The relationship between anterior and apical compartment support

Abstract

Objective: The purpose of this study was to determine whether the degree of anterior compartment (bladder) and apical compartment (cervix) prolapse are correlated, and whether 2 anterior compartment elements (urethra and bladder) are related at maximal Valsalva.

Study design: Women with a complete spectrum of pelvic support were recruited for a pelvic support study. Dynamic magnetic resonance scans were taken during Valsalva. A convenience sample of 153 women with a mean age of 53.3 +/- 12.5 (SD) years with a uterus in situ was studied. Anterior compartment status was assessed by the most caudal bladder point and the internal urinary meatus. The external cervical os was used to assess the apical compartment. The position of the bladder, urethra, and uterus were determined in 20 nulliparous women to determine their reference locations. The distances of each structure below the reference positions were calculated at maximum Valsalva.

Results: Average distances of the bladder base, urethra, and uterus from the reference positions at maximal Valsalva were 4.1 +/- 2.4 cm, 3.1 +/- 1.3 cm, and 4.3 +/- 2.4 cm, respectively. The Pearson correlation coefficient of the relationship between the bladder base and uterine distances was r = 0.73 (r2 = 0.53). The Pearson correlation coefficient of the bladder distance and urethral distance was r = 0.82 (r2 = 0.67).

Conclusion: Half of the observed variation in anterior compartment support may be explained by apical support.

Figures

Figure 1

Left panel shows a sagittal section of a woman with a descent of the bladder (B) and uterus (U). The arrows point to the sacro-coccygeal articulation dorsally and the inferior pubic point ventrally. The right panel shows the SCIPP line (x-axis) and the perpendicular y-axis, most caudal bladder point (closed circle), internal urinary meatus (open circle), and external cervical os (triangle).

Figure 2

A, Uterine descent without bladder descent. B, Bladder and urethra both descend without uterus. C, Similar descent of the bladder and uterus with noticeably less decent of the urethra in contrast to B. Note, when bladder base and urethra are in the same location, a single mark is shown.

Figure 3

Location of the bladder and uterus at rest and at maximal Valsalva.

Figure 4

Enlarged view of the urethra and bladder locations at rest and maximal Valsalva. Because of co-localization, the “normal” position of the bladder and urethra are the same. The figures were enlarged compared with Figure 3 in order to show the overlap of the bladder and urethral locations. In doing so, the most dependent bladder point during maximal Valsalva is not shown.

Figure 5

Correlation between bladder and uterus. The distance between the “normal” location and the position during maximal Valsalva maneuver for both the most caudal point of the bladder and the external cervical os.

Figure 6

Correlation between bladder and urethra. The distance between the “normal” location and the position during maximal Valsalva maneuver for both the most caudal point of the bladder and the internal urinary meatus.