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John O L Delancey - One of the best experts on this subject based on the ideXlab platform.

  • Perineal Body anatomy in living women: 3-dimensional analysis using thin-slice magnetic resonance imaging.
    American journal of obstetrics and gynecology, 2020
    Co-Authors: Kindra A Larson, Aisha Yousuf, Dee E Fenner, Christina Lewicky-gaupp, John O L Delancey
    Abstract:

    The objective of the study was to describe a framework for visualizing the Perineal Body's complex anatomy using thin-slice magnetic resonance (MR) imaging. Two millimeter thick MR images were acquired in 11 women with normal pelvic support and no incontinence/prolapse symptoms. Anatomic structures were analyzed in axial, sagittal, and coronal slices. Three-dimensional (3-D) models were generated from these images. Three distinct Perineal Body regions are visible on MR imaging: (1) a superficial region at the level of the vestibular bulb, (2) a midregion at the proximal end of the superficial transverse Perineal muscle, and (3) a deep region at the level of the midurethra and puborectalis muscle. Structures are best visualized on axial scans, whereas craniocaudal relationships are appreciated on sagittal scans. The 3-D model further clarifies interrelationships. Advances in MR technology allow visualization of Perineal Body anatomy in living women and development of 3-D models that enhance our understanding of its 3 different regions: superficial, mid, and deep. Copyright © 2010 Mosby, Inc. All rights reserved.

  • in vivo estimation of Perineal Body properties using ultrasound quasistatic elastography in nulliparous women
    Journal of Biomechanics, 2015
    Co-Authors: Luyun Chen, John O L Delancey, James A Ashtonmiller
    Abstract:

    Objective The Perineal Body must undergo a remarkable transformation during pregnancy to accommodate an estimated stretch ratio of over 3.3 in order to permit vaginal delivery of the fetal head. Yet measurements of Perineal Body elastic properties are lacking in vivo, whether in the pregnant or non-pregnant state. The objective of this study, therefore, was to develop a method for measuring Perineal Body elastic modulus and to test its feasibility in young nulliparous women.

  • the length of anterior vaginal wall exposed to external pressure on maximal straining mri relationship to urogenital hiatus diameter and apical and bladder location
    International Urogynecology Journal, 2014
    Co-Authors: Aisha Yousuf, Luyun Chen, James A Ashtonmiller, Kindra A Larson, John O L Delancey
    Abstract:

    Introduction and hypothesis In cystoceles, the distal anterior vaginal wall (AVW) bulges out through the introitus and is no longer in contact with the posterior vaginal wall or Perineal Body, exposing the pressure differential between intra-abdominal pressure and atmospheric pressure. The goal of this study is to quantify the length of the exposed vaginal wall length and to investigate its relationship with other factors associated with the AVW support, such as most dependent bladder location, apical location, and hiatus diameter, demonstrating its key role in cystocele formation.

  • Levator defects affect Perineal position independently of prolapse status
    American Journal of Obstetrics and Gynecology, 2010
    Co-Authors: Natalie A. Clark, Aisha Yousuf, Cynthia Brincat, John O L Delancey
    Abstract:

    Objective The purpose of this study was to determine the effect of levator defects on Perineal position and movement irrespective of prolapse status. Study Design Forty women from an ongoing study were divided into 2 groups of 20 women with and without severe levator defects. Prolapse status was matched between groups, with 50% of the women having stage III or greater anterior wall prolapse. Perineal structure locations were measured against standard axes on magnetic resonance scans at rest, maximum contraction (Kegel), and maximum Valsalva maneuver. Differences in location were calculated and compared. Results In women with levator defects, independently of prolapse status: (1) At rest, the Perineal Body was 1.3 cm, and the anal sphincter was 1.0 cm more caudal ( P ≤ .01); at maximum contraction, the Perineal Body and the anal sphincter were both 1.2 cm more caudal ( P ≤ .01); with maximum Valsalva maneuver, the Perineal Body was 1.3 cm more caudal, and the anal sphincter was 1.2 cm more caudal ( P ≤ .01). (2) At rest, the levator hiatus was 0.8 cm larger, and the urogenital hiatus was 1.0 cm larger ( P ≤ .01). (3) At rest, the bladder was 0.07 cm more posterior ( P ≤ .02); with maximum contraction, it was 1.9 cm lower ( P ≤ .02). (4) With maximum Valsalva maneuver, the bladder was 1.5 cm lower and displaced further caudally ( P ≤ .03). Conclusion When we controlled for prolapse, the women with levator defects had a more caudal location of their Perineal structures and larger hiatuses at rest, maximum contraction, and maximum Valsalva maneuver.

