Cargando…

Surgical anatomy of the mid‐vagina

AIM: The mid‐vagina (MV) represents Level II of the vagina. The surgical anatomy of the MV has not been recently subject to a comprehensive examination and description. MV surgery involving anterior and posterior colporrhaphy represents a key part of surgery for a majority of pelvic organ prolapse (...

Descripción completa

Detalles Bibliográficos
Autores principales: Haylen, Bernard T., Vu, Dzung, Wong, Audris, Livingstone, Sarah
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9540639/
https://www.ncbi.nlm.nih.gov/pubmed/35731184
http://dx.doi.org/10.1002/nau.24994
_version_ 1784803749805424640
author Haylen, Bernard T.
Vu, Dzung
Wong, Audris
Livingstone, Sarah
author_facet Haylen, Bernard T.
Vu, Dzung
Wong, Audris
Livingstone, Sarah
author_sort Haylen, Bernard T.
collection PubMed
description AIM: The mid‐vagina (MV) represents Level II of the vagina. The surgical anatomy of the MV has not been recently subject to a comprehensive examination and description. MV surgery involving anterior and posterior colporrhaphy represents a key part of surgery for a majority of pelvic organ prolapse (POP). METHODS: Literature review and surgical observations of many aspects of the MV were performed including MV length and width; MV shape; immediate relationships; histological analysis; anterior and posterior MV prolapse assessment and anterior MV surgical aspects. Unpublished pre‐ and postoperative quantitative data on 300 women undergoing posterior vaginal compartment repairs are presented. RESULTS: The MV runs from the lower limit of the vaginal vault (VV) to the hymen. Its length is a mean of 5 cm. Its shape in section overall is a compressed rectangle. Its longitudinal shape is created by its anterior and posterior walls being inverse trapezoid in shape. Histology comprises three layers: (i) mucosa; (ii) muscularis; (iii) adventitia. MV prolapse staging uses pelvic organ prolapse quantification (POP‐Q). Anterior MV prolapse can be quantitatively assessed using POP‐Q while posterior MV prolapse can be assessed with POP‐Q or PR‐Q. Around 50% of both cystocele and rectocele are due to VV defects. POP will increase anterior MV width and length. Native tissue anterior colporrhaphy is the current conventional repair with mesh disadvantages outweighing advantages. Posteriorly, Level II (MV) defects are far smaller (mean 1.3 cm) than Level I (mean 6.0 cm) and Level III (mean 2.9 cm). CONCLUSION: An understanding of the surgical anatomy of the MV can assist anterior and posterior colporrhaphy. In particular, if VV support is employed, the Level II component of a posterior repair should be relatively small.
format Online
Article
Text
id pubmed-9540639
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher John Wiley and Sons Inc.
record_format MEDLINE/PubMed
spelling pubmed-95406392022-10-14 Surgical anatomy of the mid‐vagina Haylen, Bernard T. Vu, Dzung Wong, Audris Livingstone, Sarah Neurourol Urodyn Reviews AIM: The mid‐vagina (MV) represents Level II of the vagina. The surgical anatomy of the MV has not been recently subject to a comprehensive examination and description. MV surgery involving anterior and posterior colporrhaphy represents a key part of surgery for a majority of pelvic organ prolapse (POP). METHODS: Literature review and surgical observations of many aspects of the MV were performed including MV length and width; MV shape; immediate relationships; histological analysis; anterior and posterior MV prolapse assessment and anterior MV surgical aspects. Unpublished pre‐ and postoperative quantitative data on 300 women undergoing posterior vaginal compartment repairs are presented. RESULTS: The MV runs from the lower limit of the vaginal vault (VV) to the hymen. Its length is a mean of 5 cm. Its shape in section overall is a compressed rectangle. Its longitudinal shape is created by its anterior and posterior walls being inverse trapezoid in shape. Histology comprises three layers: (i) mucosa; (ii) muscularis; (iii) adventitia. MV prolapse staging uses pelvic organ prolapse quantification (POP‐Q). Anterior MV prolapse can be quantitatively assessed using POP‐Q while posterior MV prolapse can be assessed with POP‐Q or PR‐Q. Around 50% of both cystocele and rectocele are due to VV defects. POP will increase anterior MV width and length. Native tissue anterior colporrhaphy is the current conventional repair with mesh disadvantages outweighing advantages. Posteriorly, Level II (MV) defects are far smaller (mean 1.3 cm) than Level I (mean 6.0 cm) and Level III (mean 2.9 cm). CONCLUSION: An understanding of the surgical anatomy of the MV can assist anterior and posterior colporrhaphy. In particular, if VV support is employed, the Level II component of a posterior repair should be relatively small. John Wiley and Sons Inc. 2022-06-22 2022-08 /pmc/articles/PMC9540639/ /pubmed/35731184 http://dx.doi.org/10.1002/nau.24994 Text en © 2022 The Authors. Neurourology and Urodynamics published by Wiley Periodicals LLC. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Reviews
Haylen, Bernard T.
Vu, Dzung
Wong, Audris
Livingstone, Sarah
Surgical anatomy of the mid‐vagina
title Surgical anatomy of the mid‐vagina
title_full Surgical anatomy of the mid‐vagina
title_fullStr Surgical anatomy of the mid‐vagina
title_full_unstemmed Surgical anatomy of the mid‐vagina
title_short Surgical anatomy of the mid‐vagina
title_sort surgical anatomy of the mid‐vagina
topic Reviews
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9540639/
https://www.ncbi.nlm.nih.gov/pubmed/35731184
http://dx.doi.org/10.1002/nau.24994
work_keys_str_mv AT haylenbernardt surgicalanatomyofthemidvagina
AT vudzung surgicalanatomyofthemidvagina
AT wongaudris surgicalanatomyofthemidvagina
AT livingstonesarah surgicalanatomyofthemidvagina