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Urogynaecology and pelvic floor problems
Published in Helen Bickerstaff, Louise C Kenny, Gynaecology, 2017
Uterovaginal prolapse is caused by failure of the interaction between the levator ani muscles and the ligaments and fascia that support the pelvic organs. For a detailed description of the relationships and function of these structures, see the review by Wei & De Lancey in Further reading. The levator ani muscles are puborectalis, pubococcygeus and iliococcygeus. They are attached on each side of the pelvic side wall from the pubic ramus anteriorly (pubococcygeus), over the obturator internus fascia to the ischial spine to form a bowl-shaped muscle filling the pelvic outlet and supporting the pelvic organs (see Chapter 1, The development and anatomy of the female sexual organs and pelvis). There is a gap between the fibres of the puborectalis on each side to allow passage of the urethra, vagina and rectum, called the urogenital hiatus. The levator muscles support the pelvic organs and prevent excessive loading of the ligaments and fascia.
Urogenital prolapse
Published in David M. Luesley, Mark D. Kilby, Obstetrics & Gynaecology, 2016
Sushma Srikrishna, Dudley Robinson
The muscle fibres of the pelvic diaphragm are arranged to form a broad U-shaped layer of muscle with a defect anteriorly. This physiological defect is the urogenital hiatus and allows the passage of the urethra, vagina and rectum through the pelvic floor.
The use of 3D ultrasound in comparing surgical techniques for posterior wall prolapse repair: a pilot randomised controlled trial
Published in Journal of Obstetrics and Gynaecology, 2021
Alexandros Derpapas, Gopalan Vijaya, Kostis Nikolopoulos, Manolis Nikolopoulos, Dudley Robinson, Ruwan Fernando, Vik Khullar
More importantly though, we have demonstrated that 3D translabial ultrasonography of the pelvic floor is a useful tool for surgeons in evaluating the outcome of surgical management of prolapse by depicting the reduction in the urogenital hiatus postoperatively, which complements the examination by POP-Q. Using a reference line connecting the inferior pubic rami to the perineal body, urogenital hiatal dimensions can be ultrasonagraphically calculated with moderate to very good inter- and intra-rater reliability. Postoperative reduction in the GH size as measured by ultrasound in this cohort corresponded with the anatomical improvement in GH measured by POP-Q. This was evident even by comparing the two surgical techniques; women who were allocated to the FEP technique demonstrated a narrower urogenital hiatus than those in the standard colporrhaphy group. A greater reduction in the urogenital hiatus following fascial and epithelial plication could possibly be attributed to the conservation and utilisation of the excessive vaginal epithelium, which helps approximate the lateral attachments of the endopelvic fascia to the midline.