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Pelvic Floor Anatomy as It Relates to the Design and Development of Vaginal Mesh Kits

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The Innovation and Evolution of Medical Devices

Abstract

Pelvic floor architectural defects are related to parity, aging, hysterectomy, and chronic straining. The muscles and the supportive connective tissue can be torn, stretched, or denervated. Basic understanding of pelvic floor anatomy is essential to understanding why the use of vaginal mesh kits was seen as a plausible surgical solution. The goal of the current chapter is to use the suspension bridge analogy and simple representative drawings to communicate to readers the complex pelvic floor anatomy and function and the rationale behind mesh usage.

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References

  1. NIH state-of-the science conference statement on prevention of fecal and urinary incontinence in adults. NIH Consens State Sci Statements. 2007;24(1):1–37.

    Google Scholar 

  2. Nygaard I, Barber MD, Burgio KL, Kenton K, Meikle S, Schaffer J, et al. Prevalence of symptomatic pelvic floor disorders in US women. JAMA. 2008;300(11):1311–6.

    Article  CAS  Google Scholar 

  3. Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol. 1997;89(4):501–6.

    Article  CAS  Google Scholar 

  4. Boyles SH, Weber AM, Meyn L. Procedures for pelvic organ prolapse in the United States, 1979–1997. Am J Obstet Gynecol. 2003;188(1):108–15.

    Article  Google Scholar 

  5. Smith FJ, Holman CD, Moorin RE, Tsokos N. Lifetime risk of undergoing surgery for pelvic organ prolapse. Obstet Gynecol. 2010;116(5):1096–100.

    Article  Google Scholar 

  6. Aigmueller T, Dungl A, Hinterholzer S, Geiss I, Riss P. An estimation of the frequency of surgery for posthysterectomy vault prolapse. Int Urogynecol J. 2010;21(3):299–302.

    Article  Google Scholar 

  7. Quiroz LH, Munoz A, Shippey SH, Gutman RE, Handa VL. Vaginal parity and pelvic organ prolapse. J Reprod Med. 2010;55(3–4):93–8.

    PubMed  PubMed Central  Google Scholar 

  8. Boreham MK, Wai CY, Miller RT, Schaffer JI, Word RA. Morphometric analysis of smooth muscle in the anterior vaginal wall of women with pelvic organ prolapse. Am J Obstet Gynecol. 2002;187(1):56–63.

    Article  Google Scholar 

  9. Morgan DM, Rogers MA, Huebner M, Wei JT, Delancey JO. Heterogeneity in anatomic outcome of sacrospinous ligament fixation for prolapse: a systematic review. Obstet Gynecol. 2007;109(6):1424–33.

    Article  Google Scholar 

  10. Jakus SM, Shapiro A, Hall CD. Biologic and synthetic graft use in pelvic surgery: a review. Obstet Gynecol Surv. 2008;63(4):253–66.

    Article  Google Scholar 

  11. Burger JW, Luijendijk RW, Hop WC, Halm JA, Verdaasdonk EG, Jeekel J. Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg. 2004;240(4):578–83. discussion 583-5

    PubMed  PubMed Central  Google Scholar 

  12. Luijendijk RW, Hop WC, van den Tol MP, de Lange DC, Braaksma MM, Ijzermans JN, et al. A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med. 2000;343(6):392–8.

    Article  CAS  Google Scholar 

  13. Ricci JV, Thom CH. The myth of a surgically useful fascia in vaginal plastic reconstructions. Q Rev Surg Obstet Gynecol. 1954;11(4):253–61.

    CAS  Google Scholar 

  14. Gitsch E, Palmrich AH. Operative anatomie. Berlin: De Gruyter; 1977.

    Book  Google Scholar 

  15. Albright T, Gehrich A, Davis G, Sabi F, Buller J. Arcus tendineus fascia pelvis: a further understanding. Am J Obstet Gynecol. 2005;193(3):677–81.

