Normal Vaginal Axis

M, Funt; Thompson, John D.; Birch, Herbert G.

doi:10.1097/00007611-197812000-00026

Cited by 51 publications

(31 citation statements)

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“…Preoperatively, in our study the upper portions of the vagina were lying in a n almost horizontal plane, with a mean angle of 108 ~ ( Fig. 2A and B) between the upper and lower vaginal portions, which angle is smaller than the 130 ~ previously reported by Funt et al [7], reflecting the fact that our patients had no laxness in their uterosacral-cardinal complexes. After VH (Fig.…”

Section: Discussioncontrasting

confidence: 49%

“…The upper vagina lies above the rectum, which in turn lies upon the parallel to the levator plate. Funt et al [7] and DeLancey [8], also using vaginography, confirmed an angulated shape of the normal upper vagina in the upright as well as the supine position. Funt et al [7] also showed that the upper vaginal axis pointed just above the center of the fourth sacral vertebra and The topography of the vagina in relation to the pelvic floor and bony pelvis has also been studied by magnetic resonance imaging [9] and dynamic fluoroscopy [10], and are confirmed by ultrasound in the present study.…”

Section: Discussionmentioning

confidence: 86%

“…Funt et al [7] and DeLancey [8], also using vaginography, confirmed an angulated shape of the normal upper vagina in the upright as well as the supine position. Funt et al [7] also showed that the upper vaginal axis pointed just above the center of the fourth sacral vertebra and The topography of the vagina in relation to the pelvic floor and bony pelvis has also been studied by magnetic resonance imaging [9] and dynamic fluoroscopy [10], and are confirmed by ultrasound in the present study. Moreover, using pelvic dissection in 61 cadavers, DeLancey [11] noted that the upper third of the vagina is suspended from the pelvic walls by the vertical fibers of the paracolpium, a continuation of the uterosacral and cardinal ligaments.…”

Section: Discussionmentioning

confidence: 86%

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Vaginal axis after abdominal, vaginal and laparoscopic hysterectomy: A preliminary study with perineal ultrasonography using contrast medium

et al. 1996

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Fifteen consecutive women (mean age 44.5 years) without pelvic relaxation underwent total abdominal (5), vaginal (5) and laparoscopic (5) hysterectomy for benign disease. The vaginal axes of the patients were examined prior to and on average 7 weeks (range 3-10) after the operation with perineal ultrasonography enhanced with an ultrasound contrast medium (SHU454/Echovist-300). Transabdominal and vaginal hysterectomies were performed in the classic manner, i.e. the round as well as cardinal and sacrouterine ligaments were attached to the vaginal vault, followed by peritonealization. In laparoscopic hysterectomy the round, broad and outer parts of the uterosacral and the upper parts of the cardinal ligaments were desiccated by bipolar electrocoagulation and cut with laparoscopic scissors. The vagina was closed by interrupted sutures with no specific fixation of the round, cardinal or uterosacral ligaments. Preoperative ultrasound findings showed that in all women the vagina was an angulated organ. The mean preoperative angle between the upper and lower vaginal portions was 108 degrees, in both the supine and the standing positions. Postoperatively this angulated shape remained almost unchanged after vaginal (mean angle 117 degrees ) and laparoscopic hysterectomy (mean angle 130 degrees ), whereas after transabdominal hysterectomy the vaginal axis rotated anteriorly and became an almost straight tube (mean angle 158 degrees). We conclude that the vaginal axis, at least at an early stage after vaginal and laparoscopic hysterectomy remained in almost the same position as preoperatively, in contrast to that after abdominal hysterectomy. A tight attachment of the round ligaments to the vaginal vault in the abdominal approach could explain the outcome of transabdominal hysterectomy, and should be called into question.

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Section: Discussioncontrasting

confidence: 49%

Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 86%

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Vaginal axis after abdominal, vaginal and laparoscopic hysterectomy: A preliminary study with perineal ultrasonography using contrast medium

et al. 1996

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“…6). The levator plate sloped anteriorly and inferiorly from the pubococcygeal line at a mean angle of 178 (range 8-24) in nulliparous controls, 178 (14)(15)(16)(17)(18)(19)(20)(21)(22) in multiparous controls, 218 (20-22) in the vaginal repair group, and 238 (20-30) in the abdominal repair group (Fig. 6).…”

Section: Resultsmentioning

confidence: 98%

Vaginal Configuration on MRI after Abdominal Sacrocolpopexy and Sacrospinous Ligament Suspension

et al. 2001

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An MRI study was conducted to compare the vaginal configuration of women who had undergone sacrospinous fixation with transvaginal needle suspension or abdominal sacrocolpopexy with retropubic colposuspension with that of normal controls. MRI examination demonstrated that in normal controls the lower vagina formed an acute angle (mean 53 degrees) with the pubococcygeal line and intersected the upper vagina at a mean angle of 145 degrees. In the abdominal repair group the lower vagina intersected the pubococcygeal line at a mean angle of 57 degrees and joined the upper segment at a mean angle of 137 degrees. In the vaginal repair group the lower vagina intersected the pubococcygeal line at a mean angle of 54 degrees and joined the upper segment at a mean angle of 220 degrees. Our study demonstrated that abdominal sacrocolpopexy with retropubic colposuspension more closely restored the vagina to its normal configuration, whereas sacrospinous fixation with transvaginal needle suspension creates an abnormal vaginal axis.

