Original scientific paper
BIOMECHANICS OF THE SUPPORT OF PELVIC ORGANS Pelvimetric study of the suspension system in genital prolapses
Momčilo B Lazarevski
; Department of Obstetrics & Gynecology, Faculty of Medicine, University »Sv. Kiril i Metodij«, Skopje, Macedonia
Abstract
Aim. The mechanisms of the support of pelvic organs are still debatable. There are three major concepts regarding the role of the suspension and sustention systems: »suspensionistic«, »sustentionistic« and »dualistic«. The aim of this paper is to elucidate the role of the suspension system in these phenomena. Material and method. The study involves 441 patients (340 genital prolapses and 101 control cases). All patients are submitted to a standard colpocystography (pelvigraphy during maximal contraction of pelvic diaphragm and during maximal bearing down). The suspension system is simplified as a chain composed of three links and the pelvimetric measurements are made between the well defined points: lower edge of pubic symphysis, bladder neck, external uterine orifice and middle point of anterior surface of third sacral vertebra. Biomechanical study of changes of these parameters is carried out through analysis of elastic oscillations and plastic deformation indices. Results. The index of elastic oscillation within control group of the whole suspension system is 7.8%, however, all part of the system do not comport uniformly. The most important oscillations are registered at genito-sacral (15.3%), and much smaller at pubo-urinary distance (3.3%). However, the index of uro-genital part is negative (–1.5%), demonstrating that this part of suspension, where the ureter is located, is maximally protected from distension. With hysteroprolapses, the elastic oscillation indices of whole system increase proportionally to the degree of descent, reaching maximum of 45%. Analyzed separately, all elements of suspension do not comport uniformly, as well. Genito-sacral portion indices are always highest, reaching maximum of 49.5%, pubo-urinary portion presents smaller indices (max. 29.5%). However, the indices of urogenital segment increase very slowly with intravaginal hysteroprolapses, but they show a sharp increase after uterine exteriorization (max. 42.7%). The analysis of plastic deformation indices of hysteroprolapses demonstrates that the whole suspension system changes parallel prolapse progression (15.4%, 28.0%, 68.0% and 73.3%). The highest deteriorations are registered at genito-sacral part (max. 105.3%). The indices of pubo-urinary part run at a somewhat lower level (max. 53.4%). However, the indices of uro-genital portion are very interesting: with intravaginal hysteroprolapses, they are even negative, but after uterine exteriorization, they increase sharply, reaching maximum value of 32.3%. Within sliding bladder prolapses, urogenital portion is six times more deteriorated than with concomitant ones. Conclusion. The biomechanical analysis implies that genital prolapse is primarily connected with deteriorations of the suspension system. Consequently, genital prolapse surgery should be primarily directed towards realization of adequate correction of deteriorations of the suspension system. The correction could be done by shortening of respective elements of suspension system (resection, plication or duplication), or by their substitution with heterogeneous material. Due to high resistance of heterogeneous material, substitution gives better and more durable results.
Keywords
genital prolapse; endopelvic fascia; suspension system of genital organs; support of pelvic organs
Hrčak ID:
23855
URI
Publication date:
1.9.2006.
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