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R Genadry

Publications and source records attributed to R Genadry.

At least 19 recordsLinked to original sources
PubMed2003

Focal levator ani eventrations: detection and characterization by magnetic resonance in patients with pelvic floor dysfunction.

The aim of this study was to assess the frequency and imaging characteristics of focal levator eventrations in patients with pelvic floor dysfunction on magnetic resonance (MRI). A review of 81 dynamic MR pelvic examinations in patients with pelvic floor dysfunction was carried out to detect and characterize focal eventrations in the levator ani muscle. These were defined as muscle outpouchings which made an angle of >180 degrees with the remainder of the muscle and had a depth of >or=1 cm. Of 81 patients 11(13.5%) had focal eventrations in the levator muscle on MRI: bilateral in 2 cases, right in 5 and left in 4. There was protrusion of pelvic viscera into the eventration in 5 cases, fat in 7 and fluid in 1. Focal levator ani muscle abnormalities are not uncommon on MRI in patients with pelvic floor dysfunction. Characterization of levator muscle morphology can be useful as a research tool in this population.

Adult↗
PubMed2002

Controversies in female urethral anatomy and their significance for understanding urinary continence: observations and literature review.

To re-examine the anatomy of the female urethra and related structures, three female pelves serially sectioned in sagittal, coronal or transverse planes, and four sets of transverse histological slides of female urethras, were studied. The observations were assembled, rendered as illustrations, and correlated with published works to present an overall explanation of the gross and histological anatomy of the female pelvis and perineum as related to continence. The figures accompanying the text present the anatomy in a series of views in the three anatomical planes. The anatomical relationships of the paraurethral and paravaginal tissues are examined in relation to the conflicting nomenclature applied to these structures. The figures show the spatial relationships within the pelves and perineum that explain their effective function in urinary continence.

Adult↗
PubMed2001

Endourethral MRI.

Although high-resolution MRI with phased array pelvic, endorectal, and endovaginal coils has dramatically enhanced the ability to visualize abnormalities of the female urethra and periurethral tissues, controversy still remains about the anatomy of this region. This study introduces an endourethral approach for ultra-high-resolution MRI of the female urethra and the periurethral tissues. To this end, two different radiofrequency (RF) receiver coil designs for an endourethral insertion have been developed: a single-loop coil and a phased array/quadrature coil. Both designs feature a flexible coil circuit, small loss tuning and matching directly at the coil, active decoupling, and the integration of a lambda/4 coaxial choke to decrease unbalanced currents and limit potential RF heating effects. Effective reduction of the mutual inductance between the two coils of the phased array design was achieved by introducing a metallic "paddle" to steer the flux between the coils. The performance of the coils has been evaluated in female human cadaver studies and in an in vivo pig experiment. The novel endourethral approach enabled a dramatic increase of the signal-to-noise ratio (SNR) at the region of interest (ROI). High-resolution MR images of the female urethra have been acquired with a spatial resolution down to 78 x 78 microm. Histologic correlation was achieved for the MR images generated. The achieved high local SNR and resulting high spatial resolution will add valuable information to the discussion of female urethral anatomy. Magn Reson Med 45:138-146, 2001.

Animals↗
PubMed2001

Stress incontinence observed with real time sonography and dynamic fastscan magnetic resonance imaging--insights into pathophysiology.

Our concepts of pathophysiology of stress urinary continence have been greatly shaped by developments in radiographic imaging. Simple radiographs with and without contrast initially revealed the importance of urethral descent in pathogenesis. More recently, magnetic resonance imaging (MRI) and real time ultrasonography are showing soft tissue detail within both a global pelvic and a local urethral context. Careful examination of these studies can extend our concepts of pathophysiology and lead us beyond existing paradigms. We propose a unified theory of stress incontinence based on our dynamic fastscan MRI and real time ultrasonograms of stress incontinence, incorporating known details of pelvic anatomy, sphincteric location and function. The hypothesis introduces the concept of a continence threshold at which the urethra is subjected simultaneously to both shearing and explusive forces. If these forces are sufficient to overcome urethral coaptation at threshold, leakage results. The model proposes an anatomical sequence of changes through which the incontinent urethra cycles between periods of rest and increased abdominal pressure, and suggests a way in which repeated episodes of prolpase and urethral traction by shearing forces exerted by the vagina on the urethra may contribute to the development of intrinsic sphincteric deficiency.

