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J O DeLancey

Publications and source records attributed to J O DeLancey.

At least 19 recordsLinked to original sources
PubMed2001

Pelvic muscle activity in nulliparous volunteers.

The aim of this study was to describe normal characteristics of spontaneous and voluntary pelvic muscle function in nulliparous healthy continent women and to assess the reaction of the pelvic floor to stress and fatigue. Ten nulliparous volunteers were recruited. Pelvic muscle strength was evaluated by palpation and perineal ultrasound. Kinesiological EMG and perineal ultrasound were performed to test for possible fatigue and to assess bladder neck mobility during coughing with a pre-contraction of the pelvic floor muscles. Bladder neck mobility did not increase after attempts to fatigue the pelvic floor muscles. Bladder neck descent was significantly less when the women were instructed to contract the pelvic floor muscles before coughing. The contraction of the pelvic floor muscles stabilizes the vesical neck in nulliparous women.

Adult↗
PubMed2001

Pelvic floor muscle contraction during a cough and decreased vesical neck mobility.

OBJECTIVE: To test the hypothesis that a voluntary pelvic muscle contraction initiated in preparation for a cough, a maneuver we call the Knack, significantly reduces vesical neck displacement. METHODS: A convenience sample of 22 women consisted of 11 young, continent nulliparas (mean age [+/- standard deviation] 24.8 +/- 7.0 years) and 11 older, incontinent paras (mean age [+/-SD] 66.9 +/- 3.9 years). With the use of perineal ultrasound, we quantified vesical neck displacement at rest and during coughs using caliper tracing and a coordinate system. The subjects coughed with and without voluntary pelvic floor muscle contraction. RESULTS: Vesical neck mobility during coughs was significantly decreased when voluntary contraction was used: from a median (range) of 5.4 (20.0) mm without volitional contraction to 2.9 (18.3) mm with volitional contraction (P <.001). The younger women demonstrated a median (range) decrease in excursion from 4.6 (19.5) to 0.0 (17.0) mm (P =.007), and the older incontinent women demonstrated a median (range) decrease from 6.2 (10.0) to 3.5 (15.4) mm (P =.003). At rest, the median vesical neck position in the group of older incontinent women was significantly further dorsocaudal (P =.001) than in the younger women. CONCLUSION: A pelvic floor muscle contraction in preparation for, and throughout, a cough can augment proximal urethra support during stress, thereby reducing the amount of dorsocaudal displacement.

Adult↗
PubMed2001

Visibility of pelvic organ support system structures in magnetic resonance images without an endovaginal coil.

OBJECTIVE: The aim of this study was to determine which elements of the pelvic organ support system are visible on magnetic resonance imaging performed without an endovaginal coil. STUDY DESIGN: Proton density-weighted pelvic magnetic resonance images were obtained for 20 healthy continent nulliparous women with a mean (+/-SD) age of 30.1 +/- 5.1 years (range, 22-42 years). Standardized analyses of transverse, coronal, and sagittal key images were carried out to describe pelvic organ support system anatomy. RESULTS: Details of both the muscular and fascial supports were clearly seen. The endopelvic fascia was visible on transverse images and could be seen to laterally attach the proximal vagina to the pelvic wall. Its appearance was consistent with its composition of a network of connective tissue, vessels, and nerves. The upward, lateral, and dorsal direction of its most cephalic suspending fibers was visible on both transverse and coronal images. The different nature of the uterosacral ligament relative to the cardinal ligaments was also demonstrated in transverse images. The endopelvic fascia's attachment to the pelvic walls was visible in the midvagina. The 3 parts of the levator ani muscle were likewise visible-the pubococcygeus, puborectalis, and iliococcygeus. Fusion of the levator ani muscle and the vagina at the level of the middle urethra could be recognized on transverse and coronal images. CONCLUSION: Magnetic resonance imaging depicted structures of the pelvic organ supports, including the endopelvic fascia and pelvic floor muscles, without the need for an endovaginal coil.

Adult↗
PubMed2001

A structured system to evaluate urethral support anatomy in magnetic resonance images.

