Skip to main content

Advertisement

SpringerLink
Log in

Magnetic resonance imaging-based three-dimensional model of anterior vaginal wall position at rest and maximal strain in women with and without prolapse

  • Original Article
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

Abstract

Introduction and hypothesis

Two-dimensional magnetic resonance imaging (MRI) demonstrates apical support and vaginal length contribute to anterior wall prolapse (AWP). This paper describes a novel three-dimensional technique to examine the vagina and its relationship to pelvic sidewalls at rest and Valsalva.

Methods

Twenty women (10 with AWP and 10 with normal support) underwent pelvic magnetic resonance imaging at rest and Valsalva. Three-dimensional reconstructions of the pelvic bones and anterior vaginal wall were created to assess morphologic changes occurring in prolapse.

Results

In women with AWP, Valsalva caused downward translation of the vagina along its length. A transition point separated a proximal region supported by levator muscles and a distal, unsupported region no longer in contact with the perineal body. In this latter region, sagittal and frontal plane “cupping” occurs. The distal vagina rotated inferiorly along an arc centered on the inferior pubis.

Conclusion

Downward translation, cupping, and distal rotation are three novel characteristics of AWP demonstrated by this three-dimensional technique.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL (1997) Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol 89(4):501–506

    Article  CAS  PubMed  Google Scholar 

  2. Jelovsek JE, Maher C, Barber MD (2007) Pelvic organ prolapse. Lancet 369(9566):1027–1038

    Article  PubMed  Google Scholar 

  3. He W, Sengupta M, Velkoff V, DeBarros K (2005) 65± in the US: 2005, current population report, special studies. United States Government Printing Office, Washington DC. December 2005. Available from: www.census.gov

  4. Benson JT, Lucente V, McClellan E (1996) Vaginal versus abdominal reconstructive surgery for the treatment of pelvic support defects: a prospective randomized study with long-term outcome evaluation. Am J Obstet Gynecol 175(6):1418–1421, discussion 1421–1422

    Article  CAS  PubMed  Google Scholar 

  5. Nguyen JN, Burchette RJ (2008) Outcome after anterior vaginal prolapse repair: a randomized controlled trial. Obstet Gynecol 111(4):891–898

    PubMed  Google Scholar 

  6. Nguyen JK (2001) Current concepts in the diagnosis and surgical repair of anterior vaginal prolapse due to paravaginal defects. Obstet Gynecol Surv 56(4):239–246

    Article  CAS  PubMed  Google Scholar 

  7. Maher C, Baessler K (2006) Surgical management of anterior vaginal wall prolapse: an evidencebased literature review. Int Urogynecol J Pelvic Floor Dysfunct 17(2):195–201

    Article  PubMed  Google Scholar 

  8. Maher CF, Murray CJ, Carey MP, Dwyer PL, Ugoni AM (2001) Iliococcygeus or sacrospinous fixation for vaginal vault prolapse. Obstet Gynecol 98(1):40–44

    Article  CAS  PubMed  Google Scholar 

  9. Shull BL, Bachofen C, Coates KW, Kuehl TJ (2000) A transvaginal approach to repair of apical and other associated sites of pelvic organ prolapse with uterosacral ligaments. Am J Obstet Gynecol 183(6):1365–1373, discussion 1373–1374

    Article  CAS  PubMed  Google Scholar 

  10. Hsu Y, Chen L, Summers A, Ashton-Miller JA, DeLancey JO (2008) Anterior vaginal wall length and degree of anterior compartment prolapse seen on dynamic MRI. Int Urogynecol J Pelvic Floor Dysfunct 19(1):137–142

    PubMed  Google Scholar 

  11. Rooney K, Kenton K, Mueller ER, FitzGerald MP, Brubaker L (2006) Advanced anterior vaginal wall prolapse is highly correlated with apical prolapse. Am J Obstet Gynecol 195(6):1837–1840

    Article  PubMed  Google Scholar 

  12. Summers A, Winkel LA, Hussain HK, DeLancey JO (2006) The relationship between anterior and apical compartment support. Am J Obstet Gynecol 194(5):1438–1443

    Article  PubMed  Google Scholar 

  13. Delancey JO (2002) Fascial and muscular abnormalities in women with urethral hypermobility and anterior vaginal wall prolapse. Am J Obstet Gynecol 187(1):93–98

