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Li M, Liu T, Wang B, Qiao P, Wang S. MR defecography in assessing stress urinary incontinence with or without symptomatic pelvic organ prolapse. World J Urol 2024; 42:321. [PMID: 38744781 DOI: 10.1007/s00345-024-05014-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 04/22/2024] [Indexed: 05/16/2024] Open
Abstract
PURPOSE Utilize magnetic resonance defecography (MRD) to analyze the primary pelvic floor dysfunctions in patients with stress urinary incontinence (SUI) associated with pelvic organ prolapse (POP), and in SUI patients with asymptomatic POP. METHOD We performed MRD in both SUI and POP subjects. As a primary analysis, the functional MR parameters were compared between the isolated POP and POP combined SUI groups. As a secondary analysis, the functional MR data were compared between the POP combined SUI and the SUI with asymptomatic POP (isolated SUI) groups. RESULTS MRD noted the main characteristics of SUI combined moderate or severe POP, including the shorter closed urethra length (1.87 cm vs. 2.50 cm, p < 0.001), more prevalent urethral hypermobility (112.31° vs. 85.67°, p = 0.003), bladder neck funneling (48.28% vs. 20.51%, p = 0.020), lower position of vesicourethral junction (2.11 cm vs. 1.67 cm, p = 0.030), and more severe prolapse of the posterior bladder wall (6.26 cm vs. 4.35 cm, p = 0.008). The isolated SUI patients showed the shortest length of the closed urethra (1.56 cm vs. 1.87 cm, p = 0.029), a larger vesicourethral angle (153.80° vs. 107.58°, p < 0.001), the more positive bladder funneling (84.85% vs. 48.28%, p = 0.002) and a special urethral opening sign (45.45% vs. 3.45%, p < 0.001). CONCLUSIONS Patients with SUI accompanying POP primarily exhibit excessive urethral mobility and a shortened urethral closure. SUI patients with asymptomatic POP mainly show dysfunction of the urethra and bladder neck, characterized by the opening of the urethra and bladder neck and a shortened urethral closure.
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Affiliation(s)
- Min Li
- Department of Radiology, Beijing Chao Yang Hospital, Capital Medical University, 8 Workers Stadium South Road, Chaoyang District, Beijing, 10020, China.
| | - Tongtong Liu
- Department of Radiology, Beijing Chao Yang Hospital, Capital Medical University, 8 Workers Stadium South Road, Chaoyang District, Beijing, 10020, China
| | - Biao Wang
- Department of Urology, Beijing Chao Yang Hospital, Capital Medical University, 8 Workers Stadium South Road, Chaoyang District, Beijing, 10020, China
| | - Peng Qiao
- Department of Urology, Beijing Chao Yang Hospital, Capital Medical University, 8 Workers Stadium South Road, Chaoyang District, Beijing, 10020, China
| | - Sumei Wang
- Department of Gynecology, Beijing Chao Yang Hospital, Capital Medical University, 8 Workers Stadium South Road, Chaoyang District, Beijing, 10020, China.
