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Levator ani

Pan Chi
The efficacy of laparoscopic total mesorectum excision (TME) has been confirmed by many clinical trials and guidelines. But two issues on laparoscopic TME are still questioned, including the integrity of specimen membrane of TME and the incidence of postoperative sexual dysfunction. According to my experiences and the primary results of the multicenter clinical trial (LASRE, identifier: NCT01899547) conducted by me, the integrity of the specimen membrane of laparoscopic TME is not inferior to the open TME...
October 25, 2016: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
Ingrid Volløyhaug, Isabelle van Gruting, Kim van Delft, Abdul H Sultan, Ranee Thakar
AIMS: To study changes in bladder neck, urethral mobility and urinary incontinence (UI) from pregnancy to 4 years postpartum and demonstrate any association to mode of delivery or presence of levator ani muscle (LAM) injury. Secondly, we aimed to correlate bladder neck and urethral mobility to UI symptoms. METHODS: Prospective study of 180 women, recruited in their first pregnancy and followed up 1 and/or 4 years postpartum. UI symptoms were assessed with a validated questionnaire...
October 24, 2016: Neurourology and Urodynamics
Shintaro Makino, Jun Takeda, Satoru Takeda
No abstract text is available yet for this article.
October 2016: Taiwanese Journal of Obstetrics & Gynecology
Rahul Gujrathi, Kanchan Gupta, Chetan Ravi, Bhujang Pai
BACKGROUND: Sciatica has been classically described as pain in the back and hip with radiation in the leg along the distribution of the sciatic nerve, secondary to compression or irritation of the sciatic nerve. Spinal abnormality being the most common etiology, is one of the most common indications for MRI of the lumbosacral spine. Here we describe imaging findings secondary to a supralevator perianal abscess causing irritation of the sciatic nerve, which was diagnosed on MRI of the lumbosacral spine...
2016: Polish Journal of Radiology
Diego Raimondo, Aly Youssef, Mohamed Mabrouk, Simona Del Forno, Valentina Martelli, Gianluigi Pilu, Nicola Rizzo, Letizia Zannoni, Roberto Paradisi, Renato Seracchioli
OBJECTIVE: Pelvic floor muscle (PFM) dysfunction seems to play an important role in the pathophysiology of pain in women with with pelvic pain syndromes, including deep infiltrating endometriosis (DIE). The aim of the study was to evaluate static and dynamic morphometry of PFM in women affected by DIE, in comparison to asymptomatic control women, using three-dimensional (3D) and four-dimensional (4D) transperineal ultrasound. METHODS: A pilot, prospective study was conducted between March 2015 and November 2015, at our tertiary center...
October 8, 2016: Ultrasound in Obstetrics & Gynecology
Adil E Bharucha, Tae Hee Lee
Although pelvic pain is a symptom of several structural anorectal and pelvic disorders (eg, anal fissure, endometriosis, and pelvic inflammatory disease), this comprehensive review will focus on the 3 most common nonstructural, or functional, disorders associated with pelvic pain: functional anorectal pain (ie, levator ani syndrome, unspecified anorectal pain, and proctalgia fugax), interstitial cystitis/bladder pain syndrome, and chronic prostatitis/chronic pelvic pain syndrome. The first 2 conditions occur in both sexes, while the latter occurs only in men...
October 2016: Mayo Clinic Proceedings
Mark S Cook, Laura Bou-Malham, Mary C Esparza, Marianna Alperin
INTRODUCTION AND HYPOTHESIS: Pelvic floor muscle rehabilitation is a widely utilized, but often challenging therapy for pelvic floor disorders, which are prevalent in older women. Regimens involving the use of appendicular muscles, such as the obturator internus (OI), have been developed for strengthening of the levator ani muscle (LAM). However, changes that lead to potential dysfunction of these alternative targets in older women are not well known. We hypothesized that aging negatively impacts OI architecture, the main determinant of muscle function, and intramuscular extracellular matrix (ECM), paralleling age-related alterations in LAM...
October 4, 2016: International Urogynecology Journal
Hamad T Saleemi, Henna Farooque, Sunia Choudhury, Jun Zhang
No abstract text is available yet for this article.
September 2016: PM & R: the Journal of Injury, Function, and Rehabilitation
Danny Badawy, Elie El Rassy, Fouad Aoun, Roland Van Velthoven
High intensity focused ultrasound (HIFU) is a minimally invasive treatment option that might be considered in the management of localized prostate cancer. It is a well-tolerated treatment with few minor urologic complications and no major toxicities. In this paper, we report to our knowledge the first case of levator ani necrosis in a patient treated with HIFU, manifesting as sturdy perineal pain, which took years of NSAID intake and serial MRIs to demonstrate partial improvement. Therefore, we regard HIFU as a serious potential treatment option that still requires longer follow-up data before its approval in the personalized treatment panel of prostate cancer...
2016: Case Reports in Urology
Gökmen Sukgen, Esra Saygılı Yılmaz, Eralp Başer
Purpose. We present a case report of a woman with total POP and SUI who was treated with a technique utilizing vaginal hysterectomy followed by the placement of a four-arm synthetic polypropylene mesh implant system. Methods. An 81-year-old grand-multiparous woman presented to our clinic complaining of a vaginally protruding mass and urinary incontinence. A surgical approach including vaginal hysterectomy, anterior four-arm mesh implant, posterior large segment vaginal enterocele repair, and perineoplasty with levator ani fixation was planned...
2016: Case Reports in Obstetrics and Gynecology
E L Arreza, N P Pangilinan
No abstract text is available yet for this article.
