Biomedical subjects

Daniel M Morgan

Publications and source records attributed to Daniel M Morgan.

7 recordsLinked to original sources

PubMed2007

Comparative analysis of urinary incontinence severity after autologous fascia pubovaginal sling, pubovaginal sling and tension-free vaginal tape.

PURPOSE: Autologous fascia, Pelvicol implant and polypropylene are common materials used in suburethral anti-incontinence procedures. We explored the relative effectiveness of the autologous fascia pubovaginal sling, Pelvicol pubovaginal sling and Gynecare TVT on self-reported postoperative urinary incontinence. MATERIALS AND METHODS: The study was a mailed cross-sectional survey of health related quality of life 1 to 3 years after suburethral anti-incontinence surgery performed at our institution. The Incontinence Symptom Index was used to assess the presence and severity of urinary incontinence symptoms and the Incontinence Impact Questionnaire-7 was used to assess impairment. Regression models were developed to identify factors with an independent effect on the presence, severity and impairment of urinary incontinence symptoms. RESULTS: The questionnaire was returned by 69% of eligible respondents (173 of 250). Those with previous incontinence surgery (OR 11.0, 95% CI 2.3-51.4) and medical comorbidities (OR 1.6, 95% CI 1.1-2.2) were more likely to report urinary incontinence symptoms, ie incontinence symptom index greater than 0. Symptom severity, which was analyzed only in respondents with urinary incontinence symptoms, was greater in the Pelvicol than in the autologous fascia pubovaginal sling and TVT groups (each p <0.01). No significant difference was observed between the TVT and autologous fascia pubovaginal sling groups (p = 0.15). Also associated with higher urinary incontinence symptom severity scores were body mass index (p = 0.03), a history of incontinence surgery (p = 0.01) and lower education (p <0.01). Impairment from urinary incontinence, as assessed by the Incontinence Impact Questionnaire-7, was associated with body mass index, severe depression and current smoking (each p = 0.01) but not with surgical treatment group. CONCLUSIONS: Women who received an autologous fascia pubovaginal sling or TVT reported lower symptom severity scores than those who had a Pelvicol pubovaginal sling. Impairment was not associated with procedure type. These findings suggest better outcomes with autologous fascia pubovaginal sling and TVT. Randomized, controlled trials are needed to confirm these findings.

Cross-Sectional Studies↗

PubMed2006

Interrater reliability of assessing levator ani muscle defects with magnetic resonance images.

The objective of this study is to determine interrater reliability of assessing pubovisceral levator ani muscle defects with magnetic resonance images. Normal pubovisceral muscle was assigned a grade of 0; PVM defects were graded as mild=1 (less than half missing), moderate=2 (more than half missing), and severe=3 (total or near total loss). Among six pairs of examiners, percent agreement and weighted kappa coefficients were calculated to determine agreement between pairs of examiners and among all examiners (i.e., "overall"). For unilateral scoring, exact agreement was found in 83.7%, and differences of one, two, and three grades were found in 14.7, 1.5, and 0.1%, respectively. For bilateral scoring, exact agreement and differences of one, two and three grades were found in 75.4, 15.9, 6.9, and 1.6%, respectively. Thus, exact agreement or a one-point difference was reached in 91.3% of cases. When defect status was categorized as none/normal, minor, and major, the overall weighted kappa coefficient was 0.86 (95% CI 0.83, 0.89). There was variation among examiner pairs with unilateral (p=0.002) and bilateral (p=0.02) scoring, but not when defect status was categorized as none/normal, minor, and major (p=0.59). There was agreement to within one point in 91% of cases when six examiner pairs scored levator ani defects on a seven-point scale. Examiner pairs discriminated injury similarly when defect status was categorized as normal/none, minor, or major.

Adult↗

PubMed2005

Does vaginal closure force differ in the supine and standing positions?

OBJECTIVE: This study was undertaken to quantify resting vaginal closure force (VCF(REST)), maximum vaginal closure force (VCF(MAX)), and augmentation of vaginal closure force augmentation (VCF(AUG)) when supine and standing and to determine whether the change in intra-abdominal pressure associated with change in posture accounts for differences in VCF. STUDY DESIGN: Thirty-nine asymptomatic, continent women were recruited to determine, when supine and standing, the vaginal closure force (eg, the force closing the vagina in the mid-sagittal plane) and bladder pressures at rest and at maximal voluntary contraction. VCF was measured with an instrumented vaginal speculum and bladder pressure was determined with a microtip catheter. VCF(REST) was the resting pelvic floor tone, and VCF(MAX) was the peak pelvic floor force during a maximal voluntary contraction. VCF(AUG) was the difference between VCF(MAX) and VCF(REST). T tests and Pearson correlation coefficients were used for analysis. RESULTS: VCF(REST) when supine was 3.6 +/- 0.8 N and when standing was 6.9 +/- 1.5 N--a 92% difference (P < .001). The VCF(MAX) when supine was 7.5 +/- 2.9 N and when standing was 10.1 +/- 2.4 N--a 35% difference (P < .001). Bladder pressure when supine (10.5 +/- 4.7 cm H2O) was significantly less (P < .001) than when standing (31.0 +/- 6.4 cm H2O). The differences in bladder pressure when either supine or standing did not correlate with the corresponding differences in VCF at rest or at maximal voluntary contraction. The supine VCF(AUG) of 3.9 +/- 2.7 N, was significantly greater than the standing VCF(AUG) of 3.3+/-1.9 N. CONCLUSION: With change in posture, vaginal closure force increases because of higher intra-abdominal pressure and greater resistance in the pelvic floor muscles.

Adult↗

PubMed2005

Pudendal nerve stretch during vaginal birth: a 3D computer simulation.

