The Experts below are selected from a list of 213 Experts worldwide ranked by ideXlab platform
Jean De Leval - One of the best experts on this subject based on the ideXlab platform.
-
transObturator vaginal tape inside out for the surgical treatment of female stress urinary incontinence anatomical considerations
The Journal of Urology, 2005Co-Authors: Pierre Bonnet, David Waltregny, Olivier Reul, Jean De LevalAbstract:Purpose: We have recently described a novel surgical technique for female stress urinary incontinence, that is the transObturator vaginal tape inside out, which uses specific instruments for the passage of a synthetic tape from beneath the urethra toward the thigh folds. Herein we report the results of cadaver dissection performed to determine the anatomical trajectory of the tape and its relationships with neighboring neurovascular structures and organs. Materials and Methods: Insertion of the transObturator vaginal tape inside out tape was performed by different surgeons in 12 freshly frozen female cadavers according to the standard procedure. The thigh, Obturator, perineal and pelvic regions were dissected and tape trajectory was recorded. An additional cadaver was dissected without prior tape placement. Results: The tape was inserted according to a certain consistent path, that is penetration from the suburethral space into a strictly perineal region limited medial and cranial by the levator ani Muscle, caudal by the perineal membrane and lateral by the Obturator Internus Muscle. This region corresponded to the most anterior recess of the ischiorectal fossa. The tape then perforated the Obturator membrane and Muscles, and exited through the skin after traversing adductor Muscles and subcutaneous tissue. The tape was coursed away from 1) the dorsal nerve to the clitoris located more superficially below the perineal membrane, 2) the Obturator nerve and vessels, and 3) the saphenous and femoral vessels. Conclusions: These findings strongly suggest that our transObturator technique is highly accurate, reproducible and safe, and it does not require perioperative cystoscopy.
Vincent Delmas - One of the best experts on this subject based on the ideXlab platform.
-
anatomical risks of transObturator suburethral tape in the treatment of female stress urinary incontinence
European Urology, 2005Co-Authors: Vincent DelmasAbstract:Abstract Introduction: The objective of this study was to define the anatomical structures crossed by transObturator tape. Materials: Ten fresh, female anatomical subjects aged 74 to 89 years. Methods: TransObturator tape was inserted by outside-in way. The position of the tape was verified by perineal and abdominal dissection. Results: TransObturator tape has a transverse course. It crosses the adductor Muscles close to their pubic insertion and passes over the inferior border of the Obturator foramen by crossing the Obturator membrane, before reaching the middle plane of the perineum after having crossed the Obturator Internus Muscle. The tape passes above the internal pudendal pedicle and then under the levator ani Muscle, under the tendinous arch of the pelvic fascia and continues in the middle third of the urethrovaginal septum. It avoids femoral and Obturator vessels in the thigh and pudendal vessels in the perineum. Conclusion: The anatomical course of transObturator tape shows that the anatomical structures crossed by the tape are Muscle and fascia and, when the technique is performed correctly, no major neurovascular structures are in contact with the tape.
Pierre Bonnet - One of the best experts on this subject based on the ideXlab platform.
-
transObturator vaginal tape inside out for the surgical treatment of female stress urinary incontinence anatomical considerations
The Journal of Urology, 2005Co-Authors: Pierre Bonnet, David Waltregny, Olivier Reul, Jean De LevalAbstract:Purpose: We have recently described a novel surgical technique for female stress urinary incontinence, that is the transObturator vaginal tape inside out, which uses specific instruments for the passage of a synthetic tape from beneath the urethra toward the thigh folds. Herein we report the results of cadaver dissection performed to determine the anatomical trajectory of the tape and its relationships with neighboring neurovascular structures and organs. Materials and Methods: Insertion of the transObturator vaginal tape inside out tape was performed by different surgeons in 12 freshly frozen female cadavers according to the standard procedure. The thigh, Obturator, perineal and pelvic regions were dissected and tape trajectory was recorded. An additional cadaver was dissected without prior tape placement. Results: The tape was inserted according to a certain consistent path, that is penetration from the suburethral space into a strictly perineal region limited medial and cranial by the levator ani Muscle, caudal by the perineal membrane and lateral by the Obturator Internus Muscle. This region corresponded to the most anterior recess of the ischiorectal fossa. The tape then perforated the Obturator membrane and Muscles, and exited through the skin after traversing adductor Muscles and subcutaneous tissue. The tape was coursed away from 1) the dorsal nerve to the clitoris located more superficially below the perineal membrane, 2) the Obturator nerve and vessels, and 3) the saphenous and femoral vessels. Conclusions: These findings strongly suggest that our transObturator technique is highly accurate, reproducible and safe, and it does not require perioperative cystoscopy.