OBJECTIVE: To develop a systematic method for analyzing the normal magnetic resonance imaging location and appearance of structural features involved in urethral support. STUDY DESIGN: Multiplanar proton density magnetic resonance images of 50 nulliparous women were made at 0.5-cm intervals. The arcuate pubic ligament was the chosen reference point in all views. Structural features were located by identification of the magnetic resonance images in which they appeared. The presence or absence of urethral support structures in each scan level relative to the arcuate pubic ligament was evaluated and recorded as a graphic display. Support structures examined were the arcus tendineus fasciae pelvis, the perineal membrane, the pubococcygeal levator ani muscle and its vaginal and bony attachments, and the pubovesical muscle. Structural definitions were developed on the basis of established periurethral anatomy. Two examiners independently assessed 10 scans for interobserver concordance. This system was used in nulliparous women to quantify the location of magnetic resonance visible structures. RESULTS: Because all levels were 0.5 cm apart, slice identification represented the distance above the arcuate pubic ligament (eg, 2 images above the arcuate pubic ligament or 1.0 cm). Interobserver concordance was 88% in identification of structure location. In the axial plane, specific structural features and relationships were localized. The frequency at which a specific structure was observed at a specific image level in all women was depicted as a gray density within the graphic display. These frequencies indicated where we would expect each structure to be located in healthy women. Relationships between structures and their attachments became apparent. Consideration of expected structural locations proven by nulliparous scans will enable us to quantitatively define abnormal structures in parous women. CONCLUSIONS: This systematic magnetic resonance evaluation allows, for the first time, quantification of the normal anatomic location of urethral support structures. It can be used to help identify the difference between structural abnormalities and normal variation in parous women.

Adult↗
PubMed2001

On-screen vector-based ultrasound assessment of vesical neck movement.

OBJECTIVE: We sought to develop a vector-based assessment to determine the magnitude and direction of bladder neck movements, as well as to assess whether probe movement relative to the pubis needs to be taken into account. STUDY DESIGN: Ten nulliparous continent, 10 primiparous continent, and 10 primiparous stress-incontinent women were recruited. Perineal ultrasound scanning was performed in standing women while they were resting, performing the Valsalva maneuver, coughing, and performing Kegel exercises. A direct on-screen assessment of bladder neck displacement from rest to the peak of dynamic activity relative to the pubic axis was made. Transducer movement was assessed by measuring the displacement of the pubic bone. RESULTS: The method was feasible because measurements were possible in all 30 subjects. Vesical neck and pubic point movement in millimeters (+/- SD) and the percentage error if pubic point movement is not accounted for are as follow: strain, vesical neck 16.9 +/- 6.1 and pubic point 4.8 +/- 3.9, 28%; cough, vesical neck 10.2 +/- 5.4, pubic point 2.9 +/- 3.4, 33%; Kegel exercise, vesical neck 7.0 +/- 3.6 and pubic point 0.7 +/- 1.4, 37%. Similar discrepancies in angle were found and are presented. Uncorrected direction of vesical neck and pubic point movement in degrees and the percentage error if pubic point movement is not accounted for are as follow: strain, vesical neck 169.4 +/- 18.5 and pubic point 214.0 +/- 56.7, 18%; cough, vesical neck 162.0 +/- 12.8, pubic point 238.4 +/- 27.4, 22%; Kegel exercise, vesical neck -0.9 +/- 12.7 and pubic point -4.8 +/- 20.6, 87%. Test-retest reliability correlations were more than an r value of 0.7 in all measures and 86% of the measurements greater than 0.8. CONCLUSION: The vector-based system provides a simple method for quantifying distance and direction of vesical neck motion, as well as localizing the resting vesical neck position.

Adult↗
PubMed2001

The functional anatomy of the female pelvic floor and stress continence control system.

This paper provides an overview of the functional anatomy of the structures responsible for controlling urinary continence under stress. The stress continence control system can be divided into two parts: the system responsible for bladder neck support, and the system responsible for sphincteric closure. Age- and injury-related changes in each of these systems are discussed. Understanding the pathophysiology of incontinence on the anatomical level will help to lead to identification of specific defects, thereby allowing better individualized treatment for the incontinent patient.

Female↗
PubMed2001

Bladder neck mobility in continent nulliparous women.

