The Experts below are selected from a list of 1089 Experts worldwide ranked by ideXlab platform
K Welvaart - One of the best experts on this subject based on the ideXlab platform.
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anatomical basis of autonomic nerve preserving total mesorectal excision for rectal cancer
British Journal of Surgery, 1996Co-Authors: Klaas Havenga, M C De Ruiter, Warren E Enker, K WelvaartAbstract:Total mesorectal excision with autonomic nerve preservation for rectal cancer is based on the anatomy of the mesorectum and of the Pelvic autonomic nerves. Cadaver dissections were performed to describe the relationship between these structures. Between the rectum and the sacrum a retrorectal space can be developed, lined anteriorly by the visceral leaf and posteriorly by the parietal leaf of the Pelvic Fascia. The hypogastric nerve runs anterior to the visceral Fascia, from the sacral promontory in a laterocaudad direction. The splanchnic sacral nerves originate from the sacral foramina, posterior to the parietal Fascia, and run caudad, laterally and anteriorly. After piercing the parietal layer of the Pelvic Fascia, approximately 4 cm from the midline, the sacral nerves run between a double layer of the visceral part of the Pelvic Fascia. The relationship between the hypogastric nerves, the splanchnic nerves and the Pelvic Fascia was comparable in all six specimens examined.
Vincent Delmas - One of the best experts on this subject based on the ideXlab platform.
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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.
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terminologia anatomica versus unofficial descriptions and nomenclature of the Fasciae and ligaments of the female pelvis a dissection based comparative study
American Journal of Obstetrics and Gynecology, 2005Co-Authors: Alfredo Ercoli, Vincent Delmas, Francesco Fanfani, Pierre Gadonneix, Marcello Ceccaroni, Anna Fagotti, Salvatore Mancuso, Giovanni ScambiaAbstract:Objective The aims of this study were: (1) to define and classify those connective structures of the female pelvis that are of potential clinical interest, (2) to evaluate the adequacy of the Terminologia Anatomica (official nomenclature) and (3) to establish a correspondence between the official nomenclature and the most commonly used terms. Study design The results of 30 macroscopic and laparoscopic dissections of fresh cadavers with and without vessel injection of colored latex solutions were compared with the descriptions and definitions in the Terminologia Anatomica and the most frequently cited English and non-English literature from 1890 to 2003. Results We identified 3 groups of Fasciae, parietal Pelvic Fascia, visceral Pelvic Fascia, and extraserosal Pelvic Fascia, which could be divided into diverse clinically relevant anatomical structures characterized by different locations, spatial orientation, and consistency. These structures differed considerably with regard to number and nomenclature from those described in the Terminologia Anatomica and part of the literature. Conclusion Our results suggest that the official terminology applied to the connective structures of the female pelvis could be profitably revised and expanded. We offer a complete description of these structures and suggest a classification that may be useful for teaching and clinical purposes.
James A Ashtonmiller - One of the best experts on this subject based on the ideXlab platform.
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functional anatomy of the female Pelvic floor
Annals of the New York Academy of Sciences, 2007Co-Authors: James A Ashtonmiller, John O L DelanceyAbstract:The anatomic structures in the female that prevent inconti- nence and genital organ prolapse on increases in abdominal pressure dur- ing daily activities include sphincteric and supportive systems. In the ure- thra, the action of the vesical neck and urethral sphincteric mechanisms maintains urethral closure pressure above bladder pressure. Decreases in the number of striated muscle fibers of the sphincter occur with age and parity. A supportive hammock under the urethra and vesical neck provides a firm backstop against which the urethra is compressed during increases in abdominal pressure to maintain urethral closure pressures above the rapidly increasing bladder pressure. This supporting layer con- sists of the anterior vaginal wall and the connective tissue that attaches it to the Pelvic bones through the pubovaginal portion of the levator ani muscle, and the uterosacral and cardinal ligaments comprising the tendi- nous arch of the Pelvic Fascia. At rest the levator ani maintains closure of the urogenital hiatus. They are additionally recruited to maintain hiatal closure in the face of inertial loads related to visceral accelerations as well as abdominal pressurization in daily activities involving recruitment of the abdominal wall musculature and diaphragm. Vaginal birth is associ- ated with an increased risk of levator ani defects, as well as genital organ prolapse and urinary incontinence. Computer models indicate that vagi- nal birth places the levator ani under tissue stretch ratios of up to 3.3 and the pudendal nerve under strains of up to 33%, respectively. Research is needed to better identify the pathomechanics of these conditions.
