Skip to main content
Top
Published in: International Urogynecology Journal 11/2008

01-11-2008 | Original Article

Histomorphological analysis of the urogenital diaphragm in elderly women: a cadaver study

Authors: C. Betschart, D. Scheiner, C. Maake, M. Vich, L. Slomianka, D. Fink, D. Perucchini

Published in: International Urogynecology Journal | Issue 11/2008

Login to get access

Abstract

The objective of this study was to describe the histomorphological structure of the urogenital diaphragm in elderly women using a modern morphometric procedure. Biopsies were taken from the posterior margin of the urogenital diaphragm of 22 female cadavers (mean age, 87 years) using a 60-mm punch. Hematoxylin/eosin and Goldner sections were analyzed with the Cavalieri estimator. The mean thickness of the urogenital diaphragm was 5.5 mm. The main component was connective tissue. All biopsies contained smooth muscle. Eighteen biopsies contained more smooth muscle than striated muscle. In six of 22 biopsies, no striated muscle was found. The ratio of striated to smooth muscle to connective tissue was 1:2.3:13.3. Muscle fibers were dispersed in all parts of the urogenital diaphragm. The urogenital diaphragm of elderly women mainly consists of connective tissue. Smooth muscle was also found but to a lesser extent. The frequently used English term “perineal membrane” for the urogenital diaphragm is justified and well describes our findings in elderly women.
Literature
1.
go back to reference Dwyer PL, O’Reilly BA (2004) Transvaginal repair of anterior and posterior compartment prolapse with Atrium polypropylene mesh. BJOG 111:831–836PubMedCrossRef Dwyer PL, O’Reilly BA (2004) Transvaginal repair of anterior and posterior compartment prolapse with Atrium polypropylene mesh. BJOG 111:831–836PubMedCrossRef
2.
go back to reference Gundersen HJG, Bendtsen TF, Korbo L, Marcussen N, Møller A, Nielsen K, Nyengaard JR, Pakkenberg B, Sørensen B, Vesterby A, West MJ (1988) Some new, simple and efficient stereological methods and their use in pathological research and diagnosis. Apmis 96:379–394PubMed Gundersen HJG, Bendtsen TF, Korbo L, Marcussen N, Møller A, Nielsen K, Nyengaard JR, Pakkenberg B, Sørensen B, Vesterby A, West MJ (1988) Some new, simple and efficient stereological methods and their use in pathological research and diagnosis. Apmis 96:379–394PubMed
3.
go back to reference Luschka H (1864) Die Anatomie des Menschlichen Beckens. Laupp and Siebeck, Tübingen Luschka H (1864) Die Anatomie des Menschlichen Beckens. Laupp and Siebeck, Tübingen
4.
go back to reference Henle J (1873) Handbuch der Systematischen Anatomie des Menschen. Bd II. Friedrich Vieweg und Sohn, Braunschweig Henle J (1873) Handbuch der Systematischen Anatomie des Menschen. Bd II. Friedrich Vieweg und Sohn, Braunschweig
5.
go back to reference Borley NR (2005) True pelvis, pelvic floor and perineum. In: Standring S (ed) Gray’s anatomy. 39rd edn. Elsevier, Amsterdam, pp 1367–1369 Borley NR (2005) True pelvis, pelvic floor and perineum. In: Standring S (ed) Gray’s anatomy. 39rd edn. Elsevier, Amsterdam, pp 1367–1369
6.
go back to reference Kalischer O (1900) Die Urogenitalmuskulatur des Dammes. Karger, Berlin Kalischer O (1900) Die Urogenitalmuskulatur des Dammes. Karger, Berlin
7.
go back to reference Mirilas P, Skandalakis J (2004) Urogenital diaphragm: an erroneous concept casting its shadow over the sphincter urethrae and deep perineal space. J Am Coll Surg 198:279–290PubMedCrossRef Mirilas P, Skandalakis J (2004) Urogenital diaphragm: an erroneous concept casting its shadow over the sphincter urethrae and deep perineal space. J Am Coll Surg 198:279–290PubMedCrossRef
8.
go back to reference Gundersen HJG, Jensen EB (1987) The efficiency of systematic sampling in stereology and its prediction. J Microsc 147:229–263PubMed Gundersen HJG, Jensen EB (1987) The efficiency of systematic sampling in stereology and its prediction. J Microsc 147:229–263PubMed
9.