OBJECTIVE: To evaluate the mobility of the vesical neck during coughing and valsalva in healthy nulliparous volunteers and to test the reliability of the technique applied. DESIGN: Clinical observational study. SETTING: Department of Obstetrics and Gynaecology, Cantonal Hospital Lucerne, Switzerland. POPULATION: Thirty-nine nulliparous volunteers. METHODS: Vesical neck motion was assessed with perineal ultrasound. Intra-abdominal pressure was controlled for with an intrarectal probe. Intra-rater reliability was evaluated. RESULTS: Vesical neck mobility was significantly lower during coughing (8 mm, SD 4 mm) than during valsalva (15 mm, SD 10 mm) (P < 0.005). Between individuals mobility varied from 4 mm to 32 mm during coughing and from 2 mm to 31 mm during valsalva. Test-retest-studies showed a maximum difference between to tests during coughing of 4 mm and during valsalva of 5 mm. CONCLUSION: The bladder neck is mobile in normal continent women and bladder neck mobility is lower during coughing than during Valsalva.

Adolescent↗
PubMed2000

Urinary tract erosions after synthetic pubovaginal slings: diagnosis and management strategy.

OBJECTIVES: To review our experience with the diagnosis and management of genitourinary tract erosions after pubovaginal sling placement. METHODS: Clinic and operative records from the urology and gynecology services at two university hospitals were reviewed, and 14 patients were identified who underwent surgical treatment for a urogenital tract erosion after pubovaginal sling placement. The presenting symptoms, physical findings, diagnostic procedures, surgical treatments, and outcomes were reviewed. RESULTS: Six vaginal erosions, six urethral and vaginal erosions, and two bladder erosions occurred. All were associated with synthetic sling or suture materials. Common symptoms included vaginal and urethral pain, irritative voiding symptoms, vaginal discharge and/or bleeding, and recurrent urinary tract infections. All vaginal and urethral erosions were detected by physical examination and cystoscopy. Symptoms resolved after removal of the eroded sling component. Of the 12 patients with vaginal or urethral erosions, 7 developed recurrent postoperative stress incontinence. CONCLUSIONS: Persistent painful or irritative symptoms after pubovaginal sling placement may be due to urogenital tract erosion, especially if synthetic materials were used. Appropriate evaluation and treatment will result in dramatic symptomatic improvement, although recurrent stress incontinence may occur.

Biocompatible Materials↗
PubMed2000

Quantification of intramuscular nerves within the female striated urogenital sphincter muscle.

OBJECTIVE: To analyze the quantity and distribution of intramuscular nerves within the striated urogenital sphincter and test the hypothesis that decreased nerve density is associated with decreased striated sphincter muscle and cadaver age. METHODS: Thirteen cadaveric urethras (mean age 47 years, range 15-78 years) were selected for study. A sagittal histologic section was stained with S100 stain to identify intramuscular nerves. The number of times that a nerve was seen within the striated urogenital sphincter (nerve number) was counted. The number of axons within each nerve fascicle was also counted. Regression analysis of nerve density against muscle cell number and age was performed. RESULTS: Remarkable variation was found in the quantity of intramuscular nerves in the striated urogenital sphincter of the 13 urethras studied. The number of nerves ranged from 72 to 543, a sevenfold variation (mean 247.1 +/- standard deviation 123.2), and the range of number of axons was 431 to 3523 (2201 +/- 1152.6). The larger nerve fascicles were seen predominantly in the distal (13.1 +/- 5.7 axons per nerve) compared with the proximal part of the striated urogenital sphincter (1.2 +/- 2). Reduced nerve density throughout the striated urogenital sphincter correlated with fewer muscle cells (P =.02). Nerve density also decreased with advancing age (P =.004). CONCLUSION: Remarkable variation in the quantity of intramuscular nerves was found. Women with sparse intramuscular nerves had fewer striated muscle cells. Intramuscular nerve density declined with age.

Adolescent↗
PubMed2000

Differences in perineal lacerations in black and white primiparas.

