scholarly journals Clinical significance of neuropeptide Y expression in pelvic tissue in patients with pelvic floor dysfunction

2019 ◽  
Vol 14 (1) ◽  
pp. 126-132
Author(s):  
Limin Zhang ◽  
Xin Luo
Keyword(s):  
Pelvic Floor ◽  
Neuropeptide Y ◽  
Pelvic Floor Dysfunction ◽  
Uterosacral Ligament ◽  
Vaginal Wall ◽  
Anterior Vaginal Wall ◽  
Round Ligament ◽  
Control Group ◽  
Cardinal Ligament ◽  
Uterosacral Ligaments

AbstractObjectivesTo investigate the neuropeptide Y (NPY) expression in the tissue of pelvic floor ligament and anterior vaginal wall in female patients with pelvic organ prolapse (POP) and stress urinary incontinence (SUI).MethodSeventeen patients with POP, 6 with SUI, 13 with POP and SUI (POP&SUI), and 10 controls were included in this study from First Affiliated Hospital of JiNan University. Immunohistochemical assay was used to examine NPY expression in the tissue of round ligament, cardinal ligament of uterus, uterosacral ligament, and anterior vaginal wall. NPY expression were compared between POP, SUI, POP&SUI and controls.ResultsNPY was positive expressed in the round ligament, cardinal ligament of uterus, uterosacral ligament, and anterior vaginal subepithelial connective tissue. Compared with the control group, NPY expression in the round, cardinal, and uterosacral ligaments in patients with POP&SUI group was decreased with significant statistical difference (p<0.05). NPY expression in anterior vaginal wall was significantly decreased in POP, SUI, and POP&SUI groups compared to normal group (p<0.05). Compared to POP group, NPY expression in SUI and POP&SUI groups were significantly decreased (p<0.05), however the difference was not statistical different between SUI and POP&SUI groups (p>0.05). In POP and POP&SUI groups, the NPY expression in the cardinal ligament of uterus, uterosacral ligament, and anterior vaginal wall were negatively correlated with age (p<0.05), however, was not correlated with number of pregnancy, number of delivery, and BMI (p>0.05).ConclusionsNPY expression was reduced in the round ligament, cardinal ligament of uterus, Uterosacral ligament, and vaginal anterior wall of the patients with POP and SUI. The decreased NPY expression may play an important role in the development of pelvic floordysfunction.

scholarly journals Pelvic Floor Dysfunction, the Role of Imaging and Reconstructive Surgery

2013 ◽  
Vol 7 (1) ◽  
pp. 86-97
Author(s):  
Ahmad G Serour ◽  
Laila A Mousa
Keyword(s):  
Urinary Incontinence ◽  
Pelvic Floor ◽  
Pelvic Floor Dysfunction ◽  
Vaginal Wall ◽  
Anterior Vaginal Wall ◽  
Vaginal Prolapse ◽  
Urinary Continence ◽  
Urethral Pressure ◽  
Childbirth Trauma

