Pelvic architectural distortion is associated with pelvic organ prolapse

Abstract

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.

Prevalence of pubovisceral muscle avulsion in a general gynecology cohort: A computed tomography (CT) study

“…Another explanation could be that birth related injuries may result in an architectural distortion of the pubovisceral muscle attachment to the pubic bone, without necessarily an avulsion. 16 The connective tissue and muscular component of the supportive structures of the pelvic floor are subject to such distortion at the time of extreme loading such as that of the time of delivery.…”

Paravaginal defect: anatomy, clinical findings, and imaging

“…The abnormal appearance of pelvic sidewall tissues at the level of the vesical neck was called “architectural distortion” by Huebner [53] in 2009. This was defined as lateral “spill” of the vagina in the axial plane beyond the normal location (fig 9).…”

Measurement of the 3D geometry of the fascial arches in women with a unilateral levator defect and “architectural distortion”

“…For example, a pattern of soft tissue abnormality termed “architectural distortion,” or AD, was recently described in which the lateral vaginal wall is seen to extend beyond its normal location, appearing to contact the obturator internus muscle [10]. Women with AD are more likely (78%) to have anterior wall prolapse than both women with levator defects but no AD (61%), as well as those with normal levators and no AD (31%) [10].…”

“…For example, a pattern of soft tissue abnormality termed “architectural distortion,” or AD, was recently described in which the lateral vaginal wall is seen to extend beyond its normal location, appearing to contact the obturator internus muscle [10]. Women with AD are more likely (78%) to have anterior wall prolapse than both women with levator defects but no AD (61%), as well as those with normal levators and no AD (31%) [10]. This distortion occurs in a structurally important region of anterior vaginal wall support at the interconnection between three key support structures: 1) the arcus tendineus fascia pelvis, or fascial arch; 2) arcus tendineus levator ani, or levator arch; and 3) the pubic portion of the levator ani muscle.…”