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“…Die Scheide der gesunden Frau liegt in fast horizontaler Position mit diskreter Perinealkrü mmung der unpaaren dorsalen Levatorplatte auf [10]. Der funktionstü chtige Levator und ein intakter Aufhä ngeapparat setzt bei Erhö hung des Intraabdominaldruckes dem Tiefertreten der Vagina Widerstand entgegen und verhindert den Vorfall [28].…”

Section: Pathophysiologische ü Berlegungen Zur Scheidenstumpffixationunclassified

Die operative Therapie des Scheidenblindsackvorfalls

1996

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Es besteht heute weitgehende Einigkeit darin, daß bei der Behandlung ausgedehnter Deszensus-und Prolapszustä nde der Erhalt der Vagina ganz im Vordergrund stehen muß. Kolpokleisis oder Kolpektomie sind, selbst wenn Kohabitationen postoperativ nicht mehr erwartet werden, hö chst unbefriedigende Alternativen. Sie beeinträ chtigen das sexuelle Integritä tsgefü hl auch der ä lteren Frau. Auch die Tatsache, daß Streß-harninkontinenz nach Verschluß oder Entfernung der Vagina kaum noch behandelbar ist, spricht fü r ein organerhaltendes Vorgehen. Die perioperativen Morbiditä ts-und Mortalitä tsraten geriatrischer Patientinnen unterscheiden sich nicht von denen jü ngerer Altersgruppen und dü rfen daher nicht als Argument gegen organerhaltende Operationen herangezogen werden.Zur operativen Behandlung des prolabierten Scheidenblindsackes wurden zahlreiche abdominale und vaginale Methoden beschrieben. Sie werden unterschiedlich begrü ndet und sind hinsichtlich der langfristigen Fixierung des Scheidenstumpfs ä hnlich erfolgreich. Die Operationsqualitä t wird durch folgende wichtige Erfolgsparameter bestimmt: die Beseitigung der Beschwerden, die Herstellung einer normalen Blasen-und Darmfunktion und der Erhalt der Vagina.Im folgenden Kapitel werden Technik und Resultate der abdominalen Sakrokolpopexie als Alternative zur vaginalen sakrospinalen Fixation beschrieben. Pathophysiologische Ü berlegungen zur ScheidenstumpffixationDie Scheide der gesunden Frau liegt in fast horizontaler Position mit diskreter Perinealkrü mmung der unpaaren dorsalen Levatorplatte auf [10]. Der funktionstü chtige Levator und ein intakter Aufhä ngeapparat setzt bei Erhö hung des Intraabdominaldruckes dem Tiefertreten der Vagina Widerstand entgegen und verhindert den Vorfall [28]. Geburten, chronische Beckenbodenbelastung und angeborene Bindegewebeschwä-che kö nnen diesen Mechanismus schä digen: der Hiatus genitalis weitet sich, die Aufhä ngestrukturen der Vagina werden schwach und funktionsuntü chtig. DeLancey hat dies durch anatomische Studien belegen kö nnen [5]. Große Enterozelen und Scheidenstumpfvorfall kö nnen das Resultat eines chronisch gesteigerten Intraabdominaldruckes, der den Douglas-Raums zunehmend nach kaudal ausweitet und/oder eines defekten Halteapparat der Vagina sein, der auch dem normalen intraabdominalen Druck nicht gewachsen ist. 652 Z U M T H E M A Zusammenfassung Die abdominale Sakrokolpopexie ist eine erfolgreiche Operation zur dauerhaften Verankerung des prolabierten Scheidenstumpfs. Die Fixation sollte mö glichst tief in der Sakralhö hle (S 3-4) erfolgen, um eine physiologische Lage der Scheide auf der dorsalen unpaaren Levatorplatte zu erreichen. Sie beseitigt die Beschwerden, stellt die Anatomie wieder her und erhält die Funktion der Vagina. Unabhängig vom verwendeten Interponatmaterial (synthetisch, allogen oder autogen) ist die Rezidivrate gering. Intraoperative Komplikationen und postoperative Funktionsstö rungen des Darms sind selten. Die postoperativen Harninkontinenzrezidivraten schwanken zwischen 0 und 26 %, die De-no...

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Normal Vaginal Axis

Cited by 51 publications

References 0 publications

Vaginal axis after abdominal, vaginal and laparoscopic hysterectomy: A preliminary study with perineal ultrasonography using contrast medium

Vaginal axis after abdominal, vaginal and laparoscopic hysterectomy: A preliminary study with perineal ultrasonography using contrast medium

Vaginal Configuration on MRI after Abdominal Sacrocolpopexy and Sacrospinous Ligament Suspension

Die operative Therapie des Scheidenblindsackvorfalls

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