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DeLancey JO, Pipitone F, Masteling M, Xie B, Ashton-Miller JA, Chen L. Functional Anatomy of Urogenital Hiatus Closure: the Perineal Complex Triad Hypothesis. Int Urogynecol J 2024; 35:441-449. [PMID: 38206338 PMCID: PMC11060667 DOI: 10.1007/s00192-023-05708-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 11/18/2023] [Indexed: 01/12/2024]
Abstract
INTRODUCTION Urogenital hiatus enlargement is a critical factor associated with prolapse and operative failure. This study of the perineal complex was performed to understand how interactions among its three structures: the levator ani, perineal membrane, and perineal body-united by the vaginal fascia-work to maintain urogenital hiatus closure. METHODS Magnetic resonance images from 30 healthy nulliparous women with 3D reconstruction of selected subjects were used to establish overall geometry. Connection points and lines of action were based on perineal dissection in 10 female cadavers (aged 22-86 years), cross sections of 4 female cadavers (aged 14-35 years), and histological sections (cadavers aged 16 and 21 years). RESULTS The perineal membrane originates laterally from the ventral two thirds of the ischiopubic rami and attaches medially to the perineal body and vaginal wall. The levator ani attaches to the perineal membrane's cranial surface, vaginal fascia, and the perineal body. The levator line of action in 3D reconstruction is oriented so that the levator pulls the medial perineal membrane cranio-ventrally. In cadavers, simulated levator contraction and relaxation along this vector changes the length of the membrane and the antero-posterior diameter of the urogenital hiatus. Loss of the connection of the left and right perineal membranes through the perineal body results in diastasis of the levator and a widened hiatus, as well as a downward rotation of the perineal membrane. CONCLUSION Interconnections involving the levator ani muscles, perineal membrane, perineal body, and vaginal fascia form the perineal complex surrounding the urogenital hiatus in an arrangement that maintains hiatal closure.
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Affiliation(s)
- John O DeLancey
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, 48109, USA.
| | - Fernanda Pipitone
- Department of Obstetrics and Gynecology, University of São Paulo, São Paulo, Brazil
| | - Mariana Masteling
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Bing Xie
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China
| | | | - Luyun Chen
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, 48109, USA
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Nakahara M, Murakami N, Chiba T, Nagao A, Okuma K, Kashihara T, Kaneda T, Takahashi K, Inaba K, Nakayama Y, Kato T, Igaki H. Gynecological technical notes for appropriate spacer injections. Brachytherapy 2024; 23:45-51. [PMID: 38040606 DOI: 10.1016/j.brachy.2023.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 09/01/2023] [Accepted: 09/27/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND Despite its efficacy, if adherence to dose constraints for surrounding normal tissues proves unattainable, the risk of late radiation-related adverse events after primary radiotherapy involving brachytherapy remains a noteworthy concern. Some studies suggest that similar to prostate radiotherapy, spacers may potentially reduce doses to surrounding healthy rectal or bladder tissues. However, guidance on spacer injections for gynecologic brachytherapy is scarce, and the optimal anatomical location for spacer placement remains undefined. We discuss maximizing the effects of spacers from an anatomical perspective. FINDINGS As vesicovaginal and rectovaginal septa form part of the endopelvic fascia and are not uniform tissues, spacer injection resistance varies. In pelvic organ prolapse surgery, saline is injected into the anterior and posterior vaginal walls as a spacer, and the vagina, vesicovaginal septum, and bladder can be fluidly dissected. Relatively firm vesicovaginal septum tissue is used as a reconstructive organ, whereas rectovaginal septum tissue is less dense. Cervical cancer is invasive, involving surrounding fascia and ligaments. Ideally, the vesicovaginal and rectovaginal septa should be resected in radical hysterectomy. Here, spacer adaptation and the technical details of injection are described. When using ultrasound guidance for spacer injection, the target site should be adequately magnified, and the spacer ideally injected into the incision layer during radical hysterectomy. Finally, posthysterectomy, the intestinal tract may adhere to the vaginal cuffs. Therefore, artificial ascites may be useful; however, the spread depends on perioperative manipulation. CONCLUSIONS Anatomical and surgical viewpoints are advantageous for safe, therapeutic, and replicable spacer injection administration.
