The relationship between anterior and apical compartment support

Abstract

Objective-The purpose of this study was to determine whether the degree of anterior compartment (bladder) and apical compartment (cervix) prolapse are correlated, and whether 2 anterior compartment elements (urethra and bladder) are related at maximal Valsalva.Study design-Women with a complete spectrum of pelvic support were recruited for a pelvic support study. Dynamic magnetic resonance scans were taken during Valsalva. A convenience sample of 153 women with a mean age of 53.3 ± 12.5 (SD) years with a uterus in situ was studied. Anterior compartment status was assessed by the most caudal bladder point and the internal urinary meatus. The external cervical os was used to assess the apical compartment. The position of the bladder, urethra, and uterus were determined in 20 nulliparous women to determine their reference locations. The distances of each structure below the reference positions were calculated at maximum Valsalva.Results-Average distances of the bladder base, urethra, and uterus from the reference positions at maximal Valsalva were 4.1 ± 2.4 cm, 3.1 ± 1.3 cm, and 4.3 ± 2.4 cm, respectively. The Pearson correlation coefficient of the relationship between the bladder base and uterine distances was r = 0.73 (r 2 = 0.53). The Pearson correlation coefficient of the bladder distance and urethral distance was r = 0.82 (r 2 = 0.67).Conclusion-Half of the observed variation in anterior compartment support may be explained by apical support. KeywordsPelvic organ prolapse; MRI; Cystocele; Uterine prolapse; Biomechanics Pelvic organ prolapse is a distressing and debilitating condition for women. It requires surgery in approximately 200,000 American women each year, 1 making it the pelvic floor disorder most often requiring surgical repair.There are many different combinations of support defects in women who have pelvic organ prolapse. They can involve the anterior compartment, the posterior compartment, or the apical segment. The nature of these problems relates to the structural supports of the vagina and uterus

Anterior vaginal wall length and degree of anterior compartment prolapse seen on dynamic MRI

“…We have previously presented data indicating that about half of anterior wall descent can be explained by the degree of apical descent present (Summers et al, Am J Obstet Gynecol, 194:1438−1443, 2006. This led us to examine whether other midsagittal vaginal geometric parameters are associated with anterior wall descent.…”

Change in pelvic organ support during pregnancy and the first year postpartum: a longitudinal study

“…In theories presented by DeLancey et al the importance of apical support for developing at least anterior compartment prolapse is emphasised. 33,34 Our findings might be helpful in further explaining the link between pregnancy, delivery, and the development of POP. Finding that Pb in both delivery groups and Gh in the caesarean delivery group was shorter 12 months postpartum, compared with baseline, might indicate that the perineal POP-Q measurements had already undergone an elongation prior to 21 weeks of gestation.…”

A comparison of two different mesh kit systems for anterior compartment prolapse repair

“…This is surprising and may be considered counter-intuitive, given that apical support has been assumed to be a crucial contributor to anterior compartment failure. 10,20 Due to this perception, there has been a gradual move towards the incorporation of sacrospinous suspension at the time of cystocele repair. However, as shown in the Anterior Elevate group of this study, superior apical support does not necessarily translate to superior anterior compartment support.…”

“…8 However, failure (that is, pullthrough) of those anchoring arms is not uncommon. 9 Due to increasing emphasis on the importance of apical support for the anterior compartment, 10 mesh kit systems such as the Anterior Elevate TM (American Medical Systems) were introduced. In order to provide sacrospinous ligament (SSL) anchorage and to avoid blind transobturator trocar needle passes, the Anterior Elevate TM mesh kit system utilises tissue anchors to the arcus tendineus fascia pelvis (ATFP) and the SSL rather than the transobturator arms.…”