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Ultrasound in Obstetrics & Gynecology :... Jul 2021Transperineal ultrasound is a simple and highly repeatable method that has been used increasingly in the quantification of pelvic organ prolapse, but abnormal uterine...
OBJECTIVE
Transperineal ultrasound is a simple and highly repeatable method that has been used increasingly in the quantification of pelvic organ prolapse, but abnormal uterine descent on ultrasound in Chinese women is still poorly defined. We aimed to determine the optimal cut-off to define abnormal uterine descent on transperineal ultrasound in Chinese women.
METHODS
This prospective multicenter study recruited women who were examined in tertiary-level gynecological centers, due to symptoms of lower urinary tract and/or pelvic floor dysfunction, between February 2017 and September 2018. All recruited women underwent a standardized interview, pelvic organ prolapse quantification (POP-Q) examination, and four-dimensional transperineal ultrasound examination. On ultrasound, uterine descent was measured relative to the posteroinferior margin of the symphysis pubis during maximum Valsalva maneuver. The optimal cut-off value for definition of abnormal uterine descent was selected as the value with the highest Youden index and the diagnostic performance of this cut-off for the prediction of prolapse symptoms and POP-Q stage was assessed and compared by means of the area under the receiver-operating-characteristics curve (AUC).
RESULTS
In total, 538 Chinese women, with a mean age of 39.4 (range, 18-81) years, were enrolled into the study. Both uterine descent on transperineal ultrasound (P < 0.001) and POP-Q stage (P < 0.001) were associated strongly with presence of prolapse symptoms. Uterine descent on ultrasound was associated significantly with POP-Q stage for apical compartment prolapse (P < 0.001). The optimal cut-off value for the definition of abnormal uterine descent on transperineal ultrasound during maximum Valsalva maneuver in the prediction of prolapse symptoms was 4.79 mm above the symphysis pubis (AUC, 0.75 (95% CI, 0.71-0.78)), while the optimal cut-off values in the prediction of prolapse of POP-Q Stage ≥ 1 and POP-Q Stage ≥ 2 were 6.63 mm above the symphysis pubis (AUC, 0.83 (95% CI, 0.80-0.86)) and 8.42 mm below the symphysis pubis (AUC, 0.85 (95% CI, 0.82-0.88)), respectively.
CONCLUSIONS
The optimal cut-off value to define abnormal uterine descent on transperineal ultrasound during maximum Valsalva maneuver for the prediction of prolapse symptoms in this population of Chinese women was 4.79 mm above the symphysis pubis, close to that for predicting apical compartment prolapse of POP-Q Stage ≥ 1 (6.63 mm above the symphysis pubis). These are somewhat different from values described previously in mainly Caucasian populations. Ethnic differences should be taken into account in the evaluation of pelvic organ prolapse using transperineal ultrasound. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; China; Female; Humans; Lower Urinary Tract Symptoms; Middle Aged; Pelvic Floor; Pelvic Floor Disorders; Perineum; Predictive Value of Tests; Prospective Studies; Pubic Symphysis; ROC Curve; Reference Values; Ultrasonography; Uterine Prolapse; Uterus; Valsalva Maneuver; Young Adult
PubMed: 33094536
DOI: 10.1002/uog.23524 -
The Journal of Sexual Medicine Jan 2022The importance of the clitoris as an organ has been neglected by doctors and anatomists over the centuries. Its central role in female sexuality is widely recognized and...
BACKGROUND
The importance of the clitoris as an organ has been neglected by doctors and anatomists over the centuries. Its central role in female sexuality is widely recognized and respected. Although multiple studies have been conducted on the fundiform ligament of the penis, the literature concerning the suspensory ligament of the clitoris is extremely poor. The possibility to describe its complex structure may help us understand female orgasm and sexuality.
AIM
Carrying out an anatomical and histological study about the supporting ligaments of the clitoris and in particular the suspensory ligament of the clitoris.
STUDY DESIGN
A total of 10 female cadavers were dissected specifically for this study. All the supporting structures of the clitoris were studied, photographed and measured. A histological study of these structures was also carried out.
