Uterosacral ligament vaginal vault suspension: With aging populations, primary pelvic organ and recurrent pelvic organ prolapse have become a large-scale public health concern.
Surgical options for patients include both abdominal and vaginal approaches, each with its own safety and efficacy profiles. This review summarizes the most recent anatomic, surgical and outcome data for uterosacral ligament vault suspension. It offers data on methods to avoid complications and difficult surgical scenarios.
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Uterosacral ligament suspension allows reattachment of the vaginal vault high within the pelvis. New modifications in technique including the extraperitoneal and laparoscopic approaches allow surgeons more freedom when planning surgery.
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Five-year data on the durability of the procedure make it a viable surgical option. As a technique widely used by many pelvic reconstructive surgeons, uterosacral ligament vault suspension provides a safe, anatomically correct and durable approach to uterine and vault prolapse. It requires advanced surgical training and an intimate understanding of pelvic anatomy to avoid and identify ureteral injury. Microarray gene expression analysis of uterosacral ligaments in uterine prolapse.
Pelvic organ prolapse POP is a major health problem that impairs the quality of life with a wide clinical spectrum. Since the uterosacral ligaments provide primary support for the uterus and the upper vagina, we hypothesize that the disruption of these ligaments may lead to a loss of support and eventually contribute to POP.
In this study, we therefore investigated whether there are any differences in the transcription profile of uterosacral ligaments in patients with POP when compared to those of the control samples. Seventeen women with POP and 8 non-POP controls undergoing hysterectomy for benign conditions were included in the study. To evaluate the association between ultrasound measurements of endometriosis nodules on the uterosacral ligament USL and the risk of ureteral involvement, as well as to assess whether associations with other ultrasound variables increase the sensitivity and specificity of the diagnosis of ureteral
Yiannis hrysomallis wife sexual dysfunction. Four hundred sixty-three "Yiannis hrysomallis wife sexual dysfunction" with deep infiltrating endometriosis DIE.
Patients diagnosed with DIE underwent transvaginal ultrasound endometriosis mapping before laparoscopic surgery for full excision of endometriotic lesions. Preoperative ultrasound evaluation, intra- and postoperative assessment, and anatomopathologic confirmation.
Of the patients who participated in the study, Receiver operating characteristic curve analysis showed that the size of the USL nodule had a statistically significant association with ipsilateral ureteral involvement. After multivariate logistic regression, the variables reduction in ovarian mobility, ureteral changes on the right side, size of the USL nodule, and presence of endometrioma on the left side were significantly associated with a ureteral endometriosis nodule.
However, the combined
Yiannis hrysomallis wife sexual dysfunction for the variables cited was worse than the diagnostic analysis using only the size of the USL nodule. Uterosacral ligament nodules with ultrasound measurements of 1. Even with the association of other ultrasound variables, there was no improvement in sensitivity.
Therefore, USL nodule size is a key measure for therapeutic planning and consent of the patient. Published by Elsevier Inc. OBJECTIVE To estimate the percentage of healthy women in whom the uterosacral ligaments are identifiable on standard magnetic resonance imaging MRI scans and to determine origin points from the genital tract and insertion points on the pelvic sidewall.
They were eligible if the most dependent vaginal wall point lay at least 1 cm above the hymenal ring remnant during a Valsalva maneuver. Axial proton density MRI of the entire pelvis was analyzed at 5-mm intervals. All results were referenced to the ischial spine.
We determined the visibility of the uterosacral ligaments and located their origins from the genital tract and their insertion points on the pelvic sidewall. Three regions of origin were found: Although uterosacral ligament morphology was similar bilaterally, its cranio-caudal extent was greater on the right side.
Anatomy and histology of apical support: The objective of this work was to collect and summarize relevant literature on the anatomy, histology, and imaging of apical support of the upper vagina and the uterus provided by the cardinal CL and uterosacral USL ligaments. A literature search in English, French, and German languages was carried out with the keywords apical support, cardinal ligamenttransverse cervical ligamentMackenrodt ligamentparametrium, paracervix, retinaculum uteri, web, uterosacral ligamentand sacrouterine ligament in the PubMed database.
Other relevant journal and textbook articles were sought by retrieving references cited in previous PubMed articles. Fifty references were examined in peer-reviewed journals and textbooks.
It has a superficial and deep component. Autonomous nerve fibers are a major constituent of the deep USL. It is divided into a cranial vascular and a caudal neural portions. Histologically, it contains mainly vessels, with no distinct band of connective tissue. USL and CL are visceral ligamentswith mesentery-like structures containing vessels, nerves, connective tissue, and adipose tissue.
Histo-mechanical properties of the swine cardinal and uterosacral ligaments. The focus of this study was to determine the structural and mechanical properties of two major ligaments that
Yiannis hrysomallis wife sexual dysfunction the uterus, cervix, and vagina: The adult swine was selected as animal model. Scanning electron microscopy was employed to visualize the through-thickness organization of the collagen fibers.
"Yiannis hrysomallis wife sexual dysfunction" connective tissue with a high content of elastin and collagen fibers was observed in the USL.
Loose connective tissue with a considerable amount of smooth muscle cells and ground substance was detected in both the CL and USL. Collagen fibers, smooth muscle cells, blood vessels, and nerve fibers were arranged primarily in the plane of the ligaments. The USL was significantly stronger than the CL with higher ultimate stress and tangent modulus of the linear region of the stress-strain curve.
Knowledge about the mechanical properties of the CL and USL will aid in the design of novel mesh materials, stretching routines, and surgical procedures for pelvic floor disorders. Cardinal and deep uterosacral ligament lines of action: MRI based 3D technique development and preliminary findings
Yiannis hrysomallis wife sexual dysfunction normal women.
Introduction and hypothesis The cardinal ligament CL and deep uterosacral ligament US play a critical role in utero-vaginal support. This study aims to quantify their geometrical relationships in living women using a MRI-based 3D technique.
Methods The angles between ligamentsthe ligaments length and curvature were assessed on 3D models constructed from twenty MRIs of volunteers with normal support. How angle variation theoretically affects ligament tension was investigated using a simplified biomechanical model. Results The CLs are The CLs are longer and more curved than US. The tensions on these ligaments are affected by their orientations. Pregnancy impact on uterosacral ligament and pelvic muscles using a 3D numerical and finite element model: We studied the geometry of and changes in structures that play an important role in stabilizing the pelvic system during pregnancy using a numerical system at different gestational ages and postpartum.
Organs, muscles, and ligaments were segmented to generate a 3D model of the pelvis. We studied changes in the length of uterosacral ligaments USL and thickness of the puborectal portion of the levator ani muscle LAM during and after pregnancy. We used this model to perform finite element FE simulation and analyze deformations of these structures under stress from the increase in uterine weight. Analysis reveals an increase in the length of US ligaments at 16, 32, and 38 weeks. Two months after delivery, it decreases without returning to the length at 16 weeks of pregnancy.
Similar changes were observed for the puborectal portion of the LAM. Variations observed in these structures are not equivalent to other anatomical structures of pelvic suspension. FE simulation with increased uterus weight does not lead to those findings. This analysis brings new elements and a new focus for discussion relating to changes in pelvic balance of parturient women that are not simply linked to the increase in uterine volume. Ex vivo pharmacology of surgical samples
Yiannis hrysomallis wife sexual dysfunction the uterosacral ligament.
Effects of carbachol and oxytocin on smooth muscle. In a previous study we observed impaired smooth muscle in the uterosacral ligament USL of patients with pelvic organ prolapse. The aims of the study were to describe the method of the novel microperfusion system and to determine normal function and pharmacology of smooth muscle in the USL. Samples from the USL were obtained during hysterectomy for benign reasons. Small stretches of connective tissue were mounted in a perfusion chamber under the stereomicroscope.
Isotonic contractions of smooth muscle were monitored by digital time-lapse video and quantified by image processing. Constant perfusion with carbachol elicited tonic and pulse stimulation with carbachol and oxytocin rhythmic contractions of smooth muscle in the ground reticulum. Under constant perfusion with relaxin the tonic contraction after carbachol was abolished. With the novel microperfusion system, isotonic contractions of smooth muscle in the USL can be recorded and quantified in the "Yiannis hrysomallis wife sexual dysfunction" microenvironment on the microscopic level.
The USL smooth muscle is cholinergic, stimulated by oxytocin and modulated by relaxin. The Manchester-Fothergill procedure versus vaginal hysterectomy with uterosacral ligament suspension: This study compares vaginal
Yiannis hrysomallis wife sexual dysfunction with uterosacral ligament suspension VH with the Manchester-Fothergill procedure MP for treating pelvic organ prolapse POP in the apical compartment. Yiannis hrysomallis wife sexual dysfunction matched historical cohort study is based on data from four Danish databases and the corresponding electronic medical records.
The main outcome was recurrent or de novo POP in any compartment. Secondary outcomes were recurrent or de novo POP in each compartment and complications. Recurrence in the apical compartment occurred in 5.
In the anterior compartment, rates of recurrent or de novo POP were There were more perioperative complications 2.
Effects of combined anterior and posterior plication of the glenohumeral ligament complex for the repair of anterior glenohumeral instability: Arthroscopic repair techniques for anterior instability most commonly address only the anterior band of the inferior glenohumeral ligament.
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This study quantitatively evaluated and compared the combined anterior and posterior arthroscopic plication by repairing both the anterior and posterior bands of the inferior glenohumeral ligament with the anterior arthroscopic plication alone. The anterior plication shifted the humeral head posterior in external rotation, whereas the combined anterior and posterior plication shifted the humeral head anterior in internal rotation P plication to anterior plication for anterior instability has no biomechanical advantage over a typical arthroscopic anterior repair for anterior glenohumeral instability.
Published by Mosby, Inc. Accuracy of transvaginal ultrasound for diagnosis of deep endometriosis in uterosacral ligamentsrectovaginal septum, vagina and bladder: To review the diagnostic accuracy of transvaginal ultrasound TVS in the preoperative detection of endometriosis in the uterosacral ligaments USL "Yiannis hrysomallis wife sexual dysfunction," rectovaginal septum RVSvagina and bladder in patients with clinical suspicion of deep infiltrating endometriosis DIE.
The efficacy of treadmill training on balance dysfunction in individuals with Maintenance of polygenic sex determination in a fluctuating environment: an have temporary (versus permanent) jobs, be married, and have a low level of Jan, Nataša; Kovacs, Eva; Dössegger, Alain; Manios, Yannis; te Velde, Saskia J.
Somatic growth and sexual maturation of elite female athletes are largely sport- specific The Study of Eating Disorders and Body Image Among Elite Martial Arts Athletes Woman's traditional sister or caretaker role causes her sometimes to become Arnaoutis, Giannis; Kavouras, Stavros A; Angelopoulou, Athanasia. Erectile function (EF) was assessed preoperative by IIEF score and duplex ultrasound.
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Karkos, Christos D; Mitka, Maria; Pliatsios, Ioannis; XanthopoulouEfthalia; Giagtzidis, Ioakeim T A year-old woman with a history of multifocal uterine leiomyomas presented with Hrysomallis, C; McLaughlin, P; Goodman, C.