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Affiliation(s)
- Mariko Nakahara
- Department of Gynecology, National Cancer Center Hospital, Tokyo, Japan.
| | - Naoya Murakami
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan; Department of Radiation Oncology, Juntendo University Graduate School of Medicine, Bunkyo-ku, Japan
| | - Takahito Chiba
- Section of Radiation Safety and Quality Assurance, National Cancer Center Hospital, Tokyo, Japan
| | - Ayaka Nagao
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Kae Okuma
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Tairo Kashihara
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Tomoya Kaneda
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Kana Takahashi
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Koji Inaba
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yuko Nakayama
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Tomoyasu Kato
- Department of Gynecology, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroshi Igaki
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
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Zhou Z, Li B, Zhou J, Ma Y, Zhao Y, Tong C, Wang H, Jin D, Li Y, Yan L. Anatomical investigation of the pelvic urogenital fascia in 10 formalin-fixed female cadavers: novel insights into the laparoscopic total mesometrial resection. BMC Surg 2023; 23:329. [PMID: 37891563 PMCID: PMC10612149 DOI: 10.1186/s12893-023-02239-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
PURPOSE Previous anatomical studies of the urogenital fascia (UGF) have focused on males, and there is a lack of relevant anatomical studies on the distribution of the extraperitoneal UGF in females. METHODS In this investigation, guided by the embryonic development of the female urogenital system, the ventral pelvic fascia structure of 10 female cadavers was dissected, and the distribution and morphology of female extraperitoneal UGF were observed, recorded in text, photographs and video, and 3D modeling was performed. RESULTS We find that in the female extraperitoneal space there is a migratory fascial structure, the UGF, which surrounds the urogenital system and extends from the perinephric region to the pelvis along with the development of the urogenital organs. The two layers of the UGF are composed of loose connective tissue rich in fat that surrounds the urogenital organs, their accessory vascular structures, and the nerves of the abdominopelvic cavity. In the pelvis, it participates in the formation of the ligamentous structures around the rectum and uterus. Finally, it surrounds the bladder and gradually moves into the loose connective tissue of the medial umbilical fold. CONCLUSIONS Sorting out the distribution characteristics of UGF has some reference value for studying the metastasis of gynecological tumors, the biomechanical structure of the female pelvis, and the surgical methods of gynecology, colorectal surgery, and hernia surgery.
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Affiliation(s)
- Zheqi Zhou
- Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an, 710068, China
- Yan'an University, Yan'an, 716000, China
| | - Bin Li
- Department of Obstetrics and Gynecology, Shaanxi Provincial People's Hospital, Xi'an, 710068, China
| | - Jinsong Zhou
- Department of Human Anatomy, Histology and Embryology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, China
| | - Yanbing Ma
- Department of Human Anatomy, Histology and Embryology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, China
| | - Yang Zhao
- Editorial Board of Shaanxi Popular Medical Education, Xi'an, 710068, China
| | - Cong Tong
- Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an, 710068, China
| | - Hui Wang
- Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an, 710068, China
| | - Dian Jin
- Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an, 710068, China
| | - Yujie Li
- Yan'an University, Yan'an, 716000, China
| | - Likun Yan
- Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an, 710068, China.
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Benjamin DR, Frawley HC, Shields N, Peiris CL, van de Water ATM, Bruder AM, Taylor NF. Conservative interventions may have little effect on reducing diastasis of the rectus abdominis in postnatal women - A systematic review and meta-analysis. Physiotherapy 2023; 119:54-71. [PMID: 36934466 DOI: 10.1016/j.physio.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 11/23/2022] [Accepted: 02/23/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Diastasis of the rectus abdominis muscle (DRAM) commonly occurs in pregnancy and postnatally. Physiotherapists routinely guide women in its management, although the effectiveness of these treatments is unknown. OBJECTIVES To determine the effectiveness of conservative interventions to reduce the presence and width of DRAM in pregnant and postnatal women. DATA SOURCES EMBASE, Medline, CINAHL, PUBMED, AMED and PEDro searched until August 2021. STUDY SELECTION/ELIGIBILITY Randomised control trials examining any conservative interventions to manage DRAM during the ante- and postnatal periods were included. STUDY APPRAISAL AND SYNTHESIS METHODS Methodological quality was assessed using the Cochrane Risk of Bias 2 tool. Meta-analyses were performed using a random effects model to calculate mean differences (MD) and odds ratios (OR). A GRADE approach determined the certainty of evidence for each meta-analysis. RESULTS Sixteen trials with 698 women during the postnatal period were included. No trials evaluated interventions during the antenatal period. All interventions included some form of abdominal exercise. Other interventions included abdominal binding, kinesiotape and electrical stimulation. There was moderate certainty evidence from six trials (n = 161) that abdominal exercise led to a small reduction in inter-recti distance (MD -0.43 cm, 95% CI -0.82 to -0.05) in postnatal women compared to usual care. LIMITATIONS Three of the 16 trials had a low risk of bias. CONCLUSION AND IMPLICATIONS Conservative interventions do not lead to clinically significant reductions in inter-recti distance in women postnatally but abdominal exercises may have other physical and psychosocial benefits in the management of DRAM. Systematic Review Registration Number PROSPERO (CRD42020172529).
