Cited by 163Pelvic floor disorders treatmentsPregnancy-related medical researchUterine Myomas and Treatments

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What's new in the functional anatomy of pelvic organ prolapse?

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DeLancey, John O.L.·2016·Current Opinion in Obstetrics & Gynecology

DOI 10.1097/gco.0000000000000312PMC PMC5347042

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Abstract

Purpose of review: Provide an evidence-based review of pelvic floor functional anatomy related to pelvic organ prolapse. Recent findings: Pelvic organ support depends on interactions between the levator ani muscle and pelvic connective tissues. Muscle failure exposes the vaginal wall to a pressure differential producing abnormal tension on the attachments of the pelvic organs to the pelvic sidewall. Birth-induced injury to the pubococcygeal portion of the levator ani muscle is seen in 55% of women with prolapse and 16% of women with normal support. Failure of the lateral connective tissue attachments between the uterus and vagina to the pelvic wall (cardinal, uterosacral, and paravaginal) are strongly related with prolapse (effect sizes ∼2.5) and are also highly correlated with one another (r ∼ 0.85). Small differences exist with prolapse in factors involving the vaginal wall length and width (effect sizes ∼1). The primary difference in ligament properties between women with and without prolapse is found in ligament length. Only minor differences in ligament stiffness are seen. Summary: Pelvic organ prolapse occurs because of injury to the levator ani muscles and failure of the lateral connections between the pelvic organs to the pelvic sidewall. Abnormalities of the vaginal wall fascial tissues may play a minor role.

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Authors: DeLancey, J. O. L.
Affiliations: Women's Hospital (US)
Corresponding author: DeLancey, John O.L.
ORCID: DeLancey, John O.L.
Venue: Current Opinion in Obstetrics & Gynecology
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2016-10
Volume: 28
Issue: 5
Pages: 420-429
ISSN: 1040-872X (ISSN-L)
1473-656X
DOI: 10.1097/gco.0000000000000312
PMC: PMC5347042
OpenAlex: W2509938651
Cited by: 159
References: 48
Citations by year: 2026: 12 · 2025: 26 · 2024: 22 · 2023: 24 · 2022: 29 · 2021: 20 · 2020: 10 · 2019: 9 · 2018: 5 · 2017: 2
FWCI: 0.85
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Locations: Current Opinion in Obstetrics & Gynecology (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
Funders: National Institutes of Health
National Institute of Child Health and Human Development
Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD038665, P50HD044406)
Topics: Health Sciences › Medicine › Urology › Pelvic floor disorders treatments
Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy-related medical research
Health Sciences › Medicine › Obstetrics and Gynecology › Uterine Myomas and Treatments
Keywords: pelvic organ prolapse, levator ani muscle, pelvic connective tissue, cardinal ligament, uterosacral ligament, ligament length, ligament stiffness
MeSH terms: Biomechanical Phenomena, Elasticity, Female, Humans, Ligaments, Uterus, Vagina, Viscosity, Pelvic Floor, Pelvic Organ Prolapse

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