title: The relationship between superior attachment points for anterior wall mesh operations and the upper vagina using a 3-dimensional magnetic resonance model in women with normal support.
abstract: OBJECTIVE
  We examined structural relationships between anterior mesh kit suspension points and the upper vagina in women with normal support.
  
  
  METHODS
  Eleven women with normal support underwent supine, multiplanar magnetic resonance pelvic imaging at rest and maximal Valsalva. Using 3-dimensional models generated from these images, anterior wall mesh kit anchoring points were identified along the arcus tendineus fascia pelvis. We then measured the percentage of anterior vagina above and posterior to superior suspension points.
  
  
  RESULTS
  The anterior vagina extended above superior attachment points in 100% of women at rest and in 73% during Valsalva. It extended posterior to them in 82% and 100% (rest and Valsalva, respectively). The mean percentage of anterior vaginal length above superior anchoring sites was 40 +/- 14% at rest and 29 +/- 12% during Valsalva.
  
  
  CONCLUSIONS
  The upper vagina lies above and posterior to superior suspension points in the majority of women with normal support.
authors.affiliation: Pelvic Floor Research Group, Division of Gynecology, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Kindra A
authors.initials: KA
authors.lastname: Larson
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Hsu
authors.forename: John O L
authors.initials: JO
authors.lastname: DeLancey
mesh_terms: D000328:Adult; D005205:Fascia / Q000033:anatomy & histology; D000071938:Fasciotomy; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D008953:Models, Anatomic; D017773:Pelvic Floor / Q000033:anatomy & histology; D013526:Surgical Mesh; D014596:Uterine Prolapse / Q000473:pathology / Q000601:surgery*; D014621:Vagina / Q000033:anatomy & histology* / Q000601:surgery*; D014636:Valsalva Maneuver