The Long and Short of it: Anterior Vaginal Wall Length before and after Anterior Repair

Swenson, Carolyn W.; Morgan, Daniel M.; DeLancey, John O.L.

doi:10.1016/j.jmig.2014.12.077

Cited by 3 publications

(5 citation statements)

References 8 publications

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“…Increased vaginal length has been found in women with prolapse both at rest and at maximal Valsalva loading [39]. Empirically, one common prolapse surgery procedure, anterior repair, reduced the vaginal length by 28% on average and showed great result in restoring pelvic floor support [38]. Our preliminary simulation results suggest that longer AVW alone can result in greater prolapse size which suggests why the surgical procedure resulting in shorter vaginal length often restores pelvic floor support.…”

Section: Discussionmentioning

confidence: 71%

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Development of anatomically based customizable three-dimensional finite-element model of pelvic floor support system: POP-SIM1.0

et al. 2019

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To develop an anatomically based customizable finite-element (FE) model of the pelvic floor support system to simulate pelvic organ prolapse (POP): POP-SIM1.0. This new simulation platform allows for the construction of an array of models that objectively represent the key anatomical and functional variation in women with and without prolapse to test pathomechanism hypotheses of the prolapse formation. POP-SIM1.0 consists of anatomically based FE models and a suite of Python-based tools developed to rapidly construct FE models by customizing the base model with desired structural parameters. Each model consists of anatomical structures from three support subsystems which can be customized based on magnetic resonance image measurements in women with and without prolapse. The customizable structural parameters include presence of levator ani (LA) avulsion, hiatus size, anterior vaginal wall dimension, attachment fascia length and apical location in addition to the tissue material properties and intra-abdominal pressure loading. After customization, the FE model was loaded with increasing intra-abdominal pressure (0–100 cmH 2 O) and solved using ABAQUS explicit solver. We were able to rapidly construct anatomically based FE models with specific structural geometry which reflects the morphology changes often observed in women with prolapse. At maximum loading, simulated structural deformations have similar anatomical characteristics to those observed during clinical exams and stress magnetic resonance images. Simulation results showed the presence of LA muscle avulsion negatively impacts the pelvic floor support. The normal model with intact muscle had the smallest exposed vaginal length of 11 mm, while the bilateral avulsion produced the largest exposed vaginal length at 24 mm. The unilateral avulsion model had an exposed vaginal length of 18 mm and also demonstrated a tipped perineal body similar to that seen in clinical observation. Increasing the hiatus size, vaginal wall length and fascia length also resulted in worse pelvic floor support, increasing the exposed vaginal length from 18 mm in the base model to 33 mm, 54 mm and 23.5 mm, respectively. The developed POP-SIM1.0 can simulate the anatomical structure changes often observed in women with prolapse. Preliminary results showed that the presence of LA avulsion, enlarged hiatus, longer vaginal wall and fascia length can result in larger prolapse at simulated maximum Valsalva.

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Section: Discussionmentioning

confidence: 71%

“…The effect of increasing AVW length, a common morphological change observed in women with prolapse [38,39], is shown in figure 10. The AVW length was increased 1.4 times from 62 to 87 mm, as shown by the red line in figure 10a,b, while keeping the apex location the same.…”

Section: Resultsmentioning

confidence: 99%

Development of anatomically based customizable three-dimensional finite-element model of pelvic floor support system: POP-SIM1.0

et al. 2019

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“…AVL is on average 6.1± 1.3 cm in women with normal support and lengthened in women with a cystocele 5 . As around 1.0–1.5 cm of the upper anterior vagina is involved in the makeup of the anterior fornix, that is, Level I vagina (VV 2 ), the effective anterior mid‐vaginal length (AMVL) would be close to 5.0 cm, similar to the PMVL.…”

Section: Introductionmentioning

confidence: 99%

“…Post-hysterectomy, the anterior vaginal length (AVL) is that between the anterior fornix next to the cervix down to the anterior aspect of the hymen. 3,5 Post-hysterectomy, the AVL is that between the anterior aspect of the vaginal cuff and the anterior aspect of the hymen.…”