Computer Systems↗
PubMed1999

Anatomy of pelvic arteries adjacent to the sacrospinous ligament: importance of the coccygeal branch of the inferior gluteal artery.

OBJECTIVE: To describe the arterial vascular anatomy in the area of the sacrospinous ligament. METHODS: Cadaver pelvises were dissected to reveal the anatomy of the sacrospinous ligament with emphasis on vascular and neuroanatomy. Flexible rulers were used to measure the coccygeal branch in five hemipelvises. RESULTS: The pudendal vessels and nerve pass immediately medial and inferior to the ischial spine (within 0.5 cm of the spine) and behind the sacrospinous ligament. The pudendal artery lies anterior to the sacrotuberous ligament, which passes behind the ischial spine to its attachment at the posterior ischial tuberosity. The inferior gluteal artery originates from the posterior or the anterior branch of the internal iliac artery to pass behind the sciatic nerve and the sacrospinous ligament. There is a 3- to 5-mm window in which the inferior gluteal vessel is left uncovered above the top of the sacrospinous ligament and below the lower edge of the main body of the sciatic nerve plexus. The coccygeal branch of the inferior gluteal artery passes immediately behind the midportion of the sacrospinous ligament and pierces the sacrotuberous ligament in multiple sites. The main body of the inferior gluteal artery leaves the pelvis by passing posterior to the upper edge of the sacrospinous ligament and following the inferior portion of the sciatic nerve out of the greater sciatic foramen. CONCLUSION: Sutures placed through the sacrospinous ligament at least 2.5 cm from the ischial spine along the superior border of the sacrospinous ligament and without transgressing the entire thickness are in an area generally free of arterial vessels.

Arteries↗
PubMed1996

Anatomic goals in the correction of female stress urinary incontinence.

The goal of stress incontinence surgery is to prevent opening of the urethra during increases in intra-abdominal pressure. Greater refinements in the understanding of the pathophysiology of incontinence and experience with newer treatments have extended surgical thinking beyond the familiar paradigm "to place the urethra in a high retropubic position." When incontinence is associated with vaginal hypermobility, vaginal support may be sufficient to restore continence if the suburethral vaginal wall is sufficiently strong, an evaluation which must often be made by physical examination alone. However, when the vaginal wall is weak, the urethra will require an alternative form of support, usually a sling. If the urethra is intrinsically deficient, vaginal support may not be sufficient to prevent opening during increased intra-abdominal pressure, and coaptation by sling obstruction or periurethral bulking injection may be required. Most laparoscopic approaches to stress incontinence use Burch's method, which offers excellent urethral stability provided the suburethral vaginal wall is strong. Newer insights into the relation between vaginal mobility and urethral closure are discussed, as well as anatomic aspects of the Burch suspension relevant to laparoscopic repair.

Female↗
PubMed1995

Radiography, sonography, and magnetic resonance imaging for stress incontinence. Contributions, uses, and limitations.

Imaging has increased our ability to understand stress incontinence and prolapse and has advanced our existing concepts of pathophysiology. Once these conceptual contributions have been made, imaging modalities may fade from current use, but the lessons learned will remain. It is the relationship of clinical imaging to conceptual development that is important. Conventional radiographic studies are well understood and can be obtained in most facilities. Sonographic units are currently available in many urologic and gynecologic clinics and offices and can be adapted for stress incontinence studies. The benefits of real-time studies and soft-tissue detail at the urethrovesical junction and office-based convenience make this an attractive new technique. The global pelvic approach offered by MR imaging offers spectacular imaging possibilities, which can help in complex cases and in future concepts in the field. MR imaging is rapidly evolving and may continue to offer new insights as technology permits. In accordance with Hodgkinson's earlier observations, imaging should not be routinely required in all patients undergoing evaluation for stress incontinence, but should certainly be considered in failed operations, complex prolapse, and when clinical diagnosis is in doubt. It is always better to use an imaging technique, no matter how expensive, than to end up with a bad surgical result.

