title: Paravaginal defect: A new classification of fascial and muscle tears in the paravaginal region.
abstract: The lateral support of the vaginal wall depends on the integrity of the paravaginal section of the visceral pelvic fascia, levator ani, and their connection. Various defects of the muscle and fascia can result in identical clinical findings-ie, the descent of the lateral vaginal sulcus. In this study, we created a realistic scheme for classifying paravaginal defects, based on the complex relationship of the pelvic fascia with the levator ani. Surgical observations, cadaver examinations, and a complex magnetic resonance imaging (MRI)-based 3-dimensional (3D) model were used to analyze the spatial relationships of normal and defective anatomy of the female pelvic floor. Descent of the lateral vaginal sulcus can result from a defect in the paravaginal visceral pelvic fascia, levator ani, or both. The fascial defect can be partial or complete, and the muscle defect can vary in location. A detailed illustrated classification is presented. We present a new model of the pathology that underlies a common clinical finding.
authors.affiliation: Department of Urology, 3rd Faculty of Medicine, Charles University, Prague, Czech Republic.|Department of Urology and Urogynecology, Klinikum Ernst Von Bergmann, Potsdam, Germany.
authors.forename: Michal
authors.initials: M
authors.lastname: Otcenasek
authors.affiliation: Department of Urology and Urogynecology, Klinikum Ernst Von Bergmann, Potsdam, Germany.
authors.forename: Annett
authors.initials: A
authors.lastname: Gauruder-Burmester
authors.affiliation: Institute for the Care of Mother and Child, 3rd Faculty of Medicine, Charles Univesity, Prague.
authors.forename: Lucia A
authors.initials: LA
authors.lastname: Haak
authors.affiliation: Department of Urology, 3rd Faculty of Medicine, Charles University, Prague, Czech Republic.
authors.forename: Robert
authors.initials: R
authors.lastname: Grill
authors.affiliation: Department of Urology and Urogynecology, Klinikum Ernst Von Bergmann, Potsdam, Germany.
authors.forename: Gralf
authors.initials: G
authors.lastname: Popken
authors.affiliation: Department of Anatomy, 3rd Faculty of Medicine, Charles University, Prague, Czech Republic.
authors.forename: Vaclav
authors.initials: V
authors.lastname: Baca
mesh_terms: D000328:Adult; D000368:Aged; D005205:Fascia / Q000293:injuries*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009132:Muscles / Q000293:injuries*; D017773:Pelvic Floor / Q000293:injuries*; D014621:Vagina / Q000033:anatomy & histology* / Q000293:injuries / Q000473:pathology; D014947:Wounds and Injuries / Q000145:classification
keywords: avulsion; endopelvic fascia; levator ani; paravaginal defect; visceral pelvic fascia