RESULTS
The suspensory ligament of the clitoris is a multidimensional structure consisting of three anatomically and histologically distinct components. The superficial layer originates from the anterior abdominal wall, it is the anatomical extension of the fascia superficialis of the abdomen. It mainly consists of loosely organized elastic fibers, fibroblasts and few loosely organized collagen fibers. The intermediate component also originates from the anterior abdominal wall through the extensions of the abdominal aponeurosis that reach the body of the clitoris. It completely encloses the clitoral body and sends lateral extensions to the labia majora. Histologically, this layer mainly consists of well-organized collagen fibers as well as fibroblasts. The deep component is shorter and extends from the pubic symphysis to the knee of the clitoris and also connects the two crus to the pubic symphysis. It almost exclusively consists of very well organized collagen fibers.
CONCLUSION
The suspensory ligament of the clitoris is a multidimensional structure that extends from the anterior abdominal wall to the clitoris. Unlike previous descriptions of the ligament supporting the clitoris, we observed that this structure consists of three anatomically and histologically distinct layers. These new anatomical considerations must be taken into account for any surgery affecting the subcutaneous tissues of the pubis and the abdomen as well as for reconstructive surgery of the clitoris and metoidioplasty. Botter C, Botter M, Pizza C, et al., The Suspensory Ligament of the Clitoris: A New Anatomical and Histological Description. J Sex Med 2022;19:12-20.
Topics: Clitoris; Female; Humans; Ligaments; Male; Penis; Sex Reassignment Surgery; Vulva
PubMed: 34802957
DOI: 10.1016/j.jsxm.2021.10.002 -
The Journal of the American Academy of... Jul 2022The goal of this study was to investigate prevalence and morphometric parameters of pubic ligaments and the interpubic disk and its cavity using imaging methods for use...
INTRODUCTION
The goal of this study was to investigate prevalence and morphometric parameters of pubic ligaments and the interpubic disk and its cavity using imaging methods for use in clinical medicine.
METHODS
Pubic symphysis morphology was investigated in 652 patients (348 women and 304 men), from which 449 CT scans and 203 MR scans were available. The average age of men was 48 years and women 39 years. Investigated parameters included dimensions of the interpubic disk, visibility and width of the reinforcing ligaments, and visibility, dimensions, and location of the symphysial cavity. The results were compared with MR scans of 20 healthy volunteers and 21 dissected anatomic specimens.
RESULTS
The craniocaudal, ventrodorsal, and mediolateral diameters of the pubic disk were 36 to 37.7, 14.8 to 15.2, and 2.2 to 4.2 mm in women and 42 to 42.3, 18.6 to 19, and 2.4 to 4.5 mm in men, respectively. Higher age correlated with shorter mediolateral diameter and larger craniocaudal and ventrodorsal diameters. The superior pubic ligament was visible in 93.1% of men (1.44 mm thick) and in 100% of women (1.7 mm); the inferior pubic ligament in 89.7% of men (1.74 mm) and 88% of women (1.95 mm), the anterior pubic ligament in 96.6% of men (1.5 mm) and 82% of women (1.34 mm); and the posterior pubic ligament in 65.5% of men (1.18 mm) and 63.7% of women (0.83 mm). A symphysial cavity was found in 24% of men and 22.9% of women, with craniocaudal, ventrodorsal, and mediolateral dimensions of 13, 10.7, and 3.2 mm in men and 9.5, 10.7, and 3 mm in women, respectively.
CONCLUSION
The presented morphologic parameters provide an anatomic reference for diagnostics of pathologic conditions of the pubic symphysis. The following anatomic structures should be added to the official anatomic terminology: symphysial cavity (cavitas symphysialis), retropubic eminence (eminentia retropubica), anterior pubic ligament (ligamentum pubicum anterius), and posterior pubic ligament (ligamentum pubicum posterius).
LEVEL OF EVIDENCE
II-III.
Topics: Female; Humans; Ligaments, Articular; Magnetic Resonance Imaging; Male; Middle Aged; Pubic Bone; Pubic Symphysis; Tomography, X-Ray Computed
PubMed: 35550443
DOI: 10.5435/JAAOS-D-21-00933 -
AJR. American Journal of Roentgenology Sep 2015In a patient with symptoms referable to the groin, there can be a number of causes to consider and at times the cause of the symptoms is multifactorial. Although... (Review)
Review
OBJECTIVE
In a patient with symptoms referable to the groin, there can be a number of causes to consider and at times the cause of the symptoms is multifactorial. Although ultrasound can be effective in the evaluation of the groin, the depth and complexity of the anatomy can be problematic. A protocol-driven approach for ultrasound evaluation of the groin will help to ensure an accurate and comprehensive evaluation. This article summarizes the ultrasound technique and protocol for evaluation of the groin to include evaluation of the hip joint, anterior hip musculature, the iliopsoas bursa, the inguinal lymph nodes, the pubic symphyseal region, and the inguinal region for hernias. Common pathologic conditions and pitfalls related to ultrasound evaluation of the groin will be reviewed.