Female↗
PubMed1986

Adenocarcinoma arising in adenomyosis detected by atypical cytology.

Adenocarcinoma in adenomyosis is unusual and in most cases is associated with adenocarcinoma in the surface endometrium. In the latter, the diagnosis is made in the removed specimen because of the finding of adenocarcinoma in curettings. In contrast, adenocarcinoma arising in adenomyosis without surface endometrial changes is extremely rare and presents major diagnostic problems. The two cases reported herein demonstrate the significance of atypical vaginal cytology in the recognition of such lesions.

Adenocarcinoma↗
PubMed1985

Thyrotropin-releasing hormone-induced contraction of urethral and vaginal muscle.

Pressure studies were carried out in 10 women to determine whether TRH stimulates muscular contractions in the genitourinary system. TRH (500 micrograms) or saline was administered iv as a bolus injection. Whereas saline had no effect, TRH increased intraurethral pressures in all women, vaginal pressure in 7, and bladder pressure in none. These findings suggest that TRH, acting centrally, peripherally, or both, may play a role in initiating muscular contractions in the female genitourinary tract.

Adult↗
PubMed1985

Rectal serosal hematoma: an unusual complication of culdocentesis.

Culdocentesis is currently a widely used diagnostic technique in gynecology. Although associated with numerous theoretical risks, few complications have been documented in anecdotal reports. Rectal serosal hematoma, an unusual complication of culdocentesis, is described.

Adult↗
PubMed1983

Suburethral diverticulum: classification and therapeutic considerations.

The records of 70 patients with a suburethral diverticulum were reviewed. Cases were classified according to their anatomic site of origin in an attempt to rationalize the appropriate therapeutic approach. It is suggested that suburethral diverticulum arising in the lower third of the urethra be preferably treated by marsupialization with tissue excision for histologic confirmation, and those diverticula arising in the upper two thirds of the urethra be treated by excision. In those cases in which multiple diverticula are suspected, an anterior vaginoplasty should be carried out in an attempt to reduce the morbidity associated with excision only.

Adolescent↗
PubMed1981

Primary, papillary peritoneal neoplasia.

Subsequent to the recognition of the intraperitoneal tumors of low malignant potential, clinicians have repeatedly faced the ambiguities inherent in a disease that seems aggressive on the basis of its wide distribution in the peritoneal cavity but benign on the basis of its histopathology and clinical course. Whereas the occasional case has been associated with extensive local reaction and ascites, except for a rare exception these tumors result in prolonged survival and in an absence of extraabdominal extension. The current review of 154 cases followed from 2 to 40 years, performed in an attempt to understand this perplexing disease, leads to the following conclusions: 1) Whereas frequently beginning on the ovary and showing a predilection for the pelvis, there are examples of widely disseminated peritoneal disease with minimal, if any, ovarian involvement; 2) the outcome without adjunctive therapy is excellent and thus such therapy is contraindicated in view of the death of only 2 of the 154 patients with disease, 1 of whom had had adjunctive intraperitoneal isotope therapy; and 3) this disease is best understood as a diffuse primary peritoneal tumor probably developing on the basis of irritating agents' reaching the abdominal cavity from the lower genital canal, a process similar to that proposed for the genesis of endometriosis. Such a low-grade primary in situ tumor that may involve the entire peritoneal cavity is compatible with prolonged survival.

Adolescent↗
PubMed1980

Tubo-ovarian abscess: a retrospective review.

The charts of 160 patients with tubo-ovarian abscesses (TOAs) were reviewed. Patients were divided into two groups according to their response to initial medical therapy. Predictive factors were identified for the two groups. Prognosis was predictable on the basis of extent of disease at diagnosis and the initial response to medical therapy. There was no apparent association between a unilateral TOA and the use of an intrauterine contraceptive device. A minimum pregnancy rate of 8% was observed in patients maintaining reproductive function. No patient with a bilateral TOA conceived. Of all patients admitted to the hospital with TOA, 53% ultimately required surgical therapy. High residual morbidity and/or resultant infertility mandates more aggressive attempts at prevention.

Abscess↗