    Article  Google Scholar 

  16. DeLancey JO. Anatomic aspects of vaginal eversion after hysterectomy. Am J Obstet Gynecol. 1992;166(6 Pt 1):1717–24. discussion 1724-8

    Article  CAS  Google Scholar 

  17. Shobeiri SA, Leclaire E, Nihira MA, Quiroz LH, O’Donoghue D. Appearance of the levator ani muscle subdivisions in endovaginal three-dimensional ultrasonography. Obstet Gynecol. 2009;114(1):66–72.

    Article  Google Scholar 

  18. Campbell RM. The anatomy and histology of the sacrouterine ligaments. Am J Obstet Gynecol. 1950;59(1):1–12.

    Article  CAS  Google Scholar 

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

    Article  CAS  Google Scholar 

  20. Richardson AC, Edmonds PB, Williams NL. Treatment of stress urinary incontinence due to paravaginal fascial defect. Obstet Gynecol. 1981;57(3):357–62.

    CAS  PubMed  Google Scholar 

  21. DeLancey J. Fascial and muscular abnormalities in women with urethral hypermobility and anterior vaginal wall prolapse. Am J Obstet Gynecol. 2002;187(1):93–8.

    Article  Google Scholar 

  22. Chesson RR, Schlossberg SM, Elkins TE, Menefee S, McCammon K, Franco N, et al. The use of fascia lata graft for correction of severe or recurrent anterior vaginal wall defects. J Pelvic Surg. 1999;5(2):96–103.

    Google Scholar 

  23. Bump RC, Mattiasson A, Bo K, Brubaker LP, DeLancey JO, Klarskov P, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol. 1996;175(1):10–7.

    Article  CAS  Google Scholar 

  24. Oelrich T. The striated urogenital sphincter muscle in the female. Anat Rec. 1983;205(2):223–32.

    Article  CAS  Google Scholar 

  25. Dwyer PL, O’Reilly BA. Transvaginal repair of anterior and posterior compartment prolapse with Atrium polypropylene mesh. Br J Obstet Gynaecol. 2004;111(8):831–6.

    Article  Google Scholar 

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

    Article  Google Scholar 

  27. Lawson JO. Pelvic anatomy. I. Pelvic floor muscles. Ann R Coll Surg Engl. 1974;54(5):244–52.

    CAS  PubMed  PubMed Central  Google Scholar 

  28. Kearney R, Sawhney R, DeLancey JOL. Levator ani muscle anatomy evaluated by origin-insertion pairs. Obstet Gynecol. 2004;104(1):168–73.

    Article  Google Scholar 

  29. Taverner D, Smiddy FG. An electromyographic study of the normal function of the external anal sphincter and pelvic diaphragm. Dis Colon Rectum. 1959;2(2):153–60.

    Article  CAS  Google Scholar 

  30. Nichols DH, Milley PS, Randall CL. Significance of restoration of normal vaginal depth and axis. Obstet Gynecol. 1970;36(2):251–6.

    CAS  PubMed  Google Scholar 

  31. Boreham MK, Wai CY, Miller RT, Schaffer JI, Word RA. Morphometric properties of the posterior vaginal wall in women with pelvic organ prolapse. Am J Obstet Gynecol. 2002;187(6):1501–8; discussion 1508–9.

    Article  Google Scholar 

  32. Takac P, Gualtieri M, Nassiri M, Candiotti K, Medina CA. Vaginal smooth muscle cell apoptosis is increased in women with pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(11):1559–64.

    Article  Google Scholar 

  33. Guaderrama NM, Liu J, Nager CW, Pretorius DH, Sheean G, Kassab G, et al. Evidence for the innervation of pelvic floor muscles by the pudendal nerve. Obstet Gynecol. 2005;106(4):774–81.

    Article  Google Scholar 

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Correspondence to S. Abbas Shobeiri .

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Alshiek, J., Shobeiri, S.A. (2019). Pelvic Floor Anatomy as It Relates to the Design and Development of Vaginal Mesh Kits. In: Shobeiri, S. (eds) The Innovation and Evolution of Medical Devices. Springer, Cham. https://doi.org/10.1007/978-3-319-97073-8_7

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  • DOI: https://doi.org/10.1007/978-3-319-97073-8_7

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-97072-1

  • Online ISBN: 978-3-319-97073-8

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