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International Urogynecology Journal

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01-07-2014 | Original Article

Relationship between intra-abdominal pressure and vaginal wall movements during Valsalva in women with and without pelvic organ prolapse: technique development and early observations

Authors: D. M. Spahlinger, L. Newcomb, J. A. Ashton-Miller, J. O. L. DeLancey, Luyun Chen

Published in: International Urogynecology Journal | Issue 7/2014

Abstract

Objectives

To develop and test a method for measuring the relationship between the rise in intra-abdominal pressure and sagittal plane movements of the anterior and posterior vaginal walls during Valsalva in a pilot sample of women with and without prolapse.

Methods

Mid-sagittal MRI images were obtained during Valsalva while changes in intra-abdominal pressure were measured via a bladder catheter in 5 women with cystocele, 5 women with rectocele, and 5 controls. The regional compliance of the anterior and posterior vagina wall support systems were estimated from the ratio of displacement (mm) of equidistant points along the anterior and posterior vaginal walls to intra-abdominal pressure rise (mmHg).

Results

The compliance of both anterior and posterior vaginal wall support systems varied along different regions of vaginal wall for all three groups, with the highest compliance found near the vaginal apex and the lowest near the introitus. Women with cystocele had more compliant anterior and posterior vaginal wall support systems than women with rectocele. The movement direction differs between cystocele and rectocele. In cystocele, the anterior vaginal wall moves mostly toward the vaginal orifice in the upper vagina, but in a ventral direction in the lower vagina. In rectocele, the direction of the posterior vaginal wall movement is generally toward the vaginal orifice.

Conclusions

Movement of the vaginal wall and compliance of its support is quantifiable and was found to vary along the length of the vagina. Compliance was greatest in the upper vagina of all groups. Women with cystocele demonstrated the most compliant vaginal wall support.

Nygaard I, Barber MD, Burgio KL, Kenton K, Meikle S, Schaffer J, Spino C, Whitehead WE, Wu J, Brody DJ, Pelvic Floor Disorders Network (2008) Prevalence of symptomatic pelvic floor disorders in US women. JAMA 300:1311–1316PubMedCentralPubMedCrossRef

Boyles SH, Weber AM, Meyn L (2003) Procedures for pelvic organ prolapse in the United States, 1979–1997. Am J Obstet Gynecol 188:108–115PubMedCrossRef

Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL (1997) Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol 89:501–506PubMedCrossRef

Fialkow MF, Newton KM, Lentz GM, Weiss NS (2008) Lifetime risk of surgical management of pelvic organ prolapse or urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 19:437–440PubMedCrossRef

Richardson AC, Lyons JB, Williams NL (1976) A new look at pelvic relaxation. Am J Obstet Gynecol 126:568–573PubMed

Malbrain ML, De Laet I, Viaene D, Schoonheydt K, Dits H (2008) In vitro validation of a novel method for continuous intra-abdominal pressure monitoring. Intensive Care Med 34:740–745PubMedCrossRef

Tumbarello JA, Hsu Y, Lewicky-Gaupp C, Rohrer S, DeLancey JO (2010) Do repetitive Valsalva maneuvers change maximum prolapse on dynamic MRI? Int Urogynecol J 21(10):1247–1251. doi:10.1007/s00192-010-1178-1 PubMedCentralPubMedCrossRef

DeLancey JO, Morgan DM, Fenner DE, Kearney R, Guire K, Miller JM, Hussain H, Umek W, Hsu Y, Ashton-Miller JA (2007) Comparison of levator ani muscle defects and function in women with and without pelvic organ prolapse. Am J Obstet Gynecol 109:295–302CrossRef

Hsu Y, Chen L, Tumbarello J, Ashton-Miller JA, DeLancey JO (2010) In vivo assessment of anterior compartment compliance and its relation to prolapse. Int Urogynecol J 21:1111–1115PubMedCentralPubMedCrossRef

10.

Larson KA, Hsu Y, Chen L, Ashton-Miller JA, DeLancey JO (2010) Magnetic resonance imaging-based three-dimensional model of anterior vaginal wall position at rest and maximal strain in women with and without prolapse. Int Urogynecol J 21:1103–1109PubMedCentralPubMedCrossRef

11.

Larson KA, Luo J, Guire KE, Chen L, Ashton-Miller JA, DeLancey JO (2012) 3D analysis of cystoceles using magnetic resonance imaging assessing midline, paravaginal, and apical defects. Int Urogynecol J 23(3):285–293. doi:10.1007/s00192-011-1586-x PubMedCentralPubMedCrossRef

12.

Luo J, Larson KA, Fenner DE, Ashton-Miller JA, DeLancey JO (2012) Posterior vaginal prolapse shape and position changes at maximal Valsalva seen in 3-D MRI-based models. Int Urogynecol J 23(9):1301–1306. doi:10.1007/s00192-012-1760-9 PubMedCentralPubMedCrossRef

13.

Cosson M, Lambaudie E, Boukerrou M, Lobry P, Crépin G, Ego A (2004) A biomechanical study of the strength of vaginal tissues results on 16 post-menopausal patients presenting with genital prolapse. Eur J Obstet Gynecol Reprod Biol 112:201–205PubMedCrossRef

14.

Cosson M, Boukerrou M, Lacaze S, Lambaudie E, Fasel J, Mesdagh H, Lobry P, Ego A (2007) A study of pelvic ligament strength. Eur J Obstet Gynecol Reprod Biol 109(1):80–87CrossRef

15.

Zimmern PE, Eberhart RC, Bhatt A (2009) Methodology for biomechanical testing of fresh anterior wall vaginal samples from postmenopausal women undergoing cystocele repair. Neurourol Urodyn 28(4):325–329PubMedCrossRef

16.

Epstein LB, Graham CA, Heit MH (2007) Systemic and vaginal biomechanical properties of women with normal vaginal support and pelvic organ prolapse. Am J Obstet Gynecol 197(2):165.e1–165.e6CrossRef

17.

Bertschinger KM, Hetzer FH, Roos JE, Treiber K, Marincek B, Hilfiker PR (2002) Dynamic MR imaging of the pelvic floor performed with patient sitting in an open-magnet unit versus with patient supine in a closed-magnet unit. Radiology 223(2):501–508PubMedCrossRef

18.

Fielding JR, Griffiths DJ, Versi E, Mulkern RV, Lee ML, Jolesz FA (1998) MR imaging of pelvic floor continence mechanisms in the supine and sitting positions. AJR Am J Roentgenol 171(6):1607–1610PubMedCrossRef

19.

Fusco MA, Martin RS, Chang MC (2001) Estimation of intra-abdominal pressure by bladder pressure measurement: validity and methodology. J Trauma 50:297–302PubMedCrossRef

20.

Chen L, Ashton-Miller JA, DeLancey JO (2009) A 3D finite element model of anterior vaginal wall support to evaluate mechanisms underlying cystocele formation. J Biomech 42(10):1371–1377PubMedCentralPubMedCrossRef

Title: Relationship between intra-abdominal pressure and vaginal wall movements during Valsalva in women with and without pelvic organ prolapse: technique development and early observations
Authors: D. M. Spahlinger
L. Newcomb
J. A. Ashton-Miller
J. O. L. DeLancey
Luyun Chen
Publication date: 01-07-2014
Publisher: Springer London
Published in: International Urogynecology Journal / Issue 7/2014
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-013-2298-1

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Relationship between intra-abdominal pressure and vaginal wall movements during Valsalva in women with and without pelvic organ prolapse: technique development and early observations

Abstract

Objectives

Methods

Results

Conclusions

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Abstract

Objectives

Methods

Results

Conclusions

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