CONCLUSION
There are many potential pathologic conditions in a patient with groin symptoms. Because symptoms may be multifactorial and history may be ambiguous or misleading, a protocol-driven evaluation with ultrasound is recommended. The hip joint is evaluated for effusion, synovitis, and labral abnormalities. The muscles and tendons, including the common aponeurosis at the pubic symphysis, are evaluated for tendinosis and tears. Dynamic evaluation should be considered to assess for snapping hip syndrome. Iliopsoas bursal distention and lymph node enlargement are other considerations. Last, inguinal region hernias must be evaluated during the Valsalva maneuver and documented in two orthogonal planes to avoid several important diagnostic pitfalls.
Topics: Groin; Hernia, Inguinal; Humans; Lymph Nodes; Musculoskeletal Diseases; Pubic Symphysis; Ultrasonography
PubMed: 26102306
DOI: 10.2214/AJR.15.14523 -
Sports Health 2017Evaluation of groin pain in athletes may be challenging as pain is typically poorly localized and the pubic symphyseal region comprises closely approximated tendons and... (Review)
Review
CONTEXT
Evaluation of groin pain in athletes may be challenging as pain is typically poorly localized and the pubic symphyseal region comprises closely approximated tendons and muscles. As such, magnetic resonance imaging (MRI) and ultrasound (US) may help determine the etiology of groin pain.
EVIDENCE ACQUISITION
A PubMed search was performed using the following search terms: ultrasound, magnetic resonance imaging, sports hernia, athletic pubalgia, and groin pain. Date restrictions were not placed on the literature search.
STUDY DESIGN
Clinical review.
LEVEL OF EVIDENCE
Level 4.
RESULTS
MRI is sensitive in diagnosing pathology in groin pain. Not only can MRI be used to image rectus abdominis/adductor longus aponeurosis and pubic bone pathology, but it can also evaluate other pathology within the hip and pelvis. MRI is especially helpful when groin pain is poorly localized. Real-time capability makes ultrasound useful in evaluating the pubic symphyseal region, as it can be used for evaluation and treatment.
CONCLUSION
MRI and US are valuable in diagnosing pathology in athletes with groin pain, with the added utility of treatment using US-guided intervention. Strength-of Recommendation Taxonomy: C.
Topics: Athletic Injuries; Groin; Humans; Magnetic Resonance Imaging; Pain; Pubic Symphysis; Ultrasonography
PubMed: 28850315
DOI: 10.1177/1941738117694841 -
International Journal of... 2021Symphysis pubis tuberculosis (TB) is extremely rare in the reported literature. The diagnosis of pelvic TB is confounded by close differentials such as osteomyelitis as...
Symphysis pubis tuberculosis (TB) is extremely rare in the reported literature. The diagnosis of pelvic TB is confounded by close differentials such as osteomyelitis as well as the low yield of TB bacilli in microbiological sampling in the initial stages of the disease. Pelvic TB should be suspected early on in areas with high TB burden, and prompt treatment with antitubercular treatment may help prevent disability associated with the disease. Here, we present a 49-year-old diabetic man with pubic symphysis TB which was diagnosed on the basis of clinical and radiological aspects, with near-total resolution following 9 months of anti-tubercular treatment.
Topics: Antitubercular Agents; Humans; Male; Middle Aged; Osteomyelitis; Pubic Symphysis; Radiography; Tuberculosis
PubMed: 33707381
DOI: 10.4103/ijmy.ijmy_16_21 -
Journal of Biomechanics Dec 2020Studies have shown that some vertical birthing positions, such as squatting and standing, may influence labour and childbirth. However, a rigorous biomechanical...
