Graphic integration of causal factors of pelvic floor disorders: an integrated life span model

DeLancey, John O.L.; Low, Lisa Kane; Miller, Josef M.; Patel, Divya; Tumbarello, Julie

doi:10.1016/j.ajog.2008.04.001

Cited by 193 publications

(145 citation statements)

References 6 publications

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“…4 The pathophysiological model of UI is based on a genetically predetermined functional continence reserve, which decreases with both age and injuries to the pelvic floor. 5 Epidemiological studies indicate that risk factors for UI are age, parity, previous pelvic or perineal surgery, obesity and chronic diseases. [6][7][8][9][10][11] More recently, a report that major depression may be involved in the onset of UI has opened up the field to new pathophysiological hypotheses.…”

Section: Introductionmentioning

confidence: 99%

Incidence and remission of urinary incontinence at midlife: a cohort study

Legendre

Ringa

Panjo

et al. 2014

BJOG

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Objective Urinary incontinence (UI) is often considered to be an age-related disease that develops gradually as women grow older. Much remains to be learnt about factors that promote its incidence or its remission. Our objective was to assess its incidence and risk factors.Design Longitudinal cohort study.Setting French GAZEL cohort.Population A cohort of 4127 middle-aged women (aged 47-52 years at baseline) over an 18-year period (1990-2008).Methods UI was defined as 'difficulty retaining urine'. The question was asked at baseline and repeated every 3 years over an 18-year period. Two groups (UI incidence and remission) were analysed according to status at baseline (continent or incontinent). A multivariable analysis (Cox model) was used to estimate the risk factors for UI incidence and remission.Main outcome measures Annual incidence and remission rates and risk factors for UI incidence and remission.Results The annual incidence and remission rates for UI were 3.3% and 6.2%, respectively. High educational level (hazard ratio[HR] = 1.28; 95% confidence interval [95% CI] = 1.05-1.55), parity, i.e. at least one baby versus no baby (HR = 1.64; 95% CI = 1.19-2.27), menopause (HR = 5.44; 95% CI = 4.47-6.63), weight gain, i.e. for each kilogram change in weight (HR = 1.00; 95% CI = 1.00-1.02), onset of depressive symptoms (HR = 1.31; 95% CI = 1.09-1.57) and impairment in health-related quality of life incidence (social isolation dimension [HR = 1.29; 95% CI = 1.04-1.60] and energy dimension [HR = 1.41; 95% CI = 1.17-1.70]) were associated with an increased probability of UI. The factors associated with persistent UI were age (HR = 0.58; 95% CI = 0.55-0.61), weight gain (HR = 0.99; 95% CI = 0.98-0.99) and transition to menopausal status (HR = 1.54; 95% CI = 1.19-1.99).Conclusions Our study suggests that, in our population of middleaged women, age, menopause, weight gain, onset of depression and impaired health-related quality of life may promote UI.

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Section: Introductionmentioning

confidence: 99%

Incidence and remission of urinary incontinence at midlife: a cohort study

Legendre

Ringa

Panjo

et al. 2014

BJOG

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“…In 1970, Nichols et al [10] were able to identify a definitive anatomical and histological facial structure between the rectum and vagina in all dissections. Delancey [11,12] confirmed the fibers of rectovaginal septum ran vertically and blended with the muscular wall of the vagina. He also demonstrated the presence of some other posterior vaginal wall supporting structures which include the endopelvic facia, levator anti muscle and perineal membrane.…”

Section: Discussionmentioning

confidence: 99%

Measuring the space between vagina and rectum as it relates to rectocele

Liu¹,

Zhai²,

Li³

et al. 2009

WJG

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AIM:To measure the normal space between the posterior wall of the vagina and the anterior wall of the respectively rectum using computed tomography (CT) and reveal its were relationship to rectocele. METHODS:A total of twenty female volunteers without rectocele were examined by CT scan. We performed a middle level continuous horizontal pelvic scan from the upper part to the lower part and collected the measurement data to analyze the results using t -test. RESULTS:Twenty volunteers were enrolled in the study. The space between the posterior wall of the vagina and the anterior wall of the rectum was measured at three levels (upper 1/3, middle, lower 1/3 level of vagina). The results showed that the space from the posterior wall of the vagina to the anterior wall of the rectum at the upper 1/3 level and the middle level was 3.896 ± 0.3617 mm and 4.6575 ± 0.3052 mm, respectively. When the two groups of data were compared, we found the space at the upper 1/3 level was shorter than at the middle level (P < 0.01). Moreover, at the lower 1/3 level the space measured was 10.058 ± 0.4534 mm. The results revealed that the space at the lower 1/3 level was longer than that at the middle level (P < 0.01). CONCLUSION:These measurement data may be helpful in assessing rectocele clinical diagnosis and functional outcomes of rectocele repair.

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“…Level II attaches the mid-vagina laterally to the arcus tendineus fascia. Level III is fusion of the lower third of the vagina to the perineal body posteriorly, perineal membrane and urethra anteriorly and levator ani muscles laterally (12). Loss of level I support results in uterine and vault prolapse while loss of level II support results in cystocele and rectocele (10).…”

Section: Discussionmentioning

confidence: 99%

Sacrospinous Ligament Fixation – A Malaysian’s Tertiary Centre Experience

Latip¹,

Ng²

2017

JSA

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During the study period from January 2008 to December 2012, 177 women had transvaginal sacrospinous ligament fixation (SSF) for vault suspension at General Hospital Kuala Lumpur. Of the 177 women, 133 (75.1%) had severe uterovaginal prolapse while 44 (24.9%) had post-hysterectomy vault prolapse. All patients with severe uterovaginal prolapse and rectocele undergone vaginal hysterectomy and posterior colporrhaphy respectively. A hundred and seventy-four patients (98.3%) had anterior repair whilst 48 (27.1%) received midurethral sling as concomitant procedure to vault suspension (SSF). The mean duration of surgery was 92.1±30.2 minutes and the mean estimated blood loss was 319±199.3mls. There was no surgical mortality. Two patients (1.1%) had rectal injuries. No patient had bladder injury or de novo urinary symptoms. The commonest immediate postoperative complications was fever (98; 55.4%) followed by buttock pain in 18 (10.2%) patients. Both complications were resolved with conservative measures. Seven patients (3.9%) had sutures erosion as late complications. Of the 177 women, 158 (89.3%) and 141 (79.7%) came for the 6 and 12 months follow-up, respectively. The success rate for all three compartments ranged from 92.4% to 98.1% at 6 months and reduced to range from 85.7% to 94.4% at 12 months. The highest success rate was observed in the posterior compartment followed by apical and anterior compartment. Equally, the recurrence rate was lowest in the posterior compartment (1.9%), followed by the central (3.8%) and anterior compartment (7.5%) at 6 months' review. This increased to 5.7% for rectocele, 7.8% for vault prolapse and 14.2% for cystocele at 12 months' follow-up. None had repeated surgery for prolapse recurrence during the study period. In conclusion, SSF remains a high priority in our therapeutic regime for the treatment of severe uterovaginal and vault prolapse as it has a reasonably good success rate with lower serious complications in the skillful hands.

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Graphic integration of causal factors of pelvic floor disorders: an integrated life span model

Cited by 193 publications

References 6 publications

Incidence and remission of urinary incontinence at midlife: a cohort study

Incidence and remission of urinary incontinence at midlife: a cohort study

Measuring the space between vagina and rectum as it relates to rectocele

Sacrospinous Ligament Fixation – A Malaysian’s Tertiary Centre Experience

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