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PubMedDate not supplied

Preservation of the fistula for reconstruction of the anal canal and the anus in atresia ani and rectovestibular fistula in 2 dogs.

OBJECTIVE: To report a technique for correction of atresia ani and rectovestibular fistula with fistula preservation, and outcome in 2 dogs. STUDY DESIGN: Case report. ANIMALS: Two intact female puppies. METHODS: The fistula was approached by episiotomy. A vertical median perineal incision was made starting dorsal to the anal region and extended to surround the fistula. The rectum and vagina were separated, and the end of the fistula was sutured to the skin. RESULTS: Early postoperative complications included constipation, fecal incontinence, and perineal soiling, but long-term outcome was good in both dogs. CONCLUSION: With careful dissection, the fistula and internal anal sphincter can be preserved and used in the surgical reconstruction of the anal canal and anus. CLINICAL RELEVANCE: Preservation of the fistula may provide an internal sphincter that contributes to a better functional result during correction of atresia ani. A surgical approach that combines episiotomy and perineal incision for separation of the vagina and rectum, and preserves the fistula may decrease the risk of dehiscence.

Animals↗
PubMed2000

US identification of the anal sphincter complex and levator ani muscle in neonates: infracoccygeal approach.

PURPOSE: To identify the anal sphincter complex and levator ani muscle at transperineal ultrasonography (US) with the infracoccygeal approach. MATERIALS AND METHODS: Infracoccygeal US was performed with a 7-MHz linear-array transducer in 40 healthy neonates. The babies were placed in the supine position, and both legs were drawn up to the chest. The buttocks were accordingly lifted up. The approach site was just inferior to the coccyx and posterior to the anus. Scanning was performed to obtain transverse images of the anorectal area. The thickness of the anal sphincter complex and the puborectalis muscle were measured. RESULTS: Infracoccygeal US revealed the internal anal sphincter (IAS), the external anal sphincter (EAS), and the puborectalis muscle in all babies. The IAS and EAS were depicted as inner and outer hypoechoic ringlike structures, respectively. A round, hyperechoic space (intersphincteral space) was present between the hypoechoic IAS and EAS. The puborectalis muscle was identified as a U-shaped hypoechoic structure. The bulbocavernosus and ischiocavernous muscles were also identified. Mean thicknesses were as follows: IAS, 1.3 mm +/- 0.3 (SD) (range, 0.8-1.9 mm); EAS, 1.6 mm +/- 0.3 (range, 1.2-2.3 mm); and puborectalis muscle, 1.1 mm +/- 0.3 (range, 0.6-1.9 mm). CONCLUSION: Infracoccygeal transperineal US is an excellent diagnostic modality for demonstrating the anal sphincter complex and levator ani muscle in neonates.

Anal Canal↗
PubMed1980

Comparative study of the periurethral and perianal parts of the human levator ani muscle.

The present study has used histochemical and electron microscopic techniques to provide a quantitative comparison of the striated muscle fibre populations in the periurethral and perianal regions of the human levator ani muscle. Both regions consist predominantly of type I (slow twitch) fibres together with a small number of type II (fast twitch) fibres. However, marked differences have been demonstrated between the two regions with regard to proportions of the two fibre types, diameters of the constituent fibres and the distribution of muscle spindles. These observations are discussed in relation to the differing functional activity of the periurethral and perianal regions of the levator ani muscle.

Adenosine Triphosphatases↗
PubMed1992

Study of uterine prolapse by magnetic resonance imaging: topographical changes involving the levator ani muscle and the vagina.

Alternations of the pelvic structure with an emphasis on those of the levator ani muscle, associated with uterine prolapse, were studied using sagittal magnetic resonance images obtained from 19 subjects without and 14 with uterine or vaginal prolapse of varied degree and 3 patients with Rokitansky syndrome who had undergone a McIndoe operation. Two additional patients with a grade III uterine prolapse were also studied before and 2-3 months after corrective surgery consisting of vaginal hysterectomy combined with anterior colporrhaphy and posterior colpoperineorrhaphy. Absence or presence of prolapse, irrespective of its grade, was found to be related to whether or not a reference line extrapolated from the levator plate crossed the pubis on sagittal images. This was the case as well in patients with Rokitansky syndrome with a neovagina and loss of such crossings was restored in patients with prolapse after surgery. Backward bending of the upper vagina noted in nonprolapse conditions was usually absent in patients with uterine prolapse. These results document that topographical changes involving the levator ani muscle and the vagina occur in association with uterine prolapse.