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pathophysiology of adult urinary incontinence
Gastroenterology, 2004Co-Authors: John O L Delancey, James A AshtonmillerAbstract:The anatomic structures that prevent stress incontinence, urinary incontinence during elevations in abdominal pressure, can be divided into 2 systems: a sphincteric system and a supportive system. The action of the vesical neck and urethral sphincteric mechanisms at rest constrict the urethral lumen and keep urethral closure pressure higher than bladder pressure. The striated urogenital sphincter, the smooth muscle sphincter in the vesical neck, and the circular and longitudinal smooth muscle of the urethra all contribute to closure pressure. The mucosal and vascular tissues that surround the lumen provide a hermetic seal, and the connective tissues in the urethral wall also aid coaptation. Decreases in striated muscle sphincter fibers occur with age and parity, but the other tissues are not well understood. The supportive hammock under the urethra and vesical neck provides a firm backstop against which the urethra is compressed during increases in abdominal pressure to maintain urethral closure pressures above rapidly increasing bladder pressure. The stiffness of this supportive layer is presumed to be important to the degree to which compression occurs. This supporting layer consists of the anterior vaginal wall and the connective tissue that attaches it to the Pelvic bones through the pubovaginal portion of the levator ani muscle and also the tendinous arch of the Pelvic Fascia. Activation of the levator muscle during abdominal pressurization is important to this stabilization process. The integrity of the connection between the vaginal wall and tendinous arch also plays an important role.
John O L Delancey - One of the best experts on this subject based on the ideXlab platform.
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The functional anatomy of the female Pelvic floor and stress continence control system. Scand J Urol Nephrol Suppl
2020Co-Authors: James A Ashton-miller, John O L DelanceyAbstract:ABSTRACT: The anatomic structures in the female that prevent incontinence and genital organ prolapse on increases in abdominal pressure during daily activities include sphincteric and supportive systems. In the urethra, the action of the vesical neck and urethral sphincteric mechanisms maintains urethral closure pressure above bladder pressure. Decreases in the number of striated muscle fibers of the sphincter occur with age and parity. A supportive hammock under the urethra and vesical neck provides a firm backstop against which the urethra is compressed during increases in abdominal pressure to maintain urethral closure pressures above the rapidly increasing bladder pressure. This supporting layer consists of the anterior vaginal wall and the connective tissue that attaches it to the Pelvic bones through the pubovaginal portion of the levator ani muscle, and the uterosacral and cardinal ligaments comprising the tendinous arch of the Pelvic Fascia. At rest the levator ani maintains closure of the urogenital hiatus. They are additionally recruited to maintain hiatal closure in the face of inertial loads related to visceral accelerations as well as abdominal pressurization in daily activities involving recruitment of the abdominal wall musculature and diaphragm. Vaginal birth is associated with an increased risk of levator ani defects, as well as genital organ prolapse and urinary incontinence. Computer models indicate that vaginal birth places the levator ani under tissue stretch ratios of up to 3.3 and the pudendal nerve under strains of up to 33%, respectively. Research is needed to better identify the pathomechanics of these conditions
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functional anatomy of the female Pelvic floor
Annals of the New York Academy of Sciences, 2007Co-Authors: James A Ashtonmiller, John O L DelanceyAbstract:The anatomic structures in the female that prevent inconti- nence and genital organ prolapse on increases in abdominal pressure dur- ing daily activities include sphincteric and supportive systems. In the ure- thra, the action of the vesical neck and urethral sphincteric mechanisms maintains urethral closure pressure above bladder pressure. Decreases in the number of striated muscle fibers of the sphincter occur with age and parity. A supportive hammock under the urethra and vesical neck provides a firm backstop against which the urethra is compressed during increases in abdominal pressure to maintain urethral closure pressures above the rapidly increasing bladder pressure. This supporting layer con- sists of the anterior vaginal wall and the connective tissue that attaches it to the Pelvic bones through the pubovaginal portion of the levator ani muscle, and the uterosacral and cardinal ligaments comprising the tendi- nous arch of the Pelvic Fascia. At rest the levator ani maintains closure of the urogenital hiatus. They are additionally recruited to maintain hiatal closure in the face of inertial loads related to visceral accelerations as well as abdominal pressurization in daily activities involving recruitment of the abdominal wall musculature and diaphragm. Vaginal birth is associ- ated with an increased risk of levator ani defects, as well as genital organ prolapse and urinary incontinence. Computer models indicate that vagi- nal birth places the levator ani under tissue stretch ratios of up to 3.3 and the pudendal nerve under strains of up to 33%, respectively. Research is needed to better identify the pathomechanics of these conditions.
