cm away from its normal position), there is little change in the exposed AVW length. With further descent, the exposed vaginal wall length increases significantly, with a 2 cm increase in exposed AVW length for every additional 1 cm of drop bladder location. A similar but weaker bilinear relationship exists between exposed AVW and apical location. Exposed vaginal wall length is also highly correlated with hiatus diameter (R2=0.85, P<0.001). Conclusion A bilinear relationship exists between exposed vaginal wall length and most dependent bladder location and apical location. It is when the bladder descent is beyond the inflection point that exposed vaginal wall length increases significantly.

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Section: Discussionmentioning

confidence: 99%

The length of anterior vaginal wall exposed to external pressure on maximal straining MRI: relationship to urogenital hiatus diameter, and apical and bladder location

et al. 2014

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“…The underlying pathomechanics of cystocele, or anterior compartment prolapse, have begun to receive attention in terms of the associated geometric changes (Hsu et al, 2008a; Larson et al, 2010a; Larson et al, 2012a) as well as putative biomechanical changes (Chen et al, 2009). A knowledge gap remains, however, as to how and why a prolapse of the posterior compartment, a rectocele, forms.…”

Section: Introductionmentioning

confidence: 99%

A multi-compartment 3-D finite element model of rectocele and its interaction with cystocele

Luo

Chen

Fenner

et al. 2015

Journal of Biomechanics

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We developed a subject-specific 3-D finite element model to understand the mechanics underlying formation of female pelvic organ prolapse, specifically a rectocele and its interaction with a cystocele. The model was created from MRI 3-D geometry of a healthy 45 year-old multiparous woman. It included anterior and posterior vaginal walls, levator ani muscle, cardinal and uterosacral ligaments, anterior and posterior arcus tendineus fascia pelvis, arcus tendineus levator ani, perineal body, perineal membrane and anal sphincter. Material properties were mostly from the literature. Tissue impairment was modeled as decreased tissue stiffness based on previous clinical studies. Model equations were solved using Abaqus v 6.11. The sensitivity of anterior and posterior vaginal wall geometry was calculated for different combinations tissue impairments under increasing intraabdominal pressure. Prolapse size was reported as POP-Q point at point Bp for rectocele and point Ba for cystocele. Results show that a rectocele resulted from impairments of the levator ani and posterior compartment support. For 20% levator and 85% posterior support impairments, simulated rectocele size (at POP-Q point: Bp) increased 0.29 mm/cm H2O without apical impairment and 0.36 mm/cm H2O with 60% apical impairment, as intraabdominal pressures increased from 0 to 150 cm H2O. Apical support impairment could result in the development of either a cystocele or rectocele. Simulated repair of posterior compartment support decreased rectocele but increased a preexisting cystocele. We conclude that development of rectocele and cystocele depend on the presence of anterior, posterior, levator and/or or apical support impairments, as well as the interaction of the prolapse with the opposing compartment.

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“…The use of 3-dimensional ultrasound to assess the configuration of the genital hiatus and continuity of the levator muscle has been described [22,24,84]. In addition to the pelvic floor muscle, detailed images of the urethra and vagina are technically feasible with MRI, to assess for morphologic alterations in their associated support structures [85][86][87][88][89][90][91].…”

Section: Pelvic Floor Integritymentioning

confidence: 99%

ACR Appropriateness Criteria Pelvic Floor Dysfunction

Pannu

Javitt

Glanc

et al. 2015

Journal of the American College of Radiology

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3D analysis of cystoceles using magnetic resonance imaging assessing midline, paravaginal, and apical defects

Cited by 55 publications

References 24 publications

The length of anterior vaginal wall exposed to external pressure on maximal straining MRI: relationship to urogenital hiatus diameter, and apical and bladder location

The length of anterior vaginal wall exposed to external pressure on maximal straining MRI: relationship to urogenital hiatus diameter, and apical and bladder location

A multi-compartment 3-D finite element model of rectocele and its interaction with cystocele

ACR Appropriateness Criteria Pelvic Floor Dysfunction

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