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State of the Art Pelvic Floor Anatomy

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Abstract

We frequently associate pelvic floor injury with parity, ageing, hysterectomy, and chronic straining. Exactly what structures are injured remains the focus of intense research. Therefore, basic understanding of pelvic floor anatomy is essential to effective communication between pelvic floor specialists. The goal of the current chapter is to lay a firm anatomic foundation for interpreting different imaging modalities by emphasizing pelvic floor innervations, morphology of the levator ani muscle by origin-insertion pairs, and fascial and muscular support of the anterior and posterior compartments.

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References

  1. Olsen AL, Smith VJ, Bergstrom JO et al. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol 1997;89:501.

    Article  CAS  PubMed  Google Scholar 

  2. Boyles SH, Weber AM, Meyn L. Procedures for pelvic organ prolapse in the United States, 1979–1997. Am J Obstet Gynecol 2003;188:108.

    Article  PubMed  Google Scholar 

  3. Boyles SH, Weber AM, Meyn L. Procedures for urinary incontinence in the United States, 1979–1997. Am J Obstet Gynecol 2003;189:70.

    Article  PubMed  Google Scholar 

  4. Bonney V. The principles that should underlie all operations for prolapse. Obstet Gynaecol Br Emp 1934;41:669.

    Google Scholar 

  5. DeLancey JO. Anatomic aspects of vaginal eversion after hysterectomy. Am J Obstet Gynecol 1992;166:1717–1724.

    CAS  PubMed  Google Scholar 

  6. Campbell RM. The anatomy and histology of the sacrouterine ligaments. Am J Obstet Gynecol 1950;59:1.

    CAS  PubMed  Google Scholar 

  7. Range RL, Woodburne RT. The gross and microscopic anatomy of the transverse cervical ligaments. Am J Obstet Gynecol 1964;90:460.

    CAS  PubMed  Google Scholar 

  8. Blaisdell FE. The anatomy of the sacro-uterine ligaments. Anat Record 1917;12:1–42.

    Article  Google Scholar 

  9. Umek WH, Morgan DM, Ashton-Miller JA, DeLancey JO. Quantitative analysis of uterosacral ligament origin and insertion points by magnetic resonance imaging. Obstet Gynecol 2004;103:447.

    PubMed  Google Scholar 

  10. Richardson AC, Edmonds PB, Williams NL. Treatment of stress urinary incontinence due to paravaginal fascial defect. Obstet Gynecol 1981;57:357.

    CAS  PubMed  Google Scholar 

  11. DeLancey JO. Fascial and muscular abnormalities in women with urethral hypermobility and anterior vaginal wall prolapse. Am J Obstet Gynecol 2002;187:93.

    Article  PubMed  Google Scholar 

  12. Ricci JV, Thom CH. The myth of a surgically useful fascia in vaginal plastic reconstructions. Q Rev Surg Obstet Gynecol 1954;11:253.

    CAS  Google Scholar 

  13. Gitsch E, Palmrich AH. Operative Anatomie. De Gruyter, Berlin, 1977.

    Google Scholar 

  14. Weber AM, Walters MD. Anterior vaginal prolapse: review of anatomy and techniques of surgical repair. Obstet Gynecol 1990;89:311.

    Article  Google Scholar 

  15. Oelrich TM. The striated urogenital sphincter muscle in the female. Anat Rec 1983;205;223–232.

    Article  CAS  PubMed  Google Scholar 

  16. DeLancey JO. Structural support of the urethra as it relates to stress urinary incontinence: the hammock hypothesis [comment]. Am J Obstet Gynecol 1994;170:1713.

    CAS  PubMed  Google Scholar 

  17. DeLancey JO, Toglia MR, Perucchini D. Internal and external anal sphincter anatomy as it relates to midline obstetric lacerations. Obstet Gynecol 1997;90:924.

    Article  CAS  PubMed  Google Scholar 

  18. Shobeiri SA, Chesson RR, Gasser RF. The internal innervation and morphology of the human female levator ani muscle. Am J Obstet Gynecol 2008;199:686.e1–6.

    Article  PubMed  Google Scholar 

  19. Hsu Y, Fenner DE, Weadock WJ, DeLancey JO. Magnetic resonance imaging and 3-dimensional analysis of external anal sphincter anatomy. Obstet Gynecol 2005;106:1259.

    PubMed  Google Scholar 

  20. Lawson JO. Pelvic anatomy. I. Pelvic floor muscles. Ann R Coll Surg Engl 1974;54:244.

    CAS  PubMed  Google Scholar 

  21. Kearney R, Sawhney R, DeLancey JO. Levator ani muscle anatomy evaluated by origin-insertion pairs. Obstet Gynecol 2004;104:168–173.

    PubMed  Google Scholar 

  22. Taverner D. An electromyographic study of the normal function of the external anal sphincter and pelvic diaphragm. Dis Colon Rectum 1959;2:153.

    Article  CAS  PubMed  Google Scholar 

  23. Nichols DH, Milley PS, Randall CL. Significance of restoration of normal vaginal depth and axis. Obstet Gynecol 1970;36:251.

    CAS  PubMed  Google Scholar 

  24. Paramore RH. The uterus as a floating organ. In: Paramore RH. The statistics of the female pelvic viscera, vol 1. HK Lewis and Co, London, 1918, pp 12–15.

    Google Scholar 

  25. Barber MD, Bremer RE, Thor KB et al. Innervation of the female levator ani muscles. Am J Obstet Gynecol 2002;187:64.

    Article  PubMed  Google Scholar 

  26. Wallner C, van Wissen J, Maas CP et al. The contribution of the levator ani nerve and the pudendal nerve to the innervation of the levator ani muscles; a study in human fetuses. Eur Urol 2008;54:1136.

    Article  PubMed  Google Scholar 

  27. Noelani M, Guaderrama NM, Liu J et al. Evidence for the innervation of pelvic floor muscles by the pudendal nerve. Obstet Gynecol 2005;106:774.

    Google Scholar 

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DeLancey, J.O.L., Shobeiri, S.A. (2010). State of the Art Pelvic Floor Anatomy. In: Santoro, G.A., Wieczorek, A.P., Bartram, C.I. (eds) Pelvic Floor Disorders. Springer, Milano. https://doi.org/10.1007/978-88-470-1542-5_1

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  • DOI: https://doi.org/10.1007/978-88-470-1542-5_1

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-1541-8

  • Online ISBN: 978-88-470-1542-5

  • eBook Packages: MedicineMedicine (R0)

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