  • Perineal Body anatomy in living women 3 dimensional analysis using thin slice magnetic resonance imaging
    American Journal of Obstetrics and Gynecology, 2010
    Co-Authors: Kindra A Larson, Aisha Yousuf, Christina Lewickygaupp, Dee E Fenner, John O L Delancey
    Abstract:

    Objective The objective of the study was to describe a framework for visualizing the Perineal Body's complex anatomy using thin-slice magnetic resonance (MR) imaging. Study Design Two millimeter thick MR images were acquired in 11 women with normal pelvic support and no incontinence/prolapse symptoms. Anatomic structures were analyzed in axial, sagittal, and coronal slices. Three-dimensional (3-D) models were generated from these images. Results Three distinct Perineal Body regions are visible on MR imaging: (1) a superficial region at the level of the vestibular bulb, (2) a midregion at the proximal end of the superficial transverse Perineal muscle, and (3) a deep region at the level of the midurethra and puborectalis muscle. Structures are best visualized on axial scans, whereas craniocaudal relationships are appreciated on sagittal scans. The 3-D model further clarifies interrelationships. Conclusion Advances in MR technology allow visualization of Perineal Body anatomy in living women and development of 3-D models that enhance our understanding of its 3 different regions: superficial, mid, and deep.

Peter Petros - One of the best experts on this subject based on the ideXlab platform.

  • The Musculo-Elastic Theory of anorectal function and dysfunction
    2020
    Co-Authors: Peter Petros, Michael Swash
    Abstract:

    The Musculoelastic Theory of anorectal function and dysfunction states "Anorectal dysfunction in the female is mainly caused by lax suspensory ligaments inactivating anorectal muscle forces". Anorectal closure. The rectovaginal fascia inserts into Perineal Body, levator plate (LP) and the uterosacral ligaments . Contraction of levator plate stiffens rectovaginal fascia and both walls of rectum. Contraction of longitudinal muscle of the anus (LMA) against the uterosacral ligaments stretches the rectum around a contracted puborectalis muscle, to create the anorectal angle and closure. Defaecation. Puborectalis relaxes. Posteriorly acting LMA/LP vectors open out the anorectal angle; forward contraction of the pubococcygeus vector stiffens the Perineal Body, and anterior wall of anus; the rectum empties. Pathogenesis. Is similar to that described by the Integral Theory 1 for urinary incontinence: damaged ligaments decrease the force of opening and closure vectors. Surgery according to this theory. Reinforcement of damaged ligaments with precisely implanted polypropylene tapes restores structure and function.

  • Perineal Body repair in patients with third degree rectocele a critical analysis of the tissue fixation system
    Colorectal Disease, 2013
    Co-Authors: Florian M E Wagenlehner, G A Santoro, Peter Petros
    Abstract:

    Aim We describe the technique of tissue fixation system (TFS) Perineal Body repair in patients presenting with symptomatic third degree rectocele. Method The single sling TFS Perineal Body repair is performed in three surgical steps: (i) dissection of the rectum off the vagina and laterally displaced Perineal Body; (ii) identification of the deep transverse perineii muscles beyond their insertion point behind the descending pubic ramus; (iii) elevation and approximation of the separated and laterally displaced Perineal bodies by insertion, without tension, of non-stretch 7 mm polypropylene tape into the bodies of the deep transverse perineii muscles. Results From January 2007 to December 2009 we performed the TFS operation for 30 women, median age 61 (range 47–87) years, mean parity 2.6 (range 1–5), with third degree symptomatic low rectocele (median obstructive defaecation syndrome score 19; range 11–24). Median hospital stay was 24 (range 12–96) h. The median visual analogue scale for postoperative pain was 1 (range 1–7). Complications occurred in three cases (10%) and included a surfaced tape that was partly resected (repair maintained), a recurrence of the rectocele due to incorrect placement (failed repair) and a foreign Body abscess requiring tape removal. At 12-month follow-up, 27 patients (90%) reported normal defaecation and the median obstructive defaecation syndrome score was significantly reduced to 4 (range 1–6; P < 0.001). Conclusion The TFS Perineal Body repair is an effective, safe, minimally invasive treatment in women with symptomatic low rectocele.