OBJECTIVE: To test the null hypothesis that there are no differences in incidence of perineal and vaginal lacerations in primiparous black and white women. METHODS: We reviewed University of Michigan Hospital delivery records, from July 1996 to December 1998, of black and white women 18 years and older and at least 35 weeks' gestation who had their first vaginal delivery. Birth weight, episiotomy, gestational age, laceration, length of second stage, oxytocin use, epidural use, and operative vaginal delivery were analyzed by univariable and multivariable tests. RESULTS: We analyzed 176 black women (mean age +/- standard deviation 23.7 +/- 4.7 years; range 18-41 years) and 1633 white women (27.8 +/- 5.4 years; 18-49 years; P <.001). Black women were less likely to have second, third, or fourth degree lacerations (43% compared with 59%; P <.001). The mean length of second stage of labor was shorter in the black women (73 +/- 69 minutes; range 3-494 minutes compared with 106 +/- 78 minutes; range 2-642 minutes; P <.001). Infants of black women weighed less (3292 +/- 490 g; 1990-5190 g compared with 3429 +/- 470 g; 1860-4950 g; P <.001). Multivariable analysis showed that black women were twice as likely to deliver with intact perineums than white women (P <.001). CONCLUSION: Black primiparas were less likely to deliver with second-degree or greater lacerations and more likely to deliver with their perineums intact.

Adolescent↗
PubMed1999

MR imaging of levator ani muscle recovery following vaginal delivery.

Our aim was to quantify the changes that occur in the levator ani muscles (LA) after vaginal delivery using magnetic resonance imaging. Fourteen women underwent MRI 1 day postpartum. Six of them were also scanned 1, 2, 6 weeks and 6 months after delivery. LA signal intensities and thickness, in areas of the urogenital and the levator hiatus were assessed in the transverse plane. Perineal body position was measured in the sagittal plane. One day postpartum a higher T2-signal intensity of the LA compared to the obturator internus muscle was found in all women and a lower T1-signal intensity in 8 of 12 women. By 6 months these differences were present in only 1 woman in the left LA. An elevation in perineal body position of 13.4 +/- 7.3 mm (P < 0.05), as well as a decrease in the area of the urogenital hiatus by 27% (P<0.05) and of the levator hiatus by 22% (P < 0.05) by 2 weeks postpartum suggest a return of normal LA geometry. LA thickness showed interindividual variations, and a complete loss of LA tissue was found in 1 woman. Changes in LA signal intensity, topography and thickness during the puerperium can be documented using MR imaging.

Adult↗
PubMed1999

Structural anatomy of the posterior pelvic compartment as it relates to rectocele.

OBJECTIVE: This study was undertaken to define posterior compartment structural anatomy relevant to rectocele. STUDY DESIGN: Dissection of 42 fresh and 22 fixed cadavers was supplemented by examination of histologic (n = 3) and macroscopic (n = 5) serial sections. RESULTS: Distal posterior compartment support involves connection of the halves of the perineal membrane (urogenital diaphragm) through the perineal body, preventing downward protrusion of the lower rectum. Above this level the posterior vaginal wall is held in place by sheets of bilateral endopelvic fascia that attach each side of the posterior vaginal wall to the pelvic diaphragm. Most of these fascial fibers attach to the vaginal wall and a few fibers unite in the midline. Pelvic floor closure by the levator ani muscles relieves pressure-induced stress on the midvaginal fascial supports. CONCLUSIONS: Midline perineal membrane union supports the distal posterior compartment and a fascial connection between the pelvic diaphragm and vagina supports the mid vagina. Muscular pelvic floor closure helps to relieve fascial stress.

Adult↗
PubMed1999

Fistula-in-ano after episiotomy.

BACKGROUND: In the past 2 years, we treated three women with fourth-degree lacerations or episiotomy infections presenting with persistent pain and drainage not responding to standard treatment. CASES: These women were referred for evaluation 5 weeks, 3.5 months, and 2 years postpartum. After diagnosing fistula-in-ano, we treated them with fistulotomy and curettage, which resolved the problem. CONCLUSION: When a patient presents with pain or drainage at her episiotomy site, fistula-in-ano should be considered.

Adult↗
PubMed1999

On the lack of correlation between self-report and urine loss measured with standing provocation test in older stress-incontinent women.

