The lateral support of the vaginal wall depends on the integrity of the paravaginal section of the visceral pelvic fascia, levator ani, and their connection. Various defects of the muscle and fascia can result in identical clinical findings-ie, the descent of the lateral vaginal sulcus. In this study, we created a realistic scheme for classifying paravaginal defects, based on the complex relationship of the pelvic fascia with the levator ani. Surgical observations, cadaver examinations, and a complex magnetic resonance imaging (MRI)-based 3-dimensional (3D) model were used to analyze the spatial relationships of normal and defective anatomy of the female pelvic floor. Descent of the lateral vaginal sulcus can result from a defect in the paravaginal visceral pelvic fascia, levator ani, or both. The fascial defect can be partial or complete, and the muscle defect can vary in location. A detailed illustrated classification is presented. We present a new model of the pathology that underlies a common clinical finding.

Department of Anatomy 3rd Faculty of Medicine Charles University Prague Czech Republic

Department of Urology 3rd Faculty of Medicine Charles University Prague Czech Republic

Department of Urology and Urogynecology Klinikum Ernst Von Bergmann Potsdam Germany

Institute for the Care of Mother and Child 3rd Faculty of Medicine Charles Univesity Prague

References provided by Crossref.org

Native tissue repair of the female pelvic floor: A four-level surgical concept

Appearance of levator ani muscle subdivision defects on level III vaginal support structures in women with and without pelvic organ prolapse: an MRI study

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