  • Perineal Body repair in patients with third degree rectocele: a critical analysis of the tissue fixation system.
    Colorectal Disease, 2013
    Co-Authors: Florian M E Wagenlehner, G A Santoro, Peter Petros
    Abstract:

    Aim We describe the technique of tissue fixation system (TFS) Perineal Body repair in patients presenting with symptomatic third degree rectocele. Method The single sling TFS Perineal Body repair is performed in three surgical steps: (i) dissection of the rectum off the vagina and laterally displaced Perineal Body; (ii) identification of the deep transverse perineii muscles beyond their insertion point behind the descending pubic ramus; (iii) elevation and approximation of the separated and laterally displaced Perineal bodies by insertion, without tension, of non-stretch 7 mm polypropylene tape into the bodies of the deep transverse perineii muscles. Results From January 2007 to December 2009 we performed the TFS operation for 30 women, median age 61 (range 47–87) years, mean parity 2.6 (range 1–5), with third degree symptomatic low rectocele (median obstructive defaecation syndrome score 19; range 11–24). Median hospital stay was 24 (range 12–96) h. The median visual analogue scale for postoperative pain was 1 (range 1–7). Complications occurred in three cases (10%) and included a surfaced tape that was partly resected (repair maintained), a recurrence of the rectocele due to incorrect placement (failed repair) and a foreign Body abscess requiring tape removal. At 12-month follow-up, 27 patients (90%) reported normal defaecation and the median obstructive defaecation syndrome score was significantly reduced to 4 (range 1–6; P 

  • live anatomy of the Perineal Body in patients with third degree rectocele
    Colorectal Disease, 2013
    Co-Authors: Florian M E Wagenlehner, G A Santoro, Peter Petros
    Abstract:

    Aim In many pelvic floor disorders, the Perineal Body is damaged or destroyed. There is still a considerable variation in anatomical descriptions of the Perineal Body and even more debate with regard to its attachments and relationships. Cadaveric dissections do not always reflect the functional behaviour of structures in the pelvis and description of live anatomy on imaging studies is not always reliable. This study aimed to define the anatomy of the Perineal Body in patients with rectocele during the live dissection required for minimally invasive surgical repair. Method From January 2007 to December 2009 consecutive patients requiring surgery for third-degree rectocele and symptoms of obstructed defaecation were recruited. Participants underwent dissection of the Perineal Body, rectum and vagina preliminary to a tissue fixation system, an operation which inserts a tensioned tape to repair the Perineal Body. Results Thirty Caucasian female patients, mean age 61 (range 47–87) years, mean parity 2.6 (range 1–5), were included. Live dissection demonstrated that the Perineal Body was divided into two parts, joined by a stretched central part, anchored laterally by the deep transverse perineii muscle to the descending ramus of the pubic bone. The mean longitudinal length of the Perineal Body was 4.5 (3.5–5.5) cm, accounting for 50% of the posterior vaginal support. Conclusion In women with low rectocele, the Perineal Body appears to be divided into two parts, severely displaced behind the ischial tuberosities.

  • transvaginal Perineal Body repair for low rectocele
    Techniques in Coloproctology, 2013
    Co-Authors: Peter Petros, H Inoue
    Abstract:

    We describe our technique of low rectocele repair which is based on the approximation and lifting of the laterally displaced Perineal bodies (PBs) using the Tissue Fixation System©, a 7-mm-wide tensioned macropore polypropylene sling. In low rectocele, the PB between the rectum and vagina is thinned and laterally displaced but still attached to the deep transverse Perineal (DTP) muscle. Our technique is described with the aid of a video. The vagina and rectum are dissected off the laterally displaced PBs. The DTP attachment of each PB to the descending ramus is identified per rectum. A tunnel is created in the DTP on both sides to insert the polypropylene mesh attached to an anchor. The loop of tape between the anchors is shortened via the one-way system at the base of the anchor to elevate the inferolaterally displaced PBs to a more medial position. This is infiltrated by collagen over time, creating a “neo-central tendon.” The musculofascial layer of the rectum, the vagina, and superficial layers of the PBs are approximated. Our cure rate for low rectocele repair was in excess of 90 %, even with an early version of this procedure. Our method differs from rectocele repair with large mesh in that it precisely mimics the damaged structure and uses only very short thin strips of tape to approximate and reinforce PBs weakened by birth injury and age.

Aisha Yousuf - One of the best experts on this subject based on the ideXlab platform.

  • Perineal Body anatomy in living women: 3-dimensional analysis using thin-slice magnetic resonance imaging.
    American journal of obstetrics and gynecology, 2020
    Co-Authors: Kindra A Larson, Aisha Yousuf, Dee E Fenner, Christina Lewicky-gaupp, John O L Delancey
    Abstract:

    The objective of the study was to describe a framework for visualizing the Perineal Body's complex anatomy using thin-slice magnetic resonance (MR) imaging. Two millimeter thick MR images were acquired in 11 women with normal pelvic support and no incontinence/prolapse symptoms. Anatomic structures were analyzed in axial, sagittal, and coronal slices. Three-dimensional (3-D) models were generated from these images. Three distinct Perineal Body regions are visible on MR imaging: (1) a superficial region at the level of the vestibular bulb, (2) a midregion at the proximal end of the superficial transverse Perineal muscle, and (3) a deep region at the level of the midurethra and puborectalis muscle. Structures are best visualized on axial scans, whereas craniocaudal relationships are appreciated on sagittal scans. The 3-D model further clarifies interrelationships. Advances in MR technology allow visualization of Perineal Body anatomy in living women and development of 3-D models that enhance our understanding of its 3 different regions: superficial, mid, and deep. Copyright © 2010 Mosby, Inc. All rights reserved.

  • the length of anterior vaginal wall exposed to external pressure on maximal straining mri relationship to urogenital hiatus diameter and apical and bladder location
    International Urogynecology Journal, 2014
    Co-Authors: Aisha Yousuf, Luyun Chen, James A Ashtonmiller, Kindra A Larson, John O L Delancey
    Abstract:

    Introduction and hypothesis In cystoceles, the distal anterior vaginal wall (AVW) bulges out through the introitus and is no longer in contact with the posterior vaginal wall or Perineal Body, exposing the pressure differential between intra-abdominal pressure and atmospheric pressure. The goal of this study is to quantify the length of the exposed vaginal wall length and to investigate its relationship with other factors associated with the AVW support, such as most dependent bladder location, apical location, and hiatus diameter, demonstrating its key role in cystocele formation.

  • Levator defects affect Perineal position independently of prolapse status
    American Journal of Obstetrics and Gynecology, 2010
    Co-Authors: Natalie A. Clark, Aisha Yousuf, Cynthia Brincat, John O L Delancey
    Abstract:

    Objective The purpose of this study was to determine the effect of levator defects on Perineal position and movement irrespective of prolapse status. Study Design Forty women from an ongoing study were divided into 2 groups of 20 women with and without severe levator defects. Prolapse status was matched between groups, with 50% of the women having stage III or greater anterior wall prolapse. Perineal structure locations were measured against standard axes on magnetic resonance scans at rest, maximum contraction (Kegel), and maximum Valsalva maneuver. Differences in location were calculated and compared. Results In women with levator defects, independently of prolapse status: (1) At rest, the Perineal Body was 1.3 cm, and the anal sphincter was 1.0 cm more caudal ( P ≤ .01); at maximum contraction, the Perineal Body and the anal sphincter were both 1.2 cm more caudal ( P ≤ .01); with maximum Valsalva maneuver, the Perineal Body was 1.3 cm more caudal, and the anal sphincter was 1.2 cm more caudal ( P ≤ .01). (2) At rest, the levator hiatus was 0.8 cm larger, and the urogenital hiatus was 1.0 cm larger ( P ≤ .01). (3) At rest, the bladder was 0.07 cm more posterior ( P ≤ .02); with maximum contraction, it was 1.9 cm lower ( P ≤ .02). (4) With maximum Valsalva maneuver, the bladder was 1.5 cm lower and displaced further caudally ( P ≤ .03). Conclusion When we controlled for prolapse, the women with levator defects had a more caudal location of their Perineal structures and larger hiatuses at rest, maximum contraction, and maximum Valsalva maneuver.