Leslie E Quint - One of the best experts on this subject based on the ideXlab platform.
-
Original Article MR Imaging of Levator Ani Muscle Recovery Following Vaginal Delivery
2016Co-Authors: Ralf Tunn, John M. Thorp, JAMES ANTHONY ASHTON-MILLER, Denise Howard, Leslie E QuintAbstract:Abstract: Our aim was to quantify the changes that occur in the levator ani Muscles (LA) after vaginal delivery using magnetic resonance imaging. Fourteen women underwent MRI 1 day postpartum. Six of them were also scanned 1, 2, 6 weeks and 6 months after delivery. LA signal intensities and thickness, in areas of the urogenital and the levator hiatus were assessed in the transverse plane. Perineal body position was measured in the sagittal plane. One day postpartum a higher T2-signal intensity of the LA compared to the Obturator Internus Muscle was found in all women and a lower T1-signal intensity in 8 of 12 women. By 6 months these differences were present in only 1 woman in the left LA. An elevation in perineal body position of 13.4 +7.3 mm (P50.05), as well as a decrease in the area of the urogenital hiatus by 27 % (P50.05) and of the levator hiatus by 22 % (P50.05) by 2 weeks postpartum suggest a return of normal LA geometry. LA thickness showed interindividual variations, and a complete loss of LA tissue was found in 1 woman. Changes in LA signal intensity, topography and thickness during the puerper-ium can be documented using MR imaging
-
MR imaging of levator ani Muscle recovery following vaginal delivery.
International Urogynecology Journal, 1999Co-Authors: Ralf Tunn, John M. Thorp, JAMES ANTHONY ASHTON-MILLER, Denise Howard, Leslie E QuintAbstract:Our aim was to quantify the changes that occur in the levator ani Muscles (LA) after vaginal delivery using magnetic resonance imaging. Fourteen women underwent MRI 1 day postpartum. Six of them were also scanned 1, 2, 6 weeks and 6 months after delivery. LA signal intensities and thickness, in areas of the urogenital and the levator hiatus were assessed in the transverse plane. Perineal body position was measured in the sagittal plane. One day postpartum a higher T2-signal intensity of the LA compared to the Obturator Internus Muscle was found in all women and a lower T1-signal intensity in 8 of 12 women. By 6 months these differences were present in only 1 woman in the left LA. An elevation in perineal body position of 13.4 ±7.3 mm (P
-
mr imaging of levator ani Muscle recovery following vaginal delivery
International Urogynecology Journal, 1999Co-Authors: Ralf Tunn, John M. Thorp, Denise Howard, Leslie E QuintAbstract:Our aim was to quantify the changes that occur in the levator ani Muscles (LA) after vaginal delivery using magnetic resonance imaging. Fourteen women underwent MRI 1 day postpartum. Six of them were also scanned 1, 2, 6 weeks and 6 months after delivery. LA signal intensities and thickness, in areas of the urogenital and the levator hiatus were assessed in the transverse plane. Perineal body position was measured in the sagittal plane. One day postpartum a higher T2-signal intensity of the LA compared to the Obturator Internus Muscle was found in all women and a lower T1-signal intensity in 8 of 12 women. By 6 months these differences were present in only 1 woman in the left LA. An elevation in perineal body position of 13.4 ±7.3 mm (P<0.05), as well as a decrease in the area of the urogenital hiatus by 27% (P<0.05) and of the levator hiatus by 22% (P<0.05) by 2 weeks postpartum suggest a return of normal LA geometry. LA thickness showed interindividual variations, and a complete loss of LA tissue was found in 1 woman. Changes in LA signal intensity, topography and thickness during the puerperium can be documented using MR imaging.
John O L Delancey - One of the best experts on this subject based on the ideXlab platform.