Studies have shown that some vertical birthing positions, such as squatting and standing, may influence labour and childbirth. However, a rigorous biomechanical understanding of how different positions affect a woman's pelvis during labour is currently lacking. It was hypothesized that the position of pubic bones is affected in different positions, and thus the pubic symphysis width changes. Therefore, we measured pubic symphysis width on eleven women in their seventh to ninth months of pregnancy in different positions through three-dimensional (3D) reconstruction of pubic symphysis ultrasound images. Positions studies included those used in clinics like supine and lithotomy positions, in addition to squatting and standing, which are recommended by midwives. The results showed that the average superior and inferior pubic symphysis widths in lithotomy, squatting and standing positions were approximately 1 mm larger than those in the supine position. However, no significant difference between lithotomy, squatting and standing positions was found. The results were consistent with those of two comparable studies. A significant difference was only found between standing and squatting, standing and lithotomy in the rotation angle about the medio-lateral axis. The results suggest that positions with thigh hyperflexion and gravity effect make a difference in pubic symphysis width and might have a positive effect in childbirth. However, due to the small sample size, no definite conclusion can be drawn.
Topics: Female; Humans; Labor, Obstetric; Parturition; Pelvis; Pregnancy; Pubic Symphysis; Ultrasonography
PubMed: 33207288
DOI: 10.1016/j.jbiomech.2020.110114 -
Der Unfallchirurg May 2016
Review
Topics: Bone Plates; Evidence-Based Medicine; Fracture Fixation, Internal; Fractures, Bone; Humans; Pubic Bone; Pubic Symphysis; Rupture; Treatment Outcome
PubMed: 27146806
DOI: 10.1007/s00113-016-0165-5 -
Arthroscopy : the Journal of... Jul 2021Pubalgia means pubic pain. This is different from core muscle injury (implying muscular pathology) or inguinal disruption (different anatomic region). Athletic pubalgia...
Pubalgia means pubic pain. This is different from core muscle injury (implying muscular pathology) or inguinal disruption (different anatomic region). Athletic pubalgia includes a myriad of pathologic conditions involving the pubic symphysis, adductors, rectus abdominis, posterior inguinal wall, and/or related nerves. Moreover, growing evidence supports a link between femoroacetabular impingement (FAI) and pubalgic conditions. Constrained hip range of motion in flexion causing obligatory transitory, even ballistic, posterior tilting of the hemipelvis may produce pathologic transfer stress to not only the pubic symphysis but the sacroiliac joint, lumbar spine, and proximal hamstrings, manifesting in diverse, often-painful, conditions. In select cases of pubalgia, patients may have clinical improvement with concurrent or even isolated treatment addressing FAI. Unlike atypical posterior hip pain from FAI, which may be referred pain that might respond favorably, albeit temporarily, to an intra-articular injection, secondary pubic pain from a transfer stress pathomechanism might not be expected to benefit from such. And, it's not always FAI. Some patients who do not respond to nonoperative management may not require arthroscopic surgery and might benefit from open or laparoscopic mesh hernia repair, adductor tenotomy, primary tissue (hernia) repair, rectus abdominis repair, or even endoscopic surgery for osteitis pubis and/or pubalgia. And, finally, these may be combined with FAI surgical treatment. Refinement of definitions, pathologic conditions, technical advances, and collaboration with general surgeons will best help us treat our patients.
Topics: Athletic Injuries; Groin; Hernia; Humans; Pain; Rectus Abdominis; Sports
PubMed: 34226017
DOI: 10.1016/j.arthro.2021.04.027 -
Fa Yi Xue Za Zhi Oct 2020Adult age determination plays an important role in individual identification, criminal investigation and social welfare. The most popular adult age determination... (Review)
Review
Adult age determination plays an important role in individual identification, criminal investigation and social welfare. The most popular adult age determination indicators are pubic symphysis, iliac auricular surface, costal cartilage, cranial sutures, teeth, laryngeal cartilage, etc. In recent years, with the progress of CT imaging and 3D reconstruction technology, the adult age determination study gradually has transferred from a time-consuming general observation of bones with complex pre-processing in the past to the non-destructive, convenient, time-saving and easy to store image analysis technology. To explore more accurate, rapid and convenient adult age determination methods, multiple imaging methods and artificial intelligence have been applied in adult age determination. This paper reviews the common methods and research progress of adult age determination at home and abroad, infers the development direction of adult age determination, in order to provide reference for the improvement and optimization of forensic adult age determination.
Topics: Age Determination by Skeleton; Artificial Intelligence; Forensic Anthropology; Imaging, Three-Dimensional; Pubic Symphysis; Research
PubMed: 33295159
DOI: 10.12116/j.issn.1004-5619.2020.05.002