Section: Introductionmentioning

confidence: 99%

Surgical anatomy of the mid‐vagina

Haylen

Wong

et al. 2022

Neurourology and Urodynamics

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Aim The mid‐vagina (MV) represents Level II of the vagina. The surgical anatomy of the MV has not been recently subject to a comprehensive examination and description. MV surgery involving anterior and posterior colporrhaphy represents a key part of surgery for a majority of pelvic organ prolapse (POP). Methods Literature review and surgical observations of many aspects of the MV were performed including MV length and width; MV shape; immediate relationships; histological analysis; anterior and posterior MV prolapse assessment and anterior MV surgical aspects. Unpublished pre‐ and postoperative quantitative data on 300 women undergoing posterior vaginal compartment repairs are presented. Results The MV runs from the lower limit of the vaginal vault (VV) to the hymen. Its length is a mean of 5 cm. Its shape in section overall is a compressed rectangle. Its longitudinal shape is created by its anterior and posterior walls being inverse trapezoid in shape. Histology comprises three layers: (i) mucosa; (ii) muscularis; (iii) adventitia. MV prolapse staging uses pelvic organ prolapse quantification (POP‐Q). Anterior MV prolapse can be quantitatively assessed using POP‐Q while posterior MV prolapse can be assessed with POP‐Q or PR‐Q. Around 50% of both cystocele and rectocele are due to VV defects. POP will increase anterior MV width and length. Native tissue anterior colporrhaphy is the current conventional repair with mesh disadvantages outweighing advantages. Posteriorly, Level II (MV) defects are far smaller (mean 1.3 cm) than Level I (mean 6.0 cm) and Level III (mean 2.9 cm). Conclusion An understanding of the surgical anatomy of the MV can assist anterior and posterior colporrhaphy. In particular, if VV support is employed, the Level II component of a posterior repair should be relatively small.

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“…Its rate of occurrence increases with age 2,3 . A survey conducted, showed that about 12% of women are possibly exposed to surgery during their life in order to recover from prolapse 2,3 . The anterior wall of the pelvis is the most common site for prolapse, it accounts for eighty percent of cases 4 .…”

Section: Introductionmentioning

confidence: 99%

Comparison of 1 Versus 3 Days Post-Operative Catheterization After Anterior Colporrhaphy

Ahmadi¹,

Rahmani²,

Kambiz³

et al. 2016

AJPRHC

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With attention to the fact that after anterior colporrhaphy surgery and stitches on vaginal mucus, inserting urinary catheter is requested, according to scientific references and in order to prevent from urinary retention, it has been said that the catheter should be inserted for 3 days. But inserting the catheter leads to infections of bladder and pain. So, in the present study, we compared the removal of the catheter 24 hours versus 72 hours after the surgery, considering urinary infections, urinary retention, patient's ease and hospitalization. Within two groups of 70 patients, which has been assimilated based on basic factors (devided into two groups accidently with excel table) urinary catheter fixed for 1 and 3 days. After that, patients were compared considering urinary retention, urinary infections and the rate of patient satisfaction. Urinary retention was 28.6% in the test group and 22.9% in a controlling group which was not statistically meaningful (P=0.78). Urinary infections were 22.9% in the test group and 34.3% in the controlling group (P=0.42) and the rate of patient's satisfactions was 57.1% in the test group and 40% in controlling group (P=0.23). The hospitalization period in the test group and in the control group was 2.91±0.61 and 3.94± 0.59 days respectively with a significant difference (P=0.001). The results showed that short time catheterization is more satisfactory in comparison long catheterizations.

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The Long and Short of it: Anterior Vaginal Wall Length before and after Anterior Repair

Cited by 3 publications

References 8 publications

Development of anatomically based customizable three-dimensional finite-element model of pelvic floor support system: POP-SIM1.0

Development of anatomically based customizable three-dimensional finite-element model of pelvic floor support system: POP-SIM1.0

Surgical anatomy of the mid‐vagina

Comparison of 1 Versus 3 Days Post-Operative Catheterization After Anterior Colporrhaphy

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