Structural position of the posterior vagina and pelvic floor in women with and without posterior vaginal prolapse.
OBJECTIVE
The objective of the study was to compare pelvic structure location on magnetic resonance imaging (MRI) during maximal Valsalva among women with posterior prolapse and those with normal support.


METHODS
Subjects (n=37) had posterior vaginal wall (PVW) prolapse of +1 cm or greater. All underwent midsagittal, dynamic MRI. Structure locations (distal vagina, apex, perineal body, external anal sphincter) were determined. PVW length, levator and urogenital hiatus diameters, and prolapse diameter were measured.


RESULTS
Subjects had more caudal structures (P<.001) and larger hiatus diameters (P<.005); the posterior wall was longer, whereas the straight-line distance between the apex and distal vagina was shorter. In enteroceles, the apex was more ventrally displaced compared with rectoceles (P=.003). Unlike apical descent (r=-0.3; P=.1), PVW length and point Bp were correlated with MRI prolapse size (r=0.5; P=.002; r=0.7; P<.001, respectively).


CONCLUSIONS
At maximal Valsalva on MRI, structures are more caudal in women with posterior prolapse. The posterior vaginal wall is longer; this length strongly correlates with prolapse size.
Lewicky-Gaupp
Christina
C
Pelvic Floor Research Group, Division of Gynecology, Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI, USA.
Yousuf
Aisha
A
Larson
Kindra A
KA
Fenner
Dee E
DE
Delancey
John O L
JO
D000368:Aged; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D017773:Pelvic Floor / Q000033:anatomy & histology* / Q000473:pathology; D014596:Uterine Prolapse / Q000473:pathology*; D014621:Vagina / Q000033:anatomy & histology* / Q000473:pathology; D014636:Valsalva Maneuver
Int Urogynecol J Pelvic Floor Dysfunct. 2000;11(2):87-92
10805265
Int Urogynecol J Pelvic Floor Dysfunct. 1999;10(2):96-9
10384970
BJU Int. 2002 Sep;90(4):408-14
12175398
Int Urogynecol J Pelvic Floor Dysfunct. 1999;10(5):300-7
10543338
Dis Colon Rectum. 2000 Feb;43(2):205-12; discussion 212-3
10696895
Obstet Gynecol. 2006 May;107(5):1064-9
16648412
Int Urogynecol J Pelvic Floor Dysfunct. 1997;8(6):336-9
9609331
Am J Obstet Gynecol. 2001 Dec;185(6):1332-7; discussion 1337-8
11744905
Am J Obstet Gynecol. 2007 Nov;197(5):509.e1-6
17714680
Am J Obstet Gynecol. 2003 Nov;189(5):1261-7
14634551
Am J Obstet Gynecol. 1998 Dec;179(6 Pt 1):1446-9; discussion 1449-50
9855579
Radiographics. 2002 Mar-Apr;22(2):295-304
11896220
Obstet Gynecol. 1990 Nov;76(5 Pt 1):846-51
2216237
Int Urogynecol J Pelvic Floor Dysfunct. 2008 Jan;19(1):137-42
17579801
J Urol. 2000 Nov;164(5):1606-13
11025716
Am J Obstet Gynecol. 2004 Mar;190(3):620-7
15041990
Int Urogynecol J Pelvic Floor Dysfunct. 2008 Nov;19(11):1483-7
18682876
Am J Obstet Gynecol. 2006 May;194(5):1427-33
16579940
Am J Obstet Gynecol. 2008 Jun;198(6):651.e1-7
18241813
J Comput Assist Tomogr. 2009 Jan-Feb;33(1):125-30
19188799
Am J Obstet Gynecol. 2006 May;194(5):1438-43
16579933
AJR Am J Roentgenol. 2000 Jan;174(1):81-8
10628459
Am J Obstet Gynecol. 2002 Dec;187(6):1443-8; discussion 1448-9
12501044
Int Urogynecol J Pelvic Floor Dysfunct. 2002;13(2):80-7; discussion 87
12054187
Radiology. 1998 Mar;206(3):777-83
9494501
Radiol Med. 2002 May-Jun;103(5-6):488-500
12207184
Urology. 1999 Sep;54(3):454-7
10475353
Acta Obstet Gynecol Scand. 2006;85(12):1468-75
17260224
Int Urogynecol J Pelvic Floor Dysfunct. 2005 Mar-Apr;16(2):96-103; discussion 103
15372142