This study examined the association between the measured amount of urine lost during a standardized series of coughs in clinic (paper towel test) and questionnaire estimates of stress-related urine loss in 51 older women with mild to moderate urinary incontinence. It also examined the relationship between these questionnaire estimates and a 6-day urinary diary self-report of incontinence frequency and voiding episodes. Pearson's correlation coefficient and percent agreement were used to analyze the relationship between the variables. No significant correlations were found between the paper towel test results and questionnaire items reporting volume of urine loss. The relationship between urinary diary results and questionnaire items regarding the number of incontinence occurrences was weak but significant (r = 0.33, p = 0.045), with agreement in 53% of cases. Agreement was achieved in 68% of cases for number of voids per day recorded by urinary diary and reported by questionnaire (r = 0.65, p = 0.000). This study has quantified a weak correlation between objective and subjective measures of urine loss. These weak correlations could arise from either methodologic limitations in quantifying incontinence or the degree to which differences arise because different phenomena are being measured.

Aged↗
PubMed1998

Comparison of ureteral and cervical descents during vaginal hysterectomy for uterine prolapse.

OBJECTIVE: The study measured ureteral and cervical locations during vaginal hysterectomy for prolapse and the extent of parametrial ligament shortening possible. STUDY DESIGN: Cervical and ureteral position were measured in 26 women undergoing uterine prolapse correction. Parametrial clamp tip location was also measured. RESULTS: The cervix lay between 0 and -14.5 cm (below) the hymen (mean +/- SD -5.35 +/- 3.96 cm) and the ureters lay +5.0 to -4.0 cm (mean +/- SD +1.89 +/- 1.99 cm). Correlation of ureteral with cervical position was 0.69 (P <.01) and correlation with ipsilateral uterosacral ligament clamp positions was 0.80 (P <.01). Regression line slope relating cervical descent and cervix to ureter distance was 0.65, indicating that for every 3 cm of cervical descent there was 2 cm widening of the gap between the cervix and ureters and 1 cm descent of the ureter. CONCLUSION: For every 3 cm of cervical descent the ureters descend 1 cm, thereby widening the ureterocervical gap and permitting ligament shortening during vaginal hysterectomy.

Adult↗
PubMed1998

Examination of voiding in seated women using a remote-controlled ultrasound probe.

BACKGROUND: A remote-controlled steering arm was developed that allows the ultrasound probe to be held on the perineum under ultrasound image guidance with the woman seated on a commercially available bedside commode. TECHNIQUE: The arm's servomechanism monitors contact pressure between the scanning head and the perineum, keeping constant gentle pressure on the perineum so that the transducer follows perineal movement. EXPERIENCE: Twenty patients with urinary incontinence and ten normal volunteers were examined during two voiding episodes, one without perineal ultrasound and one with ultrasound. Ultrasound images and intrarectal pressure measurements were displayed simultaneously on a video monitor. Bladder and urethral visibility and behavior were analyzed during bladder emptying. Of the 30 women, 28 were able to void, with and without the ultrasound probe applied. Two women were not able to urinate under observation either with or without sonography. The bladder base, bladder neck, and upper two-thirds of the urethra were visible throughout voiding in the 28 women able to void. Bladder neck opening could be observed in all of the 28 women. Bladder neck descent during initiation of voiding occurred in 17 women, whereas 11 voided without bladder neck descent. CONCLUSION: The use of this device facilitates ultrasound evaluation of micturition in the physiologic sitting position and allows bladder neck behavior to be seen during bladder emptying.

Female↗
PubMed1998

Anatomy of female continence.

Various muscle, connective tissue, and neurologic structures within the pelvic floor play critical roles in the maintenance of both urinary and fecal continence. Recent advances in technology, combined with greater precision during anatomic study, have expanded our understanding of the role played by the pelvic floor in maintaining continence. The goal of this article is to summarize recent research on female pelvic anatomy, with a particular emphasis on the evidence base related to urinary incontinence. The content is organized to accomplish three aims: (1) identify, within the context of pelvic floor anatomy, the structures that comprise the urinary continence system, (2) Describe the functional dynamics of urinary continence, including factors in resting urethral pressure and pressure transmission, and (3) Present the rationale, technique, and interpretation of various methods of measuring pelvic floor function.

Female↗