go back to reference Benninghoff A, Drenckhahn D (2002) Makroskopische anatomie, histologie, embryologie, zellbiologie. Band 1: Harn- und Genitalsystem. Urban und Fischer, München, Jena Benninghoff A, Drenckhahn D (2002) Makroskopische anatomie, histologie, embryologie, zellbiologie. Band 1: Harn- und Genitalsystem. Urban und Fischer, München, Jena
10.
go back to reference Oelrich TM (1983) The striated urogenital sphincter muscle in the female. Anat Rec 2005(2):223–232CrossRef Oelrich TM (1983) The striated urogenital sphincter muscle in the female. Anat Rec 2005(2):223–232CrossRef
11.
go back to reference Jundt K, Kiening M, Fischer P, Bergauer F, Rauch E, Janni W, Peschers U, Dimpfl T (2005) Is the histomorphological concept of the female pelvic floor and its changes due to age and vaginal delivery correct? Neurourol Urodyn 24:44–50PubMedCrossRef Jundt K, Kiening M, Fischer P, Bergauer F, Rauch E, Janni W, Peschers U, Dimpfl T (2005) Is the histomorphological concept of the female pelvic floor and its changes due to age and vaginal delivery correct? Neurourol Urodyn 24:44–50PubMedCrossRef
12.
go back to reference Goepel C, Hefler L, Methfessel HD, Koelbl H (2003) Periurethral connective tissue status of postmenopausal women with genital prolapse with and without stress incontinence. Acta Obstet Gynecol Scand 82:659–664PubMedCrossRef Goepel C, Hefler L, Methfessel HD, Koelbl H (2003) Periurethral connective tissue status of postmenopausal women with genital prolapse with and without stress incontinence. Acta Obstet Gynecol Scand 82:659–664PubMedCrossRef
13.
go back to reference Perucchini D, DeLancey JO, Ashton-Miller JA, Peschers U, Kataria T (2002) Age effects on urethral striated muscle. I. Changes in number and diameter of striated muscle fibers in the ventral urethra. Am J Obstet Gynecol 186:351–355PubMedCrossRef Perucchini D, DeLancey JO, Ashton-Miller JA, Peschers U, Kataria T (2002) Age effects on urethral striated muscle. I. Changes in number and diameter of striated muscle fibers in the ventral urethra. Am J Obstet Gynecol 186:351–355PubMedCrossRef
14.
go back to reference Carlile A, Davies I, Rigby A, Brocklehurst JC (1988) Age changes in the human female urethra: a morphometric study. J Urol 139:532–535PubMed Carlile A, Davies I, Rigby A, Brocklehurst JC (1988) Age changes in the human female urethra: a morphometric study. J Urol 139:532–535PubMed
15.
go back to reference Perucchini D, DeLancey JO, Ashton-Miller JA, Galecki A, Schaer GN (2002) Age effects on urethral striated muscle. II. Anatomic location of muscle loss. Am J Obstet Gynecol 186:356–360PubMedCrossRef Perucchini D, DeLancey JO, Ashton-Miller JA, Galecki A, Schaer GN (2002) Age effects on urethral striated muscle. II. Anatomic location of muscle loss. Am J Obstet Gynecol 186:356–360PubMedCrossRef
16.
go back to reference Pandit M, DeLancey JO, Ashton-Miller JA, Iyengar J, Blaivas M, Perucchini D (2000) Quantification of intramuscular nerves within the female striated urogenital sphincter muscle. Obstet Gynecol 96(6):797–800CrossRef Pandit M, DeLancey JO, Ashton-Miller JA, Iyengar J, Blaivas M, Perucchini D (2000) Quantification of intramuscular nerves within the female striated urogenital sphincter muscle. Obstet Gynecol 96(6):797–800CrossRef
17.
go back to reference Fischer W, Pfister C, Tunn R (1992) Histomorphology of pelvic floor muscles in women with urinary incontinence. Zentralbl Gynaekol 114(4):189–194 Fischer W, Pfister C, Tunn R (1992) Histomorphology of pelvic floor muscles in women with urinary incontinence. Zentralbl Gynaekol 114(4):189–194
18.
go back to reference Richter K (1988) Surgical anatomy of the bladder neck sphincter and its significance for vaginal surgery of stress incontinence. Geburtshilfe Frauenheilkd 48(8):541–550PubMedCrossRef Richter K (1988) Surgical anatomy of the bladder neck sphincter and its significance for vaginal surgery of stress incontinence. Geburtshilfe Frauenheilkd 48(8):541–550PubMedCrossRef
19.
