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Measurement of the 3D geometry of the fascial arches in women with a unilateral levator defect and “architectural distortion”

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Abstract

Introduction and hypothesis

The arcus tendineus fascia pelvis (ATFP) and arcus tendineus levator ani (ATLA) are elements of anterior vaginal support. This study describes their geometry in women with unilateral levator ani muscle defects and associated “architectural distortion.”

Methods

Fourteen subjects with unilateral defects underwent MRI. 3D models of the arcus were generated. The locations of these relative to an ilial reference line were compared between the unaffected and affected sides.

Results

Pronounced changes occurred on the defect sides’ ventral region. The furthest point of the ATLA lays up to a mean of 10 mm (p = 0.01) more inferior and 6.5 mm (p = 0.02) more medial than that on the intact side. Similarly, the ATFP lays 6 mm (p = 0.01) more inferior than on the unaffected side.

Conclusions

The ventral arcus anatomy is significantly altered in the presence of levator defects and architectural distortion. Alterations of these key fixation points will change the supportive force direction along the lateral anterior vaginal wall, increasing the risk for anterior vaginal wall prolapse.

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Acknowledgements

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

Financial disclaimers

Dr. John OL DeLancey and Dr. James Ashton-Miller receive research support from American Medical Systems and Kimberly Clark. Dr. DeLancey has been a consultant for Johnson and Johnson. Jiajia Luo’s doctoral studies are partially funded by American Medical Systems.

Conflicts of interest

None.

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Corresponding author

Correspondence to Kindra A. Larson.

Additional information

Presented at the 30th Annual Scientific Meeting for the American Urogynecologic Society, Hollywood, FL, USA, September 2009

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Larson, K.A., Luo, J., Yousuf, A. et al. Measurement of the 3D geometry of the fascial arches in women with a unilateral levator defect and “architectural distortion”. Int Urogynecol J 23, 57–63 (2012). https://doi.org/10.1007/s00192-011-1528-7

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  • DOI: https://doi.org/10.1007/s00192-011-1528-7

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