The distance between the perceived and the actual arcus tendineus fascia pelvis during vaginal paravaginal repair

Claydon, C Sage; Maccarone, Joseph L.; Grody, Marvin H. Terry; Steinberg, Adam C.; Oyama, Ian A.; Holzberg, Adam S.; Caraballo, Ricardo

doi:10.1016/j.ajog.2004.11.046

Cited by 2 publications

(2 citation statements)

References 14 publications

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“…Therefore, a tear or weakening in the middle of the pubocervical fascia would lead to a midline cystocele, whereas a tear in the lateral attachment of the pubocervical fascia to the ATFP could theoretically lead to a paravaginal cystocele. It is possible to palpate the ATFP during vaginal surgery or to visualize it during abdominal or laparoscopic surgery [8,24–25]. The continuity between the vagina and the ATFP can be seen on MRI, but this connection has not been demonstrated using US.…”

Section: Anatomymentioning

confidence: 99%

“…The Larson study [25] also showed that during Valsalva, the movements of the anterior wall primarily occurred along the length of the vagina and that the cystocele formation took place at levels II and III. This supports the theory that the connection between the lateral edges of the vagina and the ATPF in level II is crucial for normal support of the anterior wall.…”

Section: Anatomymentioning

confidence: 99%

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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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Section: Anatomymentioning

confidence: 99%

Section: Anatomymentioning

confidence: 99%