  • Perineal Body anatomy in living women 3 dimensional analysis using thin slice magnetic resonance imaging
    American Journal of Obstetrics and Gynecology, 2010
    Co-Authors: Kindra A Larson, Aisha Yousuf, Christina Lewickygaupp, Dee E Fenner, John O L Delancey
    Abstract:

    Objective The objective of the study was to describe a framework for visualizing the Perineal Body's complex anatomy using thin-slice magnetic resonance (MR) imaging. Study Design Two millimeter thick MR images were acquired in 11 women with normal pelvic support and no incontinence/prolapse symptoms. Anatomic structures were analyzed in axial, sagittal, and coronal slices. Three-dimensional (3-D) models were generated from these images. Results Three distinct Perineal Body regions are visible on MR imaging: (1) a superficial region at the level of the vestibular bulb, (2) a midregion at the proximal end of the superficial transverse Perineal muscle, and (3) a deep region at the level of the midurethra and puborectalis muscle. Structures are best visualized on axial scans, whereas craniocaudal relationships are appreciated on sagittal scans. The 3-D model further clarifies interrelationships. Conclusion Advances in MR technology allow visualization of Perineal Body anatomy in living women and development of 3-D models that enhance our understanding of its 3 different regions: superficial, mid, and deep.

  • Pelvic structure and function at 1 month compared to 7 months by dynamic magnetic resonance after vaginal birth
    American Journal of Obstetrics and Gynecology, 2009
    Co-Authors: Aisha Yousuf, John O L Delancey, Catherine Brandon, Janis M. Miller
    Abstract:

    Objective We sought to determine whether changes exist in location and movement of pelvic floor structures at 1 and 7 months postpartum. Study Design Midsagittal magnetic resonance images from 13 primiparous women with birth events associated with levator ani damage at early (∼1 month) and late (∼7 months) postpartum time points were analyzed. Pelvic floor structure locations at rest and displacements from rest to maximum Kegel and Valsalva were determined. Urogenital and levator hiatus diameters were measured as well. Results The Perineal Body was 7.1 mm and anal verge 7.9 mm higher at 7 months postpartum ( P = .003). Both the urogenital and levator hiatus diameters were smaller at 7 months ( P Conclusion Resting locations of the Perineal Body and anal verge are higher at 7 months postpartum, but the amount of movement during Kegel or Valsalva does not change.

Kindra A Larson - One of the best experts on this subject based on the ideXlab platform.

  • Perineal Body anatomy in living women: 3-dimensional analysis using thin-slice magnetic resonance imaging.
    American journal of obstetrics and gynecology, 2020
    Co-Authors: Kindra A Larson, Aisha Yousuf, Dee E Fenner, Christina Lewicky-gaupp, John O L Delancey
    Abstract:

    The objective of the study was to describe a framework for visualizing the Perineal Body's complex anatomy using thin-slice magnetic resonance (MR) imaging. Two millimeter thick MR images were acquired in 11 women with normal pelvic support and no incontinence/prolapse symptoms. Anatomic structures were analyzed in axial, sagittal, and coronal slices. Three-dimensional (3-D) models were generated from these images. Three distinct Perineal Body regions are visible on MR imaging: (1) a superficial region at the level of the vestibular bulb, (2) a midregion at the proximal end of the superficial transverse Perineal muscle, and (3) a deep region at the level of the midurethra and puborectalis muscle. Structures are best visualized on axial scans, whereas craniocaudal relationships are appreciated on sagittal scans. The 3-D model further clarifies interrelationships. Advances in MR technology allow visualization of Perineal Body anatomy in living women and development of 3-D models that enhance our understanding of its 3 different regions: superficial, mid, and deep. Copyright © 2010 Mosby, Inc. All rights reserved.