go back to reference Bohling MW, Henderson RA, Swaim SF, Kincaid SA, Wright JC (2006) Comparison of the role of the subcutaneous tissues in cutaneous wound healing in the dog and cat. Vet Surg 35(1):3–14PubMedCrossRef Bohling MW, Henderson RA, Swaim SF, Kincaid SA, Wright JC (2006) Comparison of the role of the subcutaneous tissues in cutaneous wound healing in the dog and cat. Vet Surg 35(1):3–14PubMedCrossRef
20.
go back to reference Ulmsten U, Falconer C (1999) Connective tissue in female urinary incontinence. Curr Opin Obstet Gynecol 11(5):509–515PubMedCrossRef Ulmsten U, Falconer C (1999) Connective tissue in female urinary incontinence. Curr Opin Obstet Gynecol 11(5):509–515PubMedCrossRef
21.
go back to reference Chen X, Creed KE (2004) Histochemical and contractile properties of striated muscles of urethra and levator ani of dogs and sheep. Neurourol Urodyn 23:702–708PubMedCrossRef Chen X, Creed KE (2004) Histochemical and contractile properties of striated muscles of urethra and levator ani of dogs and sheep. Neurourol Urodyn 23:702–708PubMedCrossRef
22.
go back to reference DeLancey JO, Starr RA (1990) Histology of the connection between the vagina and levator ani muscles. Implications for urinary tract function. J Reprod Med 35:765–771PubMed DeLancey JO, Starr RA (1990) Histology of the connection between the vagina and levator ani muscles. Implications for urinary tract function. J Reprod Med 35:765–771PubMed
23.
go back to reference Dimpfl T, Jaeger C, Mueller-Felber W, Anthuber C, Hirsch A, Brandmaier R, Schuessler B (1998) Myogenic changes of the LAM in premenopausal women: the impact of vaginal delivery and age. Neurourol Urodyn 17:197–205PubMedCrossRef Dimpfl T, Jaeger C, Mueller-Felber W, Anthuber C, Hirsch A, Brandmaier R, Schuessler B (1998) Myogenic changes of the LAM in premenopausal women: the impact of vaginal delivery and age. Neurourol Urodyn 17:197–205PubMedCrossRef
24.
go back to reference Gilpin SA, Gosling JA, Smith AR, Warrell DW (1989) The pathogenesis of genitourinary prolapse and stress incontinence of urine. A histological and histochemical study. Br J Obstet Gynaecol 96:15–23PubMed Gilpin SA, Gosling JA, Smith AR, Warrell DW (1989) The pathogenesis of genitourinary prolapse and stress incontinence of urine. A histological and histochemical study. Br J Obstet Gynaecol 96:15–23PubMed
25.
go back to reference Fritsch H, Pinggera GM, Lienemann A, Mitterberger M, Bartsch G, Strasser H (2006) What are the supportive structures of the female urethra? Neurourol Urodyn 25(2):128–134PubMedCrossRef Fritsch H, Pinggera GM, Lienemann A, Mitterberger M, Bartsch G, Strasser H (2006) What are the supportive structures of the female urethra? Neurourol Urodyn 25(2):128–134PubMedCrossRef
26.
go back to reference Hanzal E, Berger E, Koelbl H (1993) Levator ani muscle morphology and recurrent genuine stress incontinence. Am Coll Obstet Gynecol 81:426–429 Hanzal E, Berger E, Koelbl H (1993) Levator ani muscle morphology and recurrent genuine stress incontinence. Am Coll Obstet Gynecol 81:426–429
27.
go back to reference Dorschner W, Biesold M, Schmidt F, Stolzenburg J (1999) The dispute about the external sphincter and the urogenital diaphragm. J Urol 162:1942–1945PubMedCrossRef Dorschner W, Biesold M, Schmidt F, Stolzenburg J (1999) The dispute about the external sphincter and the urogenital diaphragm. J Urol 162:1942–1945PubMedCrossRef
28.
go back to reference Bazhenov DV, Blinova NV (2002) Morphofunctional characteristics of the urogenital diaphragm in women. Morfologiia 122:64–67PubMed Bazhenov DV, Blinova NV (2002) Morphofunctional characteristics of the urogenital diaphragm in women. Morfologiia 122:64–67PubMed
Metadata
Title
Histomorphological analysis of the urogenital diaphragm in elderly women: a cadaver study
Authors
C. Betschart
D. Scheiner
C. Maake
M. Vich
L. Slomianka
D. Fink
D. Perucchini
Publication date
01-11-2008
Publisher
Springer-Verlag
Published in
International Urogynecology Journal / Issue 11/2008
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI
https://doi.org/10.1007/s00192-008-0669-9

Other articles of this Issue 11/2008

International Urogynecology Journal 11/2008 Go to the issue