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Affiliation(s)
- Deenika R Benjamin
- Physiotherapy, School of Allied Health, Human Services and Sport, La Trobe University, Kingsbury Drive, Bundoora 3086, Australia.
| | - Helena C Frawley
- Melbourne School of Health Sciences, The University of Melbourne, Victoria, Australia; Allied Health Research, Royal Women's Hospital, Australia; Allied Health Research, Mercy Hospital for Women, Australia.
| | - Nora Shields
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Victoria 3086, Australia.
| | - Casey L Peiris
- Physiotherapy, School of Allied Health, Human Services and Sport, La Trobe University, Kingsbury Drive, Bundoora 3086, Australia.
| | - Alexander T M van de Water
- Physiotherapy, School of Allied Health, Human Services and Sport, La Trobe University, Kingsbury Drive, Bundoora 3086, Australia.
| | - Andrea M Bruder
- Physiotherapy, School of Allied Health, Human Services and Sport, La Trobe University, Kingsbury Drive, Bundoora 3086, Australia.
| | - Nicholas F Taylor
- Physiotherapy, School of Allied Health, Human Services and Sport, La Trobe University, Kingsbury Drive, Bundoora 3086, Australia; Allied Health Clinical Research Office, Eastern Health 5 Arnold Street, Box Hill 3128, Australia.
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Abed MH, Vasaghi-Gharamaleki B, Ghazavi MT, Nikjooy A. Hip dysfunction-related urinary incontinence and total hip arthroplasty with the direct lateral approach. Low Urin Tract Symptoms 2023; 15:11-15. [PMID: 36300551 DOI: 10.1111/luts.12466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 10/03/2022] [Accepted: 10/06/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVES There is a functional relationship between the hip joint and the pelvic floor muscles. In patients with secondary osteoarthritis of the hip, urinary incontinence is also seen. Research has shown that total hip arthroplasty (THA) surgery improves the symptoms of urinary incontinence. This prospective cross-sectional study without a control group was performed on THA candidates with urinary incontinence and secondary osteoarthritis with the aim of investigating the effect of THA with a direct lateral approach and subsequent routine physiotherapy on the symptoms of urinary incontinence. METHODS Sampling was performed using a simple method among those referred to orthopedic clinics in the private sector. Data were collected in all patients before and 3 months after THA using demographic, International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and hip range of motion record tables. The results are presented as mean with standard deviation. RESULTS In this study, 16 men with a mean age of 76.75 years (±4.65) and 8 women with a mean age of 72.75 years (±7.32) participated. Before THA, stress urinary incontinence (54.16%) and urgency urinary incontinence (20.83%) had the highest frequency. However, after THA, the frequency of stress and urgency urinary incontinence decreased (16.66% and 8.33%, respectively). According to the results of the ICIQ, complete improvement of urinary incontinence symptoms was observed in up to 62.5% of the subjects. After THA, there was a significant difference between the mean total score obtained from the WOMAC questionnaire compared to before surgery. There was a significant improvement in the range of motion of the hip joint in all directions. CONCLUSIONS THA and routine hip physiotherapy in patients with urinary incontinence and secondary hip osteoarthritis have a significant positive effect on improving symptoms of urinary incontinence and hip function. In addition, it significantly improves the ICIQ and WOMAC questionnaire scores.