    Article  PubMed  Google Scholar 

  14. Larson KA, Hsu Y, DeLancey JO (2009) The relationship between superior attachment points for anterior wall mesh operations and the upper vagina using a 3-dimensional magnetic resonance model in women with normal support. Am J Obstet Gynecol 200(5):554.e1–554.e6

    Article  Google Scholar 

  15. Chen L, Ashton-Miller JA, Hsu Y, DeLancey JO (2006) Interaction among apical support, levator ani impairment, and anterior vaginal wall prolapse. Obstet Gynecol 108(2):324–332

    PubMed  Google Scholar 

  16. Chen L, Ashton-Miller JA, Delancey JO (2009) A 3D finite element model of anterior vaginal wall support to evaluate mechanisms underlying cystocele formation. J Biomech 42:1371–1277

    Article  PubMed  Google Scholar 

  17. Bertschinger KM, Hetzer FH, Roos JE, Treiber K, Marincek B, Hilfiker PR (2002) Dynamic MR imaging of the pelvic floor performed with patient sitting in an open-magnet unit versus with patient supine in a closed-magnet unit. Radiology 223(2):501–508

    Article  PubMed  Google Scholar 

  18. Fielding JR, Griffiths DJ, Versi E, Mulkern RV, Lee ML, Jolesz FA (1998) MR imaging of pelvic floor continence mechanisms in the supine and sitting positions. AJR Am J Roentgenol 171(6):1607–1610

    CAS  PubMed  Google Scholar 

  19. Barber MD, Brubaker L, Nygaard I, Wheeler TL 2nd, Schaffer J, Chen Z, Spino C (2009) Defining success after surgery for pelvic organ prolapse. Obstet Gynecol 114(3):600–609

    Article  PubMed  Google Scholar 

  20. Trowbridge ER, Fultz NH, Patel DA, DeLancey JO, Fenner DE (2008) Distribution of pelvic organ support measures in a population-based sample of middle-aged, community-dwelling African American and white women in southeastern Michigan. Am J Obstet Gynecol 198(5):548.e1-6

    Article  PubMed  Google Scholar 

  21. Swift S, Woodman P, O'Boyle A, Kahn M, Valley M, Bland D, Wang W, Schaffer J (2005) Pelvic Organ Support Study (POSST): the distribution, clinical definition, and epidemiologic condition of pelvic organ support defects. Am J Obstet Gynecol 192(3):795–806

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We gratefully acknowledge support from the National Institute of Child Health and Human Development Grants R01 HD 38665 with additional investigator support from the Office for Research on Women’s Health SCOR on Sex and Gender Factors Affecting Women’s Health 1 P50 HD044406.

Conflicts of interest

Dr. John OL DeLancey and Dr. James Ashton-Miller are consultants to American Medical Systems and Johnson and Johnson Personal Products. The other authors have no disclosures to report.

Author information

Authors and Affiliations

  1. Pelvic Floor Research Group, University of Michigan, Ann Arbor, MI, USA

    Kindra A. Larson, Yvonne Hsu, Luyun Chen, James A. Ashton-Miller & John O. L. DeLancey

  2. Department of Obstetrics and Gynecology, Division of Gynecology, University of Michigan, Ann Arbor, MI, USA

    Kindra A. Larson, Yvonne Hsu & John O. L. DeLancey

  3. Departments of Mechanical and Biomechanical Engineering, University of Michigan, Ann Arbor, MI, USA

    Luyun Chen & James A. Ashton-Miller

  4. Women’s Hospital L4100, 1500 East Medical Center Dr., Ann Arbor, MI, 48109-0276, USA

    Kindra A. Larson

Authors
  1. Kindra A. Larson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yvonne Hsu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Luyun Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. James A. Ashton-Miller
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. John O. L. DeLancey
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kindra A. Larson.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Larson, K.A., Hsu, Y., Chen, L. et al. Magnetic resonance imaging-based three-dimensional model of anterior vaginal wall position at rest and maximal strain in women with and without prolapse. Int Urogynecol J 21, 1103–1109 (2010). https://doi.org/10.1007/s00192-010-1161-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-010-1161-x

Keywords

Search

Navigation