September 2016: Ultrasound in Obstetrics & Gynecology
Aly Youssef, Marta Cavalera, Giuseppina Pacella, Ginevra Salsi, Giovanni Morganelli, Elisa Montaguti, Ilaria Cataneo, Gianluigi Pilu, Nicola Rizzo
OBJECTIVES: Caudal distension of female pelvic floor is common and results in perineal descent and a caudally curved hiatus (so called 'warping'). All the available ultrasound techniques to date however aim to reconstruct the pelvic floor using linear techniques (flat plane reconstruction). We aimed to evaluate the feasibility, reproducibility and potential usefulness of a new 3D technique, capable of reconstructing a curved plane of the levator hiatus. METHODS: We recruited a group of primiparous women to perform a 3D/4D transperineal ultrasound 3-6 months after delivery...
September 19, 2016: Ultrasound in Obstetrics & Gynecology
Louise T S Arenholt, Bodil Ginnerup Pedersen, Karin Glavind, Marianne Glavind-Kristensen, John O L DeLancey
INTRODUCTION AND HYPOTHESIS: The paravaginal defect has been a topic of active discussion concerning what it is, how to diagnose it, its role in anterior vaginal wall prolapse, and if and how to repair it. The aim of this article was to review the existing literature on paravaginal defect and discuss its role in the anterior vaginal wall support system, with an emphasis on anatomy and imaging. METHODS: Articles related to paravaginal defects were identified through a PubMed search ending 1 July 2015...
September 17, 2016: International Urogynecology Journal
Gerda Trutnovsky, Ixora Kamisan Atan, Daniela Ulrich, Andrew Martin, Hans P Dietz
INTRODUCTION: The study aimed to analyze the relation between the degree of puborectalis muscle trauma and subjective symptoms and objective findings of pelvic organ prolapse (POP), comparing two continuous scoring systems with a discrete scoring system for translabial ultrasound imaging. MATERIAL AND METHODS: In this retrospective observational study the records of patients attending a tertiary urogynecological unit between January 2012 and December 2014 were analyzed...
September 13, 2016: Acta Obstetricia et Gynecologica Scandinavica
Stefan B Albrich, K Welker, B Wolpert, J Steetskamp, S Porta, A Hasenburg, C Skala
INTRODUCTION: Pelvic floor ultrasound plays a major role in urogynecologic diagnostics. Using 3D ultrasound we can identify integrity of levator ani and measure hiatal area in the axial plane. The main goal of our study was to measure hiatal area on Valsalva in a cohort of urogynecological patients. Furthermore, we aimed to correlate hiatal area with urogynecological symptoms, levator integrity and evaluate cut-off values for pelvic organ prolapse. MATERIALS AND METHODS: In a retrospective analysis, we included 246 patients seen for urogynecological problems in our tertiary urogynecological unit...
September 12, 2016: Archives of Gynecology and Obstetrics
Luyun Chen, Sean Lisse, Kindra Larson, Mitchell B Berger, James A Ashton-Miller, John O L DeLancey
OBJECTIVE: To test the null hypothesis that six factors representing potential fascial and muscular failure sites contribute equally to the presence and size of a cystocele: two vaginal attachment factors (apical support and paravaginal defects), two vaginal wall factors (vaginal length and width), and two levator ani factors (hiatus size and levator ani defects). METHODS: Thirty women with anterior-predominant prolapse (women in a case group) and 30 women in a control group underwent three-dimensional stress magnetic resonance imaging...
October 2016: Obstetrics and Gynecology
F Cour, L Le Normand, G Meurette
OBJECTIVE: The aim was to review the safety and efficacy of surgery for posterior vaginal wall prolapse by vaginal route, in order to identify a therapeutic algorithm based on benefit/risk evaluation of each surgical procedure. MATERIAL AND METHODS: We performed a review of the litterature published up to september 2015 (PubMed, Medline, Cochrane library, Cochrane database of systemactic reviews) according to the HAS methodology. Level evidence (1 to 4) was determined for each study as well as evidence based recommendations (A, B, C or professional agreement)...
July 2016: Progrès en Urologie
Jenny Kurz, Diane Borello-France
BACKGROUND AND PURPOSE: Postpartum women with pelvic organ prolapse (POP) and urinary incontinence (UI) are often managed by physical therapists specializing in women's health. Movement system impairments often co-exist in this patient population. The purpose of this case study was to describe the physical therapy management of a post-partum female with POP complicated by additional pelvic symptoms. CASE DESCRIPTION: A 31-year-old post-partum female presented with POP, diastasis recti, UI, and constipation...
September 1, 2016: Physical Therapy
Jeffrey H Plochocki, Jose R Rodriguez-Sosa, Brent Adrian, Saul A Ruiz, Margaret I Hall
INTRODUCTION: Modern anatomical and surgical references illustrate perineal muscles all innervated by branches of the pudendal nerve but still organized into anatomically distinct urogenital and anal triangles with muscles inserting onto a central perineal body. However, this conflicts with the anatomy commonly encountered during dissection. MATERIALS AND METHODS: We use dissections of 43 human cadavers to characterize the anatomical organization of the human perineum and compare our findings to standard references...
August 26, 2016: Clinical Anatomy
Ladislav Krofta, Linda Havelková, Iva Urbánková, Michal Krčmář, Luděk Hynčík, Jaroslav Feyereisl
INTRODUCTION AND HYPOTHESIS: During vaginal delivery, the levator ani muscle (LAM) undergoes severe deformation. This stress can lead to stretch-related LAM injuries. The objective of this study was to develop a sophisticated MRI-based model to simulate changes in the LAM during vaginal delivery. METHODS: A 3D finite element model of the female pelvic floor and fetal head was developed. The model geometry was based on MRI data from a nulliparous woman and 1-day-old neonate...
August 25, 2016: International Urogynecology Journal
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