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Affiliation(s)
- Maryam Hakimi Abed
- Department of Physical Therapy, School of Rehabilitation Sciences, Rehabilitation Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Behnoosh Vasaghi-Gharamaleki
- Department of Basic Sciences in Rehabilitation, School of Rehabilitation Sciences, Rehabilitation Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Taghi Ghazavi
- Orthopedic Department, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Afsaneh Nikjooy
- Department of Physical Therapy, School of Rehabilitation Sciences, Rehabilitation Research Center, Iran University of Medical Sciences, Tehran, Iran
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7
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Tang Y, Guo X, Wang Y, Liu Z, Cao G, Zhou Y, Chen M, Liu J, Mu J, Yuan M. Rumba Dance Combined with Breathing Training as an Exercise Intervention in the Management of Stress Urinary Incontinence in Postmenopausal Women: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:ijerph20010522. [PMID: 36612845 PMCID: PMC9819238 DOI: 10.3390/ijerph20010522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/12/2022] [Accepted: 12/23/2022] [Indexed: 06/01/2023]
Abstract
Purpose: Stress urinary incontinence (SUI) refers to involuntary leakage from the urethra, synchronous with exertion/effort, sneezing or coughing, which has a negative effect on quality of life. Studies have shown that mild-to-moderate physical activities reduce the risk of SUI by multiple mechanisms. The objective of this study was to determine whether the Rumba dance combined with breathing training (RDBT) can reduce the severity of incontinence and improve the quality of life of patients with SUI. Methods: A randomized clinical trial was conducted with women who were sedentary, were postmenopausal, reported mild-to-moderate SUI on a 1-h pad test, were not already engaged in Rumba dance and did not receive estrogen replacement therapy. The patients were randomly assigned to the RDBT group (n = 13) or the control group (n = 11). The intervention included 90 min of RDBT three times per week for 16 weeks, and the vaginal resting pressure (VRP), pelvic floor muscle (PFM) strength and endurance, 1-h pad test, International Consultation on Incontinence Questionnaire—Urinary Incontinence Short Form (ICIQ—UI SF), and the Incontinence Quality of Life Questionnaire (I—QOL) were measured or completed at baseline and 16 weeks. None of the participants reported adverse events. Results: The mean (±SD) age of the participants was 55.75 ± 5.58 years. After 16 weeks, in the RDBT group, the urine leakage on the 1-h pad test was significantly decreased −2.91 ± 0.49 from the baseline (p = 0.000). The VRP increased from 76.00 ± 16.23 cmH2O to 95.09 ± 18.90 cmH2O (p = 0.000), the PFM endurance of class I (−3.15 ± 1.99% vs. −0.46 ± 0.97%, p = 0.000) and class II (−0.69 ± 0.95% vs. −0.23 ± 0.44%, p = 0.065) increased, and the grades of PFM strength of class I and class II were significantly enhanced (p < 0.01). Finally, the severity of self-reported incontinence (ICIQ—UI SF) significantly decreased from 6.12 ± 2.15 to 3.81 ± 1.68 (p = 0.000), and quality of life (I—QOL) improved from 75.73 ± 11.93 to 83.48 ± 7.88 (p = 0.005). Conclusion: A 16-week RDBT program can increase PFM strength and endurance to reduce the severity of incontinence symptoms and improve the quality of life in patients with SUI, demonstrating the feasibility of recruiting and retaining postmenopausal women with SUI into a RDBT therapeutic program.