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pathophysiology of adult urinary incontinence
Gastroenterology, 2004Co-Authors: John O L Delancey, James A AshtonmillerAbstract:The anatomic structures that prevent stress incontinence, urinary incontinence during elevations in abdominal pressure, can be divided into 2 systems: a sphincteric system and a supportive system. The action of the vesical neck and urethral sphincteric mechanisms at rest constrict the urethral lumen and keep urethral closure pressure higher than bladder pressure. The striated urogenital sphincter, the smooth muscle sphincter in the vesical neck, and the circular and longitudinal smooth muscle of the urethra all contribute to closure pressure. The mucosal and vascular tissues that surround the lumen provide a hermetic seal, and the connective tissues in the urethral wall also aid coaptation. Decreases in striated muscle sphincter fibers occur with age and parity, but the other tissues are not well understood. The supportive hammock under the urethra and vesical neck provides a firm backstop against which the urethra is compressed during increases in abdominal pressure to maintain urethral closure pressures above rapidly increasing bladder pressure. The stiffness of this supportive layer is presumed to be important to the degree to which compression occurs. This supporting layer consists of the anterior vaginal wall and the connective tissue that attaches it to the Pelvic bones through the pubovaginal portion of the levator ani muscle and also the tendinous arch of the Pelvic Fascia. Activation of the levator muscle during abdominal pressurization is important to this stabilization process. The integrity of the connection between the vaginal wall and tendinous arch also plays an important role.
Mani Menon - One of the best experts on this subject based on the ideXlab platform.
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robotic radical prostatectomy with preservation of the prostatic Fascia a feasibility study
Urology, 2005Co-Authors: Sanjeev Kaul, Akshay Bhandari, Ashok K Hemal, Adnan T Savera, Alok Shrivastava, Mani MenonAbstract:Abstract Objectives To describe a feasibility study of our ability to preserve the prostatic Fascia in men undergoing robotic radical prostatectomy. The prostate is covered anterolaterally by prostatic Fascia, also called lateral Pelvic Fascia or the parietal layer of endoPelvic Fascia. The prostatic Fascia is rich in vessels, nerves, and smooth muscle. We hypothesized that preservation of this Fascial layer may result in improved postoperative potency. Methods The technique was first attempted in 15 men undergoing radical cystoprostatectomy, in which accidental entry to the prostatic tissue is not critical. Thereafter, it was performed in 6 impotent men undergoing robotic radical prostatectomy. The Fascia was excised and stained for prostate-specific antigen and neural and muscle tissue. The technique was then performed in 35 potent men (Sexual Health Inventory for Men score greater than 21) undergoing robotic radical prostatectomy. Postoperative potency was evaluated with a self-administered questionnaire (Sexual Health Inventory for Men). Results Under the magnification of the da Vinci robotic system, and also shown histologically, the prostatic Fascia is a multiFascial layer of fibrovascular tissue, covering the anterolateral aspect of the prostate. It stains positive for smooth muscle and nerves, but negative for prostate-specific antigen. The amount of neural tissue in the Fascia is variable, but never exceeds that in the neurovascular bundle. At 12 months of follow-up, 34 (97%) of 35 men undergoing Fascia-preserving robotic radical prostatectomy had erections strong enough for vaginal penetration, and 30 (86%) had normal erections (Sexual Health Inventory for Men greater than 21). Conclusions Preservation of the prostatic Fascia is safe and feasible, without compromising the surgical margins, and allows enhanced preservation of neural tissue during robotic prostatectomy with an apparent improvement in potency.