Adult↗
PubMed2001

Abnormal expression of p27kip1 protein in levator ani muscle of aging women with pelvic floor disorders - a relationship to the cellular differentiation and degeneration.

BACKGROUND: Pelvic floor disorders affect almost 50% of aging women. An important role in the pelvic floor support belongs to the levator ani muscle. The p27/kip1 (p27) protein, multifunctional cyclin-dependent kinase inhibitor, shows changing expression in differentiating skeletal muscle cells during development, and relatively high levels of p27 RNA were detected in the normal human skeletal muscles. METHODS: Biopsy samples of levator ani muscle were obtained from 22 symptomatic patients with stress urinary incontinence, pelvic organ prolapse, and overlaps (age range 38-74), and nine asymptomatic women (age 31-49). Cryostat sections were investigated for p27 protein expression and type I (slow twitch) and type II (fast twitch) fibers. RESULTS: All fibers exhibited strong plasma membrane (and nuclear) p27 protein expression. cytoplasmic p27 expression was virtually absent in asymptomatic women. In perimenopausal symptomatic patients (ages 38-55), muscle fibers showed hypertrophy and moderate cytoplasmic p27 staining accompanied by diminution of type II fibers. Older symptomatic patients (ages 57-74) showed cytoplasmic p27 overexpression accompanied by shrinking, cytoplasmic vacuolization and fragmentation of muscle cells. The plasma membrane and cytoplasmic p27 expression was not unique to the muscle cells. Under certain circumstances, it was also detected in other cell types (epithelium of ectocervix and luteal cells). CONCLUSIONS: This is the first report on the unusual (plasma membrane and cytoplasmic) expression of p27 protein in normal and abnormal human striated muscle cells in vivo. Our data indicate that pelvic floor disorders are in perimenopausal patients associated with an appearance of moderate cytoplasmic p27 expression, accompanying hypertrophy and transition of type II into type I fibers. The patients in advanced postmenopause show shrinking and fragmentation of muscle fibers associated with strong cytoplasmic p27 expression.

Journal Article↗
PubMed2006

Impaired function of the levator ani muscle in the grand multipara and great grand multipara.

Repeated deliveries might disturb the levator function and increase defecation disorders. In this prospective study, we determined the electric activity of the levator ani muscle (LAM) in nullipara, multipara, grand multipara, and great grand multipara (20 subjects for each group). Multiparity, grand multiparity, and great grand multiparity were defined as women having 2 - 5, 6 - 9, and 10 and over deliveries, respectively. The number of deliveries of multipara, grand multipara and great grand multipara were 4.05 +/- 1.14 (2 - 5), 7.55 +/- 1.23 (6 - 9) and 12.2 +/- 2.16 (10 - 17), respectively. All women were asked whether they had experienced constipation, fecal or urinary incontinence, and/or pelvic pain. All women were also evaluated for pelvic organ prolapse. Electromyography (EMG) of the LAM at rest and on contraction was recorded. EMG is an electrical recording of muscle activity. Constipation, incontinence and pelvic organ prolapse were encountered in multipara, grandmultipara and great grand multipara women. The LAM EMG at rest and on contraction in the nullipara was accepted as control. Both the resting and contractile activities of the LAM were as follows: nullipara > multipara > grand multipara > great grand multipara. These findings indicate that levator dysfunction and defecation disorders are increased with repeated deliveries because of pudendal and/or levator ani nerve injury and traumatic injury to the LAM occurred with the mechanical stresses of vaginal deliveries.

Adult↗
PubMedDate not supplied

Atresia ani in the dog: a retrospective study.

Congenital anomalies of the rectum and anus are rare in dogs. The most frequently reported anomaly is atresia ani. Four types of atresia ani have been reported, including congenital anal stenosis (Type I); imperforate anus alone (Type II) or combined with more cranial termination of the rectum as a blind pouch (Type III); and discontinuity of the proximal rectum with normal anal and terminal rectal development (Type IV). An increased incidence was found in females and in several breeds, including miniature or toy poodles and Boston terriers. Surgical repair is the treatment of choice, but postoperative complications can occur, including fecal incontinence and colonic atony secondary to prolonged preoperative distension.

Anal Canal↗
PubMed1992

Effect of testosterone and thyroid hormone on the expression of myosin in the sexually dimorphic levator ani muscle of rat.