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Affiliation(s)
- Yuting Tang
- School of Art, Beijing Sport University, Beijing 100084, China
- Space Science and Technology Institute (Shenzhen), Shenzhen 518038, China
| | - Xian Guo
- Sport Science School, Beijing Sport University, Beijing 100084, China
- Beijing Sports Nutrition Engineering Research Center, Beijing 100084, China
| | - Yi Wang
- Physical Exercise Department, Renmin University of China, Beijing 100872, China
| | - Zeyao Liu
- Sport Science School, Beijing Sport University, Beijing 100084, China
| | - Guoxia Cao
- Sport Science School, Beijing Sport University, Beijing 100084, China
| | - Yanbing Zhou
- School of Art, Beijing Sport University, Beijing 100084, China
| | - Mengmeng Chen
- Sport Science School, Beijing Sport University, Beijing 100084, China
| | - Jingying Liu
- Sport Science School, Beijing Sport University, Beijing 100084, China
| | - Jinhao Mu
- Sport Science School, Beijing Sport University, Beijing 100084, China
| | - Mengjie Yuan
- Sport Science School, Beijing Sport University, Beijing 100084, China
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Pirri C, Petrelli L, Pérez-Bellmunt A, Ortiz-Miguel S, Fede C, De Caro R, Miguel-Pérez M, Stecco C. Fetal Fascial Reinforcement Development: From "a White Tablet" to a Sculpted Precise Organization by Movement. BIOLOGY 2022; 11:biology11050735. [PMID: 35625463 PMCID: PMC9138366 DOI: 10.3390/biology11050735] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/03/2022] [Accepted: 05/05/2022] [Indexed: 01/12/2023]
Abstract
Simple Summary Nowadays, the number of studies concerning fasciae is increasing, but few studies focus on fetal fasciae development and there is no study on the retinacula. The latter are fascial reinforcements with a crucial role in proprioception and coordination. We aimed to identify their structural organization by qualitative and quantitative assessments, to establish their role in myofascial development, highlighting their appearance and organization. Our data strongly suggest that the movement models the fascial reinforcements, structuring the fascial system, particularly at the end of the pregnancy. Abstract Fasciae have received much attention in recent years due to their important role in proprioception and muscular force transmission, but few studies have focused on fetal fasciae development and there is no study on the retinacula. The latter are fascial reinforcements that play a key role in proprioception and motor coordination. Furthermore, it is still unclear if they are genetically determined or if they are defined by movements, and if they are present during gestation or if they appear only later in the childhood. We aim to identify their structural organization by qualitative and quantitative assessments to establish their role the myofascial development, highlighting their appearance and organization. Samples from the wrist retinacula, posterior forearm, ankle retinacula, anterior leg, iliotibial tract and anterior thigh of six fetus body donors (from 24th to 40th week of gestation) and histological sections were obtained and a gross anatomy dissection was performed. Sections were stained with hematoxylin-eosin to observe their overall structure and measure their thicknesses. Using Weigert Van Gieson, Alcian blue and immunostaining to detect Hyaluronic Acid Binding Protein (HABP), Collagens I and III (Col I and III) were realized to assess the presence of elastic fibers and hyaluronan. This study confirms that the deep fasciae initially do not have organized layers and it is not possible to highlight any reinforcement. The fascial development is different according to the various area: while the deep fascia and the iliotibial tract is already evident by the 27th week, the retinacula begin to be defined only at the end of pregnancy, and their complete maturation will probably be reached only after birth. These findings suggest that the movement models the retinacula, structuring the fascial system, in particular at the end of pregnancy and in the first months of life. The fasciae can be imagined, initially, as “white tablets” composed of few elastic fibers, abundant collagens and HA, on which various forces, u movements, loads and gravity, “write their history”.
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Affiliation(s)
- Carmelo Pirri
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy; (L.P.); (C.F.); (R.D.C.)
- Correspondence: (C.P.); (C.S.)
| | - Lucia Petrelli
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy; (L.P.); (C.F.); (R.D.C.)
| | - Albert Pérez-Bellmunt
- Basic Sciences Department, Universitat Internacional de Catalunya, 08017 Barcelona, Spain; (A.P.-B.); (S.O.-M.); (M.M.-P.)