OBJECTIVE: The purpose of this study was to determine the increase in pudendal nerve branch lengths using a 3D computer model of vaginal delivery. STUDY DESIGN: The main inferior rectal and perineal branches of the pudendal nerve were dissected in 12 hemi-pelves from 6 adult female cadavers. Their 3D courses were digitized in the 4 specimens with the most characteristic nerve branching pattern, and the data were imported into a published 3D computer model of the pelvic floor. Each nerve branch was then represented by a stretchable cord with a fixation point at the ischial spine. The length change in each branch was then quantified as the fetal head descended through the pelvic floor. The maximum nerve strains ([final length minus original length/original length] x 100) were calculated for 5 degrees of perineal descent: reference descent from the literature, 1.25 cm and 2.5 cm caudal and cephalad. The effect of alternative fixation points on resultant nerve strain was also studied. RESULTS: The inferior rectal branch exhibited the maximum strain, 35%, and this strain varied by 15% from the scenario with the least perineal descent to that with the most perineal descent. The strain in the perineal nerve branch innervating the anal sphincter reached 33%, while the branches innervating the posterior labia and urethral sphincter reached values of 15% and 13%, respectively. The more proximal the nerve fixation point, the greater the nerve strain. CONCLUSION: During the second stage: (1) nerves innervating the anal sphincter are stretched beyond the 15% strain threshold known to cause permanent damage in appendicular peripheral nerve, and (2) the degree of perineal descent is shown to influence pudendal nerve strain.

Aged↗

PubMed2004

Quantitative analysis of uterosacral ligament origin and insertion points by magnetic resonance imaging.

OBJECTIVE: To estimate the percentage of healthy women in whom the uterosacral ligaments are identifiable on standard magnetic resonance imaging (MRI) scans and to determine origin points from the genital tract and insertion points on the pelvic sidewall. METHODS: Eighty-two asymptomatic women (mean +/- standard deviation age 53 +/- 12 years; mean parity 2.5, range 0-7) volunteered for this study. They were eligible if the most dependent vaginal wall point lay at least 1 cm above the hymenal ring remnant during a Valsalva maneuver. Axial proton density MRI of the entire pelvis was analyzed at 5-mm intervals. All results were referenced to the ischial spine. We determined the visibility of the uterosacral ligaments and located their origins from the genital tract and their insertion points on the pelvic sidewall. RESULTS: Uterosacral ligaments were visible in 61 (87%) of 70 analyzable scans. They extended over a mean craniocaudal distance of 21 +/- 8 mm (range 10-50). Three regions of origin were found: cervix alone, cervix and vagina in the same section, and vagina alone. Thirty-three percent, 63%, and 4% of 254 identified origin points were from these three areas, respectively. Of 259 uterosacral insertion points, 82% overlaid the sacrospinous ligament/coccygeus muscle complex, 7% the sacrum, and 11% the piriformis muscle, the sciatic foramen, or the ischial spine. Although uterosacral ligament morphology was similar bilaterally, its craniocaudal extent was greater on the right side. CONCLUSION: In healthy women, the uterosacral ligament origin and insertion points exhibited greater anatomic variation than their name would imply.

Adult↗

PubMed2003

The axial location of structural regions in the urethra: a magnetic resonance study in nulliparous women.

OBJECTIVE: To define and quantify the appearance and location of distinct regions of the bladder neck and urethra by using axial magnetic resonance images from healthy, continent, nulliparous women. METHODS: Seventy-eight asymptomatic, healthy, nulliparous women (mean age 29.2 +/- 5.4 years) volunteered for this study. All women were proven continent on urodynamic examination. Axial proton density magnetic resonance images of the pelvic floor were analyzed at 5-mm intervals. A geometric origin was established at the internal urethral meatus. The presence or absence of each of six structural regions--the bladder base, bladder neck, striated urethral sphincter, compressor urethrae and urethrovaginal sphincter, perineal membrane, and distal urethra--was then noted in each more distal image. The proportion of women in whom a structural region was seen at each 5-mm interval was recorded. RESULTS: The striated urogenital sphincter was observed at 5-25 mm distal to the bladder base. It was observed 10 and 15 mm below the bladder base in 91% (95% confidence interval [CI] 85%, 98%) and 99% (95% CI 97%, 100%), respectively, of all women. The perineal membrane, marking the distal end of the muscular urethra, was located 20-35 mm distal to the bladder base. The length of the muscular region of the urethra ranged from 20 to 35 mm (mean 24 mm, 95% CI 24, 25 mm). CONCLUSION: Magnetic resonance images allow the normal appearance and location of urethral and bladder neck structures to be quantified in healthy, continent, nulliparous women.

Adult↗

PubMed2003

A technique to evaluate the thickness and density of nonvascular smooth muscle in the suburethral fibromuscular layer.

OBJECTIVE: The suburethral fibromuscular layer (SUFML) contains nonvascular smooth muscle that may play an important role in the continence mechanism. This study was undertaken to develop a method to systematically quantify differences in the thickness and density of nonvascular smooth muscle within the SUFML and to demonstrate its use in assessing variation. STUDY DESIGN: Urethral and anterior vaginal wall sections from the urethrovesical junction of fresh cadavers were stained to define alpha actin in smooth muscle cells. The thickness of the SUFML was microscopically measured and the density of the nonvascular smooth muscle was determined with computer-aided analysis. RESULTS: The mean thickness of the SUFML was 3.04 mm (range 1.74-3.78 mm, SD +/-0.63 mm). The mean density of nonvascular smooth muscle within it was 17.94% (range 10.48%-42.84%, SD +/-9.4%). The mean age was 55 years (range 36-69 years, SD +/-10.75 years). CONCLUSION: The thickness and density of the nonvascular smooth muscle within the SUFML can be quantified and there is variation among individuals.

Actins↗