Functional Anatomy of Urogenital Hiatus Closure: the Perineal Complex Triad Hypothesis
dc.contributor.author | Pipitone, Fernanda | |
dc.contributor.author | Masteling, Mariana | |
dc.contributor.author | Xie, Bing | |
dc.contributor.author | Chen, Luyun | |
dc.contributor.author | DeLancey, John | |
dc.contributor.author | Ashton-Miller, James | |
dc.date.accessioned | 2024-01-21T16:33:58Z | |
dc.date.available | 2024-01-21T16:33:58Z | |
dc.date.issued | 2024-01-21 | |
dc.identifier.citation | International Urogynecology Journal, | en_US |
dc.identifier.uri | https://hdl.handle.net/2027.42/192090 | en |
dc.description.abstract | 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. | en_US |
dc.description.sponsorship | National Institutes of Health grants RC2 DK122379, R01 HD094954; Michigan Institute for Clinical and Health Research grant UL1TR002240; and the National Institute on Aging, Claude D. Pepper Older Americans Independence Center grant P30 AG024824 | en_US |
dc.language.iso | en_US | en_US |
dc.publisher | Springer | en_US |
dc.relation.ispartofseries | Online ahead of print | en_US |
dc.rights | Attribution-NonCommercial-NoDerivatives 4.0 International | * |
dc.rights.uri | http://creativecommons.org/licenses/by-nc-nd/4.0/ | * |
dc.subject | Levator ani · Pathophysiology of pelvic organ prolapse · Pelvic floor birth injury · Perineal body · Perineal membrane · Urogenital and levator hiatus | en_US |
dc.title | Functional Anatomy of Urogenital Hiatus Closure: the Perineal Complex Triad Hypothesis | en_US |
dc.type | Article | en_US |
dc.subject.hlbsecondlevel | Mechanical Engineering | |
dc.subject.hlbtoplevel | Engineering | |
dc.description.peerreviewed | Peer Reviewed | en_US |
dc.contributor.affiliationum | Mechanical Engineering, Department of | en_US |
dc.contributor.affiliationumcampus | Ann Arbor | |
dc.description.bitstreamurl | http://deepblue.lib.umich.edu/bitstream/2027.42/192090/1/DeLancey perineal complex IUJ 2024.pdf | |
dc.identifier.doi | doi:10.1007/s00192-023-05708-w | |
dc.identifier.doi | https://dx.doi.org/10.7302/22090 | |
dc.identifier.orcid | 0000-0003-1528-278 | en_US |
dc.description.filedescription | Description of DeLancey perineal complex IUJ 2024.pdf : Functional Anatomy of Urogenital Hiatus Closure: The Perineal Complex Triad Hypothesis | |
dc.working.doi | 10.7302/22090 | en_US |
dc.owningcollname | Mechanical Engineering, Department of |
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