ABSTRACT We are putting forward three novel concepts describing the pathophysiology concerning: • Micturition, factors that control urinary continence and different types of urinary incontinence. • Genital organs support and genital prolapse. • Defecation, causes of fecal incontinence (FI). I. Urinary continence depends on high urethral pressure (Pura) which depends upon two factors: One inherent and one acquired. 1. The inherent factor is the tough strong collagen layer constituent of the internal urethral sphincter (IUS), that creates the high wall tension necessary for keeping high urethral pressure (Pura). The IUS is a collagen-muscle tissue cylinder that extends from the bladder neck to the perineal membrane in both sexes. 2. The acquired factor, which is high alpha-sympathetic tone at the IUS gained from learning and training in early childhood, keeps it contracted and the urethra closes all the time until there is a need or a desire to void as social circumstances allow. Injury to one or both factors leads to urinary incontinence. II. The vagina is a cylinder of collagen-elastic-muscle tissues. The strong tough collagen sheet is responsible for the upright position of the vagina. The main function of the pelvic ligaments is to assign the pelvic organs to their anatomical site and keeps the pelvic organs in situ. Childbirth trauma damages the collagen layer due to overstretching of the vagina and leads to flabby and redundant vaginal walls with subsequent vaginal prolapse. When the pelvic ligaments suffer most of the trauma, the insult will lead to weakness of the pelvic ligaments, leading to vault and uterine prolapse. III. The integrity of both anal sphincters, internal anal sphincter (IAS) and external anal sphincter (EAS) is an essential factor in keeping fecal continence. Fecal continence also depends on strong pelvic floor muscles which keep an angle between the rectum and the anal canal. In addition, it depends on an acquired behavior, gained by learning and training in early childhood of maintaining high alpha-sympathetic tone at the IAS keeping the anal canal empty and closed all the time until there is a desire and/or a need to pass flatus and/ or stool and there are favorable social circumstances. The intimate relation of the IUS with the anterior vaginal wall and the IAS with the posterior vaginal wall exposes them to the childbirth trauma with subsequent damage. This will lead to stress urinary incontinence (SUI) and FI in addition to vaginal prolapse. Therefore, we have innovated an operation to treat SUI, FI and vaginal prolapse. ‘Urethro-ano-vaginoplasty’ repair operation. It consists of anterior and posterior sections. In the anterior section, we have corrected the SUI and the anterior vaginal wall descent through the following steps: 1. Expose the IUS and mend its torn wall. 2. Strengthen the anterior vaginal wall by overlapping the two vaginal flaps, and hence we can add extra support to the mended IUS and preserve the body collagen. In the posterior section, we have the following: 1. Exposed the IAS and mended the torn sphincter. 2. We have approximated the two-levator ani muscles. 3. Strengthened the posterior vaginal wall by overlapping the two vaginal flaps; as such, we would have also added extra support to the mended IAS and kept the natural body collagen. 4. We repaired the perineum. How to cite this article El Hemaly AKM, Mousa LA, Kurjak A, Kandil IM, Serour AG. Pelvic Floor Dysfunction, the Role of Imaging and Reconstructive Surgery. Donald School J Ultrasound Obstet Gynecol 2013;7(1):86-97.

Possibilities of using neodymium laser (Nd:YAG) in patients with concomitant diseases which are accompanied by pathological discharge from the genital tract

GYNECOLOGY ◽  
2020 ◽  
Vol 22 (4) ◽  
pp. 75-81
Author(s):  
Olga A. Pauzina ◽  
Inna A. Apolikhina ◽  
Darya A. Malyshkina
Keyword(s):  
Drug Therapy ◽  
Pelvic Floor ◽  
Genital Tract ◽  
Vaginal Discharge ◽  
Muscle Tone ◽  
Pelvic Floor Muscle ◽  
Pelvic Floor Dysfunction ◽  
Vaginal Wall ◽  
Neodymium Laser ◽  
Frequent Relapses

Background. Pathological vaginal discharge is the most common disorder in women after giving birth who have vaginal relaxation syndrome and vaginal wall prolapse, as well as in women during menopause. To date, there are no clear treatment regimens for mixed vulvovaginal infections, and the use of only drug therapy in patients with pelvic organ prolapse and genitourinary syndrome of menopause in combination with diseases which are accompanied by pathological vaginal discharge does not give a long lasting result and is characterized by frequent relapses. In this regard, the use of laser methods in combination with drug therapy may lead to the recovery of vaginal microbiocenosis and a decrease in the number of relapses of diseases which are accompanied by pathological discharge from the genital tract. Results. Description. This article presents a clinical case and description of the experience of using a neodymium laser for the treatment of a patient with recurrent mixed vulvovaginitis, 2nd- degree vaginal wall prolapse, loss of pelvic floor muscle tone, vaginal relaxation syndrome and sexual dysfunction using neodymium laser. The woman received 3 procedures of exposure to a neodymium laser with an interval of 2830 days. After 3 procedures of exposure to a neodymium laser, the patient has a good clinical efficacy in the recovery of vaginal microbiocenosis. Conclusions. An innovative technique of exposure to Nd:YAG neodymium laser in the practice of a gynecologist has shown high clinical efficiency in the treatment of not only pelvic floor dysfunction, but also mixed vulvovaginitis. And, despite this aspect of the use of laser technologies requires further study, we can use a neodymium laser in combination with traditional drug therapy to treat diseases which are accompanied by pathological discharge from the genital tract in cases of ineffective drug monotherapy and frequent relapses.