  • the length of anterior vaginal wall exposed to external pressure on maximal straining mri relationship to urogenital hiatus diameter and apical and bladder location
    International Urogynecology Journal, 2014
    Co-Authors: Aisha Yousuf, Luyun Chen, James A Ashtonmiller, Kindra A Larson, John O L Delancey
    Abstract:

    Introduction and hypothesis In cystoceles, the distal anterior vaginal wall (AVW) bulges out through the introitus and is no longer in contact with the posterior vaginal wall or Perineal Body, exposing the pressure differential between intra-abdominal pressure and atmospheric pressure. The goal of this study is to quantify the length of the exposed vaginal wall length and to investigate its relationship with other factors associated with the AVW support, such as most dependent bladder location, apical location, and hiatus diameter, demonstrating its key role in cystocele formation.

  • Perineal Body anatomy in living women 3 dimensional analysis using thin slice magnetic resonance imaging
    American Journal of Obstetrics and Gynecology, 2010
    Co-Authors: Kindra A Larson, Aisha Yousuf, Christina Lewickygaupp, Dee E Fenner, John O L Delancey
    Abstract:

    Objective The objective of the study was to describe a framework for visualizing the Perineal Body's complex anatomy using thin-slice magnetic resonance (MR) imaging. Study Design Two millimeter thick MR images were acquired in 11 women with normal pelvic support and no incontinence/prolapse symptoms. Anatomic structures were analyzed in axial, sagittal, and coronal slices. Three-dimensional (3-D) models were generated from these images. Results Three distinct Perineal Body regions are visible on MR imaging: (1) a superficial region at the level of the vestibular bulb, (2) a midregion at the proximal end of the superficial transverse Perineal muscle, and (3) a deep region at the level of the midurethra and puborectalis muscle. Structures are best visualized on axial scans, whereas craniocaudal relationships are appreciated on sagittal scans. The 3-D model further clarifies interrelationships. Conclusion Advances in MR technology allow visualization of Perineal Body anatomy in living women and development of 3-D models that enhance our understanding of its 3 different regions: superficial, mid, and deep.

Vik Khullar - One of the best experts on this subject based on the ideXlab platform.

  • ultrasound imaging of the Perineal Body a useful clinical tool
    International Urogynecology Journal, 2020
    Co-Authors: Victoria Asfour, Giuseppe Alessandro Digesu, Ruwan Fernando, Vik Khullar
    Abstract:

    Introduction and hypothesis The Perineal Body is a fibromuscular pyramidal structure located between the vagina and the anus. It has been difficult to image because of its small size and anatomical location. This study used 2D transPerineal ultrasound to measure the Perineal Body and assess whether there is an association with prolapse.

  • Ultrasound imaging of the Perineal Body: a useful clinical tool
    International Urogynecology Journal, 2019
    Co-Authors: Victoria Asfour, Giuseppe Alessandro Digesu, Ruwan Fernando, Vik Khullar
    Abstract:

    Introduction and hypothesis The Perineal Body is a fibromuscular pyramidal structure located between the vagina and the anus. It has been difficult to image because of its small size and anatomical location. This study used 2D transPerineal ultrasound to measure the Perineal Body and assess whether there is an association with prolapse. Methods An observational, cross-sectional study was carried out in a tertiary level Urogynaecology department and included prolapse patients and healthy nulliparous volunteers (control group). This was a clinical assessment, including POP-Q and trans-Perineal 2D ultrasound measurement of the Perineal Body height, length, perimeter, and area. Parametric tests were used, as the data were normally distributed. Results are reported as mean and 95% confidence interval (±95% CI). Results A total of 101 participants were recruited of which 22 were nulliparous healthy volunteers. Mean Perineal Body measurements in controls were height 22.5 ± 3.3 mm, length 17.4 ± 2.7 mm, perimeter 7.5 ± 0.9 mm, and area 2.8 ± 0.38 cm^2. Perineal Body measurements in 79 prolapse patients: height 16.9 ± 1.7 mm, length 16.0 ± 1.4 mm, perimeter 6.5 ± 0.5 mm and area 2.1 ± 0.5 cm^2. A small Perineal Body was strongly associated with posterior compartment prolapse (paired t test, p