Anatomy and Biomechanics of Genital Prolapse

University of Michigan Medical School, Ann Arbor.
Clinical Obstetrics and Gynecology (Impact Factor: 1.77). 01/1994; 36(4):897-909. DOI: 10.1097/00003081-199312000-00015
Source: PubMed


Normal support of the pelvic organs depends on a combination of fascial and muscular support. The specific type of prolapse that exists in an individual corresponds with specific defects in the anatomic structures responsible for normal support. Understanding the nature of this support helps to guide both surgical and nonsurgical management of these conditions. The role that vaginal birth plays in causing pelvic floor damage can be understood by recognizing that neuromuscular damage occurs during parturition.

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    • "The presence of the nerve, smooth muscle, and blood vessels indicates that ligaments are an active contractile structure. Laxity in the pubo‑urethal ligament can contribute to urinary incontinence in women (DeLancey, 1993), while laxity in the cardinal ligaments gives rise to utero‑vaginal descend. "
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    ABSTRACT: Pelvic floor dysfunction (PFD) is commonly associated with the weakness of pelvic floor muscles and the supporting connective tissue structures, which may lead to prolapse of the pelvic organs. There are various researches which have shown the significance of pelvic floor exercise (PFE) on the PFD. The last few years have seen a growing interest in the field of yoga. " Mudra " and " Bandha " are reported as pelvic floor yogic exercises (PFYEs) in the ancient Indian texts. These yogic exercises involve the coordination of breath, maintain the structural integrity of the pelvic floor, and thereby prevent PFD. It is recognized that all the female patients of PFD can be benefited from education on PFYE. So, in this article, we have tried to highlight the significance of PFYE in the preventive and therapeutic aspects of PFD.
    Full-text · Article · Dec 2014
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    • "Pelvic organ prolapse (POP), a hernia in the endopelvic fascia (1), is associated with urinary incontinence and defecation dysfunction, leading to an impaired quality of life for the affected individual (2). Epidemiological studies have revealed that numerous risk factors, including vaginal delivery, senescence, obesity and pelvic surgery, contribute to the development of the condition (3–5). "
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    ABSTRACT: Interferon (IFN)-γ is a potent proinflammatory molecule. However, few studies have investigated the expression levels of IFN-γ during pelvic organ prolapse (POP). In the present study, the expression levels and tissue localization of IFN-γ and its pathway-associated genes were detected in the vaginal walls of premenopausal females with POP and asymptomatic controls using quantitative polymerase chain reaction and immunohistochemistry. When compared with the matched controls, an 8.6-fold increase in IFN-γ, 3.8-fold increase in IFN-γ receptor (IFNGR)1, 2.6-fold increase in IFNGR2, 3.4-fold increase in signal transducer and activator of transcription-1, 2.2-fold increase in janus kinase-1 and 5.1-fold increase in nuclear factor (NF)-κB mRNA expression levels were observed in the females with premenopausal POP. In all the females with POP, higher mRNA expression levels of IFN-γ and its receptors were observed when compared with the controls. Expression levels of all the proteins were detected by immunohistochemistry, and the results demonstrated higher staining for IFN-γ, IFNGRs and pathway-associated genes in females with POP. Therefore, the results indicated that IFN-γ may be used as an inflammatory marker for POP development, and is associated with NF-κB.
    Full-text · Article · Oct 2014 · Experimental and therapeutic medicine
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    • "It causes many psychosocial problems and generates significant costs to the budget of health in many countries. In 1993 DeLancey as one of the first researchers concluded that its pathophysiology is associated with a defect in bladder neck and urethra due to the laxity of surrounding tissues and the insufficiency of the internal sphincter of urethra [1]. Various factors may affect the development of SUI. "
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    ABSTRACT: Introduction: This study is a comparative evaluation of the TVT, TOT, and our own modification of TOT (mTOT) in the treatment of female stress urinary incontinence from a single center experience. Material and methods: The study was conducted on 527 patients with SUI diagnosed on the basis of urodynamic studies. They were divided into three groups--TVT: n=142, (TOT): n=129, and mTOT: n=256. All of the patients underwent evaluation at 1, 3, and 6 months after surgery. Results were statistically analysed and compared. Results: Objective and subjective effectiveness after the surgery were not significantly different in the study groups and ranged from 90.1% to 96.4%. Mean surgery time was 32.3, 28.2, and 26.4 in the TVT, TOT, and mTOT, respectively. Mean hospitalization time was 2.51 days. Mean catheter maintenance time was significantly higher in the TVT than in other groups. In the TVT group total incidence of complications was 13.4%, and it was significantly higher than that in TOT and mTOT (9.3% and 8.6%, resp.). Conclusions: TVT, TOT, and mTOT are highly effective and safe methods in the treatment of SUI. There are no differences in the efficacy between the methods with a little higher percentage of complications in the TVT group.
    Full-text · Article · Mar 2014
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