Paravaginal defects: a comparison of clinical examination and 2D/3D ultrasound imaging

Dietz, Hans Peter; Pang, Selina M. W.; Korda, Andrew; Benness, Christopher

doi:10.1111/j.1479-828x.2005.00377.x

Cited by 40 publications

(20 citation statements)

References 16 publications

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“…Intraoperative identification of these defects is plagued with concerns of missing defects with vaginal assessment or creating iatrogenic defects when trying to assess the integrity of these tissues. In his comparison of clinical exam with ultrasound imaging of paravaginal defects, Dietz et al found poor correlations between the two and suggested the paravaginal defect “be regarded as an unproven concept.” [19] To date, we are not aware of other studies that have measured the degree of a paravaginal defect and widening of the vagina so that they could be compared between symptomatic and asymptomatic women.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2011

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Objective This study assesses relative contributions of "midline defects" (widening of the vagina) and "paravaginal defects" (separation of the lateral vagina from the pelvic sidewall). Methods Ten women with anterior predominant prolapse and 10 with normal support underwent pelvic MR imaging. 3-D models of the anterior vaginal wall (AVW) were generated to determine locations of the lateral AVW margin, vaginal width, and apical position. Results The lateral AVW margin was farther from its normal position in cases than controls throughout most of the vaginal length, most pronounced midvagina (effect sizes 2.2–2.8). Vaginal widths differed in the midvagina with an effect size of 1.0. Strong correlations between apical and paravaginal support were evident in mid and upper vagina (r=0.77–0.93). Conclusions Changes in lateral AVW location were considerably greater than changes in vaginal width in cases vs controls, both in number of sites affected and effect sizes. These "paravaginal defects" are highly correlated with apical descent.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2011

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“…The lateral attachments of the vagina at levels II and III makes the vagina appear H-shaped on the axial view [16,17,48,49]. In 2001, Ochsenbein did a study examining 40 women without a vaginal delivery (nulliparous or just after elective caesarean section) [48].…”

Section: Diagnosing a Paravaginal Defectmentioning

confidence: 99%

“…As alternatives, 2D and 3D translabial US techniques have been used. In 2005, Dietz published a paper describing the shape of the vagina in the axial plan using 3D translabial US [49]. These observations were based on the premise that the normal lateral support of the vagina to the ATFP was described as “tenting,” showing that the sulcus was lifted up towards the arcus (fig 7).…”

Section: Diagnosing a Paravaginal Defectmentioning

confidence: 99%

Paravaginal defect: anatomy, clinical findings, and imaging

et al. 2016

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Introduction and Hypothesis The paravaginal defect has been a topic of active discussion concerning 1) what it is; 2) how to diagnose it; 3) its role in anterior vaginal wall prolapse; and 4) if and how to repair it. The aim of this article is to review the existing literature on the paravaginal defect and to discuss its role in the anterior vaginal wall support system, with an emphasis on anatomy and imaging. Methods Articles related to paravaginal defects were identified through a PUBMED search ending July 1, 2015. Results The support of the anterior vaginal wall is a complex system involving the levator ani muscle, the arcus tendineus fascia pelvis (ATFP), the pubocervical fascia, and the uterosacral/cardinal ligaments. Studies conclude that physical examination is inconsistent in detecting paravaginal defects. Ultrasound (US) and magnetic resonance imaging (MRI) have been used to describe patterns in the appearance of the vagina and bladder when a paravaginal defect is suspected. Different terms have been used (e.g. “sagging of bladder base,” “loss of tenting”), which all represent changes in the support of the pelvic floor but which could be due to both paravaginal defects and levator ani defects. Conclusion Paravaginal support plays a role in the support of the anterior vaginal wall, but we still do not know the degree to which it contributes to the development of prolapse. Both MRI and US are useful in the diagnosis of paravaginal defects, but further studies are needed to evaluate their use.

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“…No studies have evaluated tenting or loss of tenting immediately after delivery. Dietz et al [24] reported the absence of tenting at rest in 32 of 57 patients (57 %), but this finding did not correlate with the [24]. Few studies have evaluated the association between the second stage of labor and LA defects, and the available results are conflicting.…”

Section: Discussionmentioning

confidence: 70%

Evaluation of labor-related pelvic floor changes 3 months after delivery: a 3D transperineal ultrasound study

Aydın

2015

Int Urogynecol J

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Changes in the levator hiatus could be transitional or persist over time. There were significant changes in levator hiatus measurements, levator thickness, levator defect incidence and loss of tenting rate between early postpartum and late postpartum. The head circumference of the fetus and the length of the first stage of labor are the shared and consistent factors that can be associated with pelvic floor trauma.

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Paravaginal defects: a comparison of clinical examination and 2D/3D ultrasound imaging

Cited by 40 publications

References 16 publications

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

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

Paravaginal defect: anatomy, clinical findings, and imaging

Evaluation of labor-related pelvic floor changes 3 months after delivery: a 3D transperineal ultrasound study

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