- ACTIUM Functional Anatomy Group, Faculty of Medicine and Health Sciences, 08195 Barcelona, Spain
| | - Sara Ortiz-Miguel
- Basic Sciences Department, Universitat Internacional de Catalunya, 08017 Barcelona, Spain; (A.P.-B.); (S.O.-M.); (M.M.-P.)
- ACTIUM Functional Anatomy Group, Faculty of Medicine and Health Sciences, 08195 Barcelona, Spain
- Unit of Human Anatomy and Embryology, Department of Pathology and Experimental Therapeutics, Faculty of Medicine and Health Sciences (Bellvitge Campus), University of Barcelona, 08907 Hospitalet del Llobregat, Spain
| | - Caterina Fede
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy; (L.P.); (C.F.); (R.D.C.)
| | - Raffaele De Caro
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy; (L.P.); (C.F.); (R.D.C.)
| | - Maribel Miguel-Pérez
- Basic Sciences Department, Universitat Internacional de Catalunya, 08017 Barcelona, Spain; (A.P.-B.); (S.O.-M.); (M.M.-P.)
| | - Carla Stecco
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy; (L.P.); (C.F.); (R.D.C.)
- Correspondence: (C.P.); (C.S.)
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9
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Bergström BS. Stress urinary incontinence is caused predominantly by urethral support failure. Int Urogynecol J 2022; 33:523-530. [PMID: 35064789 PMCID: PMC8885533 DOI: 10.1007/s00192-021-05024-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 10/28/2021] [Indexed: 12/26/2022]
Abstract
Whales are mammals that can dive to depths of > 1000 m without the high water pressure pushing open their mouth or anus. The same is true for the female urethra. The meatus externus and internus are seals that cannot be pushed open by high water pressures. Recent evidence suggests that the female meatus internus is pushed open when the bladder pressure exceeds the urethral pressure. For a relaxed detrusor, this opening is not possible for at least three reasons: the law of elastic collision, Pascal’s law of hydrostatics and the Hagen-Poiseuille law. The three laws do not support that urethral function failure is the predominant cause of stress urinary incontinence (SUI); however, they do support that urethral support failure is. Influential urogynecologists claim the opposite. TVT surgery, according to the integral theory of SUI (IT), has high failure rates because it does not principally prevent the urethra from hanging on a less mobile bladder neck. In the case of a long urethra, the tape is set too distally, and in hypomobile SUI, the use of a tension-free suburethral tape is unwarranted/ineffective, because the proximal urethra is not elevated above its resting position. A successful operation corrects urethral support failure and not urethral function failure.
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Affiliation(s)
- Bo S Bergström
- Department of Obstetrics & Gynecology Mora Hospital, 792 51, Mora, Sweden.
- Overlege at Nordfjord Hospital, N-6771, Nordfjordeid, Norway.
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The Most Common Functional Disorders and Factors Affecting Female Pelvic Floor. Life (Basel) 2021; 11:life11121397. [PMID: 34947928 PMCID: PMC8704638 DOI: 10.3390/life11121397] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 12/09/2021] [Accepted: 12/11/2021] [Indexed: 12/13/2022] Open
Abstract
The pelvic floor (PF) is made of muscles, ligaments, and fascia, which ensure organ statics, maintain muscle tone, and are involved in contractions. This review describes the myofascial relationships of PF with other parts of the body that determine the proper functions of PF, and also provides insight into PF disorders and the factors contributing to them. PF plays an important role in continence, pelvic support, micturition, defecation, sexual function, childbirth, and locomotion, as well as in stabilizing body posture and breathing, and cooperates with the diaphragm and postural muscles. In addition, PF associates with distant parts of the body, such as the feet and neck, through myofascial connections. Due to tissue continuity, functional disorders of muscles, ligaments, and fascia, even in the areas that are distant from PF, will lead to PF disorders, including urinary incontinence, fecal incontinence, prolapse, sexual dysfunction, and pain. Dysfunctions of PF will also affect the rest of the body.
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