-
pelvic cross sectional area at the level of the levator ani and prolapse
International Urogynecology Journal, 2021Co-Authors: Anne G Sammarco, David Sheyn, Christopher X Hong, Emily K Kobernik, Carolyn W Swenson, John O L DelanceyAbstract:Intraabdominal pressure acts on the pelvic floor through an aperture surrounded by bony and muscular structures of the pelvis. A small pilot study showed the area of the anterior portion of this plane is larger in pelvic organ prolapse. We hypothesize that there is a relationship between prolapse and anterior (APA) and posterior (PPA) pelvic cross-sectional area in a larger, more diverse population. MRIs from 30 prolapse subjects and 66 controls were analyzed in this case-control study. The measurement plane was tilted to approximate the level of the levator ani attachments. Three evaluators made measurements. Patient demographic characteristics were compared using Wilcoxon rank-sum and Fisher’s exact tests. A multivariable logistic regression model identified factors independently associated with prolapse. Controls were 3.7 years younger and had lower parity, but groups were similar in terms of race, height, and BMI. Cases had a larger APA (p < 0.0001), interspinous diameter (ISD) (p = 0.001), anterior-posterior (AP) diameter (p = 0.01), and smaller total Obturator Internus Muscle (OIM) area (p = 0.002). There was no difference in the size of the PPA(p = 0.12). Bivariate logistic regression showed age (p = 0.007), parity (p = 0.009), ISD (p = 0.002), AP diameter (p = 0.02), APA (p < 0.0001), and OIM size (p = 0.01) were significantly associated with prolapse; however, PPA was not (p = 0.12). After adjusting for age, parity, and major levator defect, prolapse was significantly associated with increased anterior pelvic area (p = 0.001). We confirm that a larger APA and decreasing OIM area are associated with prolapse. The PPA was not significantly associated with prolapse.
-
a novel measurement of pelvic floor cross sectional area in older and younger women with and without prolapse
American Journal of Obstetrics and Gynecology, 2019Co-Authors: Anne G Sammarco, David Sheyn, Emily K Kobernik, Tessa E Krantz, Cedric K Olivera, Antonio Antunes Rodrigues, Mariana Masteling, John O L DelanceyAbstract:Abstract Background An increase in size of the aperture of the pelvis that must be spanned by pelvic floor support structures translates to an increase in the force on these structures. Prior studies have measured the bony dimensions of the pelvis, but the effect of changes in Muscle bulk that may affect the size of this area are unknown. Objectives To develop a technique to evaluate the aperture size in the anterior pelvis at the level of the levator ani Muscle attachments, and identify age-related changes in women with and without prolapse. Study Design This was a technique development and pilot case-control study evaluating pelvic magnetic resonance imaging (MRI) from 30 primiparous women from the Michigan Pelvic Floor Research Group MRI Data Base: 10 younger women with normal support, 10 older women with, and 10 older menopausal women without prolapse. Anterior pelvic area measurements were made in a plane that included the bilateral ischial spines and the inferior pubic point, approximating the level of the arcus tendineus fascia pelvis. Measurements of the anterior pelvic area, Obturator Internus Muscles, and interspinous diameter were made by five independent raters from the Society of Gynecologic Surgeons Pelvic Anatomy Group that focused on developing pelvic imaging techniques, and evaluating inter-rater reliability. Demographic characteristics were compared across groups of interest using Wilcoxon rank sum test, Chi-square, or Fisher’s exact test where appropriate. Multiple linear regression models were created to identify independent predictors of anterior pelvic area. Results Per the study design, groups differed in age and prolapse stage. There were no differences in race, height, body mass index, gravidity or parity. Patients with prolapse had a significantly longer interspinous diameter, and more major (>50% of the Muscle) levator ani defects when compared to both older and younger women without prolapse. Inter-rater reliability was high for all measurements (ICC=.96). The anterior pelvic area (cm2) was significantly larger in older women with prolapse compared to older (60±5.1 vs. 53±4.9, p=.004) and younger (60±5.1 vs. 52±4.6, p=.001) women with normal support. The young and older normal support women did not differ in anterior pelvic area (52±4.6 vs 53±4.9, p= 0.99). After adjusting for race and BMI, increased anterior pelvic area was significantly associated with the following: 1) being an older woman with prolapse (β = 6.61cm2, p=.004), and 2) IS distance (β = 4.52cm2, p=.004). Conclusions Older women with prolapse had the largest anterior area, suggesting that the anterior pelvic area is a novel measure to consider when evaluating women with prolapse. Interspinous diameter, and being an older woman with prolapse, was associated with a larger anterior pelvic area. This suggests that reduced Obturator Internus Muscle size with age may not be the primary factor in determining anterior pelvic area, but pelvic dimensions such as interspinous diameter could play a role. The measurements were highly repeatable. The high ICC indicates that all raters were able to successfully learn the imaging software and perform measurements with high reproducibility.
