Mona McCullough

Levator ani subtended volume: a novel parameter to evaluate levator ani muscle laxity in pelvic organ prolapse

OBJECTIVE We describe a new parameter based on magnetic resonance 3-dimensional (3D) reconstructions proposed to evaluate levator ani muscle (LAM) laxity in women with pelvic organ prolapse (POP). STUDY DESIGN This is an institutional review board-approved, retrospective chart review of 35 women with POP, stages I-IV. The 3D Slicer software package was used to perform 2-dimensional and 3D measurements and the levator ani subtended volume (LASV) was described. Basically, the LASV represents the volume contained by LAM between 2 planes, which coincides with pubococcygeal line and H line. Correlations among measurements, ordinal POP stages, POP Quantification (POPQ) individual measurements, and validated questionnaires were performed. RESULTS The LASV differentiated major (III and IV) from minor (I and II) POPQ stages, which positively correlated to POP stages and POPQ individual measurements. CONCLUSION The LASV is a promising parameter to evaluate the LAM laxity.

The ureter as a landmark for robotic sacrocolpopexy.

Objective The objective of this study was to report on the location of the ureters in relation to the sacral promontory at the level of the pelvic brim. Methods Female patients undergoing indicated computed tomographic (CT) urograms were selected for this study. Charts and images from a defined 3-year study period were reviewed. The GE Centricity software was used to evaluate multiplanar CT views and measure the distance from the bilateral ureters to the midpoint of the distal sacral promontory for each subject. Results Sixty-three women underwent CT urography during the study period. Of these, 38 met the criteria for inclusion. Among these, the left ureter was 35.9 ± 4.9 mm lateral to the midsacral promontory. The right ureter was 29.7 ± 6.2 mm lateral to the sacral promontory. Conclusions On average, the sacral promontory is located 29.7 mm medial to the right ureter at the level of the pelvic brim. This represents a landmark that may prove clinically useful, along with other visual cues, in choosing the proper location for careful dissection toward the anterior longitudinal ligament during robotic sacrocolpopexy.

Third sacral foramina morphometry for sacral neuromodulation.

Objective This study is aimed to define the geometry and location of the human S3 foramen, with respect to bony landmarks visible on ultrasound. Methods Computed tomographic (CT) image data from an institutional review board–approved database of de-identified pelvic CT images were analyzed. Points along the S3 foramina and bony sacrum were tagged, and their locations saved. The saved points were mathematically analyzed to determine the geometry and relative location of the S3 foramina with respect to other bony landmarks, specifically the sacral hiatus, and the sacral spinous processes, and the caudad aspect of the bilateral SI joints (“SI line”). Descriptive statistics were used to describe the geometry and aggregate location of the S3 foramina bilaterally. CT data sets were excluded if they had evidence of pelvic bone injury, prior bony fixation, severe osteoporosis, or other deformity. Results One hundred thirty-three data sets met the inclusion criteria. The SI line was superior to the sacral hiatus for reliable S3 localization. The entire circumference of approximately 14% of the S3 foramina is located cephalad to the SI line. The sagittal angle of trajectory for S3 was approximately 70 degrees relative to the dorsal surface of the sacrum. Conclusions Clinical localization of the S3 foramen for sacral neuromodulator needle placement is best obtained when the needle tip is positioned 15 to 25 mm lateral to the sacral spinous processes and 0.0 cm to 25 mm caudad to the SI line, at the level of the dorsal sacrum surface. The findings presented in this study may be applied to improve the efficacy and accuracy of neuromodulator lead placement into the S3 foramen. This study provides rationale for the effectiveness of the crosshair placement technique and demonstrates the best location for needle repositioning when this technique is not initially successful.

Laparoscopic repair of postcoital vaginal evisceration with intact pelvic organs.

It is suggested that a laparoscopic approach may simplify repair of vaginal evisceration in patients with intact pelvic organs and limited vaginal exposure.

Estimates of the levator ani subtended volume based on magnetic resonance linear measurements

A mathematical formula to estimate the levator ani subtended volume parameter based on magnetic resonance imaging linear measurements from one axial and one sagittal view.