During postnatal development, the myosin transition from embryonic and neonatal isoforms to adult isoforms has been shown to occur with half-transition times of about 20 and 32 days in the male and female levator ani muscles, respectively. We show that this difference could not be attributed to the testosterone male hormone, since treatment of newborn females by testosterone did not modify the half-transition time. However, treatment of females by thyroid hormone accelerated the myosin transition of the female muscle, which then occurred at almost the same time as the transition of the male muscle. This suggests that the difference between the half-transition times of the male and female levator ani muscles may be largely attributed to different sensitivities of the male and female muscles to thyroid hormone. This is the first example of sexually dimorphic muscle response to thyroid hormone.

Aging↗
PubMed2005

[Overlapping of the levator ani flap to cure postpartum vaginal relaxation].

OBJECTIVE: To probe an effective method to treat postpartum vaginal relaxation. METHODS: Through an incision between the vaginal skin and mucosa, bilateral levator ani was isolated to form two levator ani flaps. The two flaps were overlapped and sutured with proper tension. Then the vaginal skin and mucosa were sutured to form a prominence at the vaginal orifice. RESULTS: 21 cases underwent this operation. Of them sixteen were followed up for 3 months to 2 years. The patients reported that their sexual lives were improved. CONCLUSIONS: The operation improved the sexual lives of the patients. The results of this method were effective and satisfactory.

Adult↗
PubMedDate not supplied

[Functional evaluation of the perineum in pregnancy. Hypertonia of the levator ani muscles].

In this study, the role of "levator ani muscles hypertonia" among pathogenetic factors of perineal obstetric injuries is analysed. For this purpose, clinical data of 142 pregnant women, who underwent functional evaluation of perineum during pregnancy and 30 days after delivery were examined. Data here reported are not sufficient to confirm the importance of this factor within the pathogenesis of postpartum perineal deficiency. Levator ani hypertonia on one hand seems to be able to obstruct fetal progression, on the other hand it presumably constitutes, as an expression of a good voluntary control of perineal muscles, a favourable prognostic factor.

Adolescent↗
PubMedDate not supplied

A reappraisal of the anatomy of the levator ani muscle in man.

A study of the attachments of the musculotendinous fibres of the levator ani muscle shows that it is made of two portions: a thick anterior portion which is mostly fleshy and a thin posterior portion which is mostly aponeurotic. The anterior portion consists of two layers: a superficial perineal layer and a deep pelvic layer. Both layers have a common origin from the back of the body of the pubic bone and the anterior part of the tendinous arch. In addition both layers make a U-shaped loop around the recto-anal junction. The posterior fibres of the deep pelvic layer received nerve supply only from the third and fourth sacral nerves. The rest of the muscle was supplied from the sacral nerves as well as the perineal branches of the pudendal nerve. The role of the anterior fibres in reinforcing the sphincters of the anal canal and fixation of the pelvic viscera is stressed. The close anatomical relation between the posterior portion of the muscle and the obturator internus suggests that the latter may play a role in supporting the weak posterior portion of the levator ani, especially during straining positions associated with lateral rotation at both hips.

Adult↗
PubMed1979

The anterior fibres of the levator ani muscle in man.

The anatomy of the anterior portion of the levator ani muscle in studied in 26 adult human cadavers of both sexes. This portion of the muscle is found to consist of three layers of muscle fibres. The three layers are: 1. The pelvic layer. Its fibres (1) are attached to the capsule of the prostate or adventitia of the lateral wall of vagina, (2) intermingle with and supplement the longitudinal muscle layer of the anal canal, and (3) are continuous with the fibres of the opposite side behind the recto-anal junction. 2. The middle layer. The most anterior fibres are twisted on themselves to form the round free border of the muscle that bounds the levator hiatus. The majority of the muscle fibres of this layer proceed backwards to cover and blend with the deep part of the external anal shincter, partly joining the anococcygeal ligament. 3. The perineal layer. These fibres surround the superficial part of the external anal sphincter. A respectable bundle of muscles fibres unites with that of the opposite side in from of the lower part of the anal canal. Remaining fibres terminate in perianal skin or anococcygeal ligament. The role of the anterior portion of the levator ani in fixation and prevention of prolapse of the pelvic viscera is stressed.

Adolescent↗
PubMed1981

Functional properties of muscle autografts substituted for the rat levator ani muscle.

The present report deals with the functional properties (contraction parameters and neuromuscular transmission) of muscle grafts and transposed muscles substituted for the levator ani muