The feasibility of uterine-vaginal axis MRI-based as evaluation of surgical efficacy in women with pelvic organ prolapse

Wang, Haifeng; Shen, Jihong; Li, Song; Gao, Zhenhua; Ke, Kunbin; Gu, Ping

doi:10.21037/atm-22-1173

Cited by 5 publications

(2 citation statements)

References 24 publications

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“…The study also found that “the uterus is retroverted…in patients with pelvic organ prolapse” [ 12 ]. A similar study found a statistically significant increase ( p < 0.05) in posterior rotation of the uterus in women with prolapse compared to women without prolapse [ 23 ]. These studies provide some additional support for an association of uterine prolapse with uterine retroversion but do not establish that prolapse was caused by retroversion.…”

Section: Discussionmentioning

confidence: 97%

Alignment of the Cervix with the Vagina in Uterine Retroversion: A Possible Risk Factor in Uterine Prolapse

et al. 2022

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Multiple observational studies have found an association of uterine prolapse with uterine retroversion. Mechanisms proposed to explain this apparent association assume that the cervix of a retroverted uterus will usually insert at the apex of the vagina, with resultant alignment of the cervix with the vagina. The angle of the axis of the cervix with the axis of the vagina was measured by two readers on 323 sagittal pelvic MRI scans and sagittal reconstructions of pelvic CT scans performed for clinical purposes. One reader observed and recorded the anatomic relations of the uterus that differed by insertion site and version: 44 of 49 retroverted uteri (89.8%) inserted at the vaginal apex, and 13 of 274 anteverted uteri (4.7%) inserted at the vaginal apex. This difference was found to be statistically significant (p < 0.05) by the Chi square test. The urinary bladder, vaginal walls, and rectum were inferiorly related to anteriorly inserted anteverted uteri. Only the vaginal lumen and the rectum at a shallow oblique angle were inferiorly related to apically inserted retroverted uteri. Most retroverted uteri insert at the apex of the vagina. Apically inserted retroverted uteri appear to receive less support from adjacent structures than anteriorly inserted anteverted uteri.

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Section: Discussionmentioning

confidence: 97%

Alignment of the Cervix with the Vagina in Uterine Retroversion: A Possible Risk Factor in Uterine Prolapse

et al. 2022

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“…Furthermore, the different levels of impairment and surgical reconstruction on the biomechanical characteristics of the pelvic floor system under multifactorial impairments are not yet understood. We have conducted related studies previously: (1) POP may be associated with mechanical imbalance and loss of physiological structural features of the pelvic floor by analyzing the rules of physiological angles from MR images ( Li et al, 2022a ; Wang et al, 2022 ); (2) the occurrence of POP may also be closely associated with the impairment of the supporting structures and disruption of the biomechanical equilibrium of the pelvic floor, and the biomechanics of the normal physiological state pelvic floor in the presence of single-organ impairment are discussed ( Xie et al, 2023 ); and (3) the biomechanical mechanism of impairment and the pathogenesis of POP are investigated during the gradual evolution from the normal physiological structural state to the prolapse pathological state of the pelvic floor ( Xue et al, 2023 ). However, we have not investigated the multifactorial impairment of the pelvic floor and the biomechanical mechanisms of clinical repair and reconstruction surgery.…”

Section: Introductionmentioning

confidence: 99%

The influence of the combined impairments and apical mesh surgery on the biomechanical behavior of the pelvic floor system

Xue,

Zheng,

Gao

et al. 2024

Front. Bioeng. Biotechnol.

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Objective: The prolapse mechanism of multifactorial impairment of the female pelvic floor system and the mechanics of the pelvic floor after apical suspension surgery are not yet understood, so we developed biomechanical models of the pelvic floor for the normal physiological state (0°) and 90° pathological state.Methods: Under different types and levels of the impairments and uterosacral suspensions, the possible changes in the morphometric characteristics and the mechanical characteristics of suspension and support functions were simulated based on the biomechanical models of the pelvic floor.Results: After the combined impairments, the descending displacement of the pelvic floor cervix and the stress and displacement of the perineal body reached maximum values. After surgical mesh implantation, the stresses of the normal pelvic floor were concentrated on the uterine fundus, cervix, and top of the bladder and the stresses of the 90° pathological state pelvic floor were concentrated on the uterine fundus, uterine body, cervix, middle of the posterior vaginal wall, and bottom of the perineal body.Conclusion: After the combined impairments, the biomechanical support of the bladder and sacrococcyx in the anterior (0°) and 90° pathological state pelvic floor system is diminished, the anterior vaginal wall dislodges from the external vaginal opening, and the posterior vaginal wall forms “kneeling” profiles. The pelvic floor system may evolve with a tendency toward the cervical prolapse with anterior and posterior vaginal wall prolapse and eventually prolapse. After surgical mesh implantation, the cervical position can be better restored; however, the load of combined impairment of the pelvic floor is mainly borne by the surgical mesh suspension, the biomechanical support function of pelvic floor organs and sacrococcyx was not repaired by the physiological structure, and the results of uterosacral suspension alone may be poor.

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Two-dimensional biomechanical finite element modeling of the pelvic floor and prolapse

Xue

Wang

Xie

et al. 2023

Biomech Model Mechanobiol

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The feasibility of uterine-vaginal axis MRI-based as evaluation of surgical efficacy in women with pelvic organ prolapse

Cited by 5 publications

References 24 publications

Alignment of the Cervix with the Vagina in Uterine Retroversion: A Possible Risk Factor in Uterine Prolapse

Alignment of the Cervix with the Vagina in Uterine Retroversion: A Possible Risk Factor in Uterine Prolapse

The influence of the combined impairments and apical mesh surgery on the biomechanical behavior of the pelvic floor system

Two-dimensional biomechanical finite element modeling of the pelvic floor and prolapse

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