Functional Anatomy of the Female Pelvic Floor

The anatomic structures in the female that prevent incontinence and genital organ prolapse on increases in abdominal pressure during daily activities include sphincteric and supportive systems. In the urethra, the action of the vesical neck and urethral sphincteric mechanisms maintains urethral closure pressure above bladder pressure. Decreases in the number of striated muscle fibers of the sphincter occur with age and parity. A supportive hammock under the urethra and vesical neck provides a firm backstop against which the urethra is compressed during increases in abdominal pressure to maintain urethral closure pressures above the rapidly increasing bladder pressure. This supporting layer consists of the anterior vaginal wall and the connective tissue that attaches it to the pelvic bones through the pubovaginal portion of the levator ani muscle, and the uterosacral and cardinal ligaments comprising the tendinous arch of the pelvic fascia. At rest the levator ani maintains closure of the urogenital hiatus. They are additionally recruited to maintain hiatal closure in the face of inertial loads related to visceral accelerations as well as abdominal pressurization in daily activities involving recruitment of the abdominal wall musculature and diaphragm. Vaginal birth is associated with an increased risk of levator ani defects, as well as genital organ prolapse and urinary incontinence. Computer models indicate that vaginal birth places the levator ani under tissue stretch ratios of up to 3.3 and the pudendal nerve under strains of up to 33%, respectively. Research is needed to better identify the pathomechanics of these conditions.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72597/1/annals.1389.034.pd

Stress urinary incontinence and genital trauma after female pelvic trauma

Combined stress urinary incontinence (SUI) and genital prolapse after fracture of the female pelvis has not been well described to date; four such cases are reported. Three of the patients had undergone reconstructive urogynecologic surgery prior to referral. None of the patients had a history of urinary incontinence or genital prolapse prior to injury. In order to correct persistent urinary incontinence and prolapse the following operations were performed: pubovaginal sling and transvaginal cystocele repair, Raz needle suspension and rectus muscle graft to the pelvic floor followed by a unilateral Burch colposuspension. On follow-up at a mean interval of 14.2 months (range 12–17), 2 have mild SUI and all 4 are without significant genital prolapse.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45899/1/192_2004_Article_BF00372744.pd

MR Imaging of Levator Ani Muscle Recovery Following Vaginal Delivery

Our aim was to quantify the changes that occur in the levator ani muscles (LA) after vaginal delivery using magnetic resonance imaging. Fourteen women underwent MRI 1 day postpartum. Six of them were also scanned 1, 2, 6 weeks and 6 months after delivery. LA signal intensities and thickness, in areas of the urogenital and the levator hiatus were assessed in the transverse plane. Perineal body position was measured in the sagittal plane. One day postpartum a higher T 2 -signal intensity of the LA compared to the obturator internus muscle was found in all women and a lower T 1 -signal intensity in 8 of 12 women. By 6 months these differences were present in only 1 woman in the left LA. An elevation in perineal body position of 13.4 ±7.3 mm ( P <0.05), as well as a decrease in the area of the urogenital hiatus by 27% ( P <0.05) and of the levator hiatus by 22% ( P <0.05) by 2 weeks postpartum suggest a return of normal LA geometry. LA thickness showed interindividual variations, and a complete loss of LA tissue was found in 1 woman. Changes in LA signal intensity, topography and thickness during the puerperium can be documented using MR imaging.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/41860/1/192-10-5-300_90100300.pd

Population structure, growth and production of the wedge clam Donax hanleyanus (Bivalvia: Donacidae) from northern Argentinean beaches

Donax hanleyanus Philippi, 1847 (Bivalvia: Donacidae) dominates fine to coarse sandy beach communities of the northern Argentinean Atlantic coast. The population biology of this intertidal wedge clam was studied by determining population structure, growth and production at the three locations Santa Teresita, Mar de las Pampas (both from December 2005 to December 2006) and Faro Querand&#305;Ž (from March 2005 to December 2006). Von Bertalanffy growth functions were established from length-frequency distributions using an asymptotic length (LN) of 44 mm and the growth constants (K) of 0.46 and 0.47 y1 respectively of Mar de las Pampas and Faro Querand&#305;Ž. Compared with growth studies four decades ago, D. hanleyanus today is growing more slowly, but is reaching a higher maximum length. Longevity is estimated to be approximately five years. The present study confirms that the overall growth performance index is habitat-specific, grouping Donacidae into tropical/subtropical, temperate and upwelling species. The intertidal biomass of D. hanleyanus ranged between 0.04 and 1.32 g ash-free dry mass (AFDM) m2yr1. Individual production revealed the highest value at 30 mm length (0.16 g AFDM m2yr1) and annual production ranged between 0.08 and 0.99 g AFDMm2yr1, resulting in renewal rate values (P/B) between 0.82 and 2.16. The P/B ratios of D. hanleyanus populations increased with decreasing latitude from temperate to tropical regions. Only at Santa Teresita D. hanleyanus was found living with the sympatric yellow clam Mesodesma mactroides. A significant negative correlation between abundances of both surf clams suggests that abundance peaks of D. hanleyanus are related with population crashes of M. mactroides. Spatial differences in abundance are significantly related to sand texture as confirmed by nonmetrical multidimensional scaling, but not to sea surface temperature. However, the decrease of D. hanleyanus seems to be principally related to human activities

On pelvic reference lines and the MR evaluation of genital prolapse: a proposal for standardization using the Pelvic Inclination Correction System

Five midsagittal pelvic reference lines have been employed to quantify prolapse using MRI. However, the lack of standardization makes study results difficult to compare. Using MRI scans from 149 women, we demonstrate how use of existing reference lines can systematically affect measurements in three distinct ways: in oblique line systems, distances measured to the reference line vary with antero-posterior location; soft issue-based reference lines can underestimate organ movement relative to the pelvic bones; and systems defined relative to the MR scanner are affected by intra- and interindividual differences in the pelvic inclination angle at rest and strain. Thus, we propose a standardized approach called the Pelvic Inclination Correction System (PICS). Based on bony structures and the body axis, the PICS system corrects for variation in pelvic inclination, at rest of straining, and allows for the standardized measurement of organ displacement in the direction of prolapse