scholarly journals MRI comparative study of levator ani muscle changes in nulliparous and multiparous females

2019 ◽  
Vol 50 (1) ◽  
Author(s):  
Heba Azzam ◽  
Manal Halim ◽  
Hany El-Assaly ◽  
Aya Heiba
Keyword(s):  
Pelvic Floor ◽  
Treatment Plan ◽  
Pelvic Floor Dysfunction ◽  
Levator Ani ◽  
Control Group ◽  
Puborectalis Muscle ◽  
Levator Ani Muscle ◽  
Vaginal Deliveries ◽  
Significant Difference ◽  
Muscle Changes

Abstract Background Pelvic floor dysfunction is known to be among the principal factors influencing public health, regarding frequency, cost and effect on women’s quality of life. Radiographic assessment of the pelvic floor function and anatomy plays a vital role in the recognition of pelvic floor defects. The aim of this study is to detect the postpartum-related levator ani muscle changes thus defining the relationship between the vaginal deliveries and the etiology of pelvic floor dysfunction in order to provide guidelines to decrease the incidence of pelvic floor injuries during parturition and guide the treatment plan. Results There was a significant difference in the puborectalis muscle thickness between the case and control groups in the right puborectalis (P value ≤ 0.001) and in the left puborectalis (P value (≤ 0.001) as well as significant midpoint thickness (P value = 0.03) with 46.2% puborectalis muscle injury in the case group compared with none in the control group. Conclusion Pelvic floor MRI is highly recommended as it is a contrast-free modality that allows for both anatomical and functional analysis. Its incorporation in the routine postpartum assessment will allow early detection of abnormalities even in asymptomatic cases thus ensuring proper management and preventing the development of pelvic floor dysfunction predisposed to by repeated vaginal deliveries.

Pelvic floor muscle weakness: a risk factor for anterior vaginal wall prolapse recurrence

2018 ◽  
Vol 29 (11) ◽  
pp. 1661-1667 ◽  
Author(s):  
Jeffrey S. Schachar ◽  
Hemikaa Devakumar ◽  
Laura Martin ◽  
Sara Farag ◽  
Eric A. Hurtado ◽  
...  
Keyword(s):  
Risk Factor ◽  
Pelvic Floor ◽  
Muscle Weakness ◽  
Pelvic Floor Muscle ◽  
Vaginal Wall ◽  
Anterior Vaginal Wall ◽  
Anterior Vaginal Wall Prolapse ◽  
Prolapse Recurrence ◽  
Pelvic Floor Muscle Weakness

scholarly journals The diagnostic value of four-dimensional ultrasound examination of perineum in the diagnosis of postpartum pelvic floor dysfunction

2021 ◽  
Vol 271 ◽  
pp. 03061
Author(s):  
Wenfang Wu ◽  
MeiYuan Li ◽  
Kanghong Wu ◽  
Yiyun Xu ◽  
Yan Cai
Keyword(s):  
Pelvic Floor ◽  
Pelvic Floor Dysfunction ◽  
Pubic Symphysis ◽  
Diagnostic Value ◽  
Control Group ◽  
Levator Ani Muscle ◽  
Lower Margin ◽  
Reliable Technique ◽  
Short Period ◽  
The Difference

Objective to explore the diagnostic value of perineal four-dimensional ultrasound (4D-US) in postpartum pelvic floor dysfunction (PFD) disease. 328 postpartum PFD patients diagnosed by clinical pelvic floor palpation from June 2018 to December 2020 were selected as the PFD group, and 328 patients without PFD were selected as the control group. All participants underwent perineal 4D-US, the indicators were statistically analyzed. The results showed that the LAT of left and right, LHLR, LHAP, LHA, resting state and holding the breath in the PFD group were higher than those in the control group, and the difference was statistically significant (P<0.05). From cervix to lower margin of pubic symphysis, bladder to lower margin of pubic symphysis of the pubic symphysis, and from the ampulla of the rectum to the lower margin of the pubic symphysis, the PFD group was larger than the control group, but the result of urethral rotation was reversed, and the difference was statistically significant (P<0.05). The morphologic features of the levator ani muscle and pelvic fissure can be detected early using 4D-US, which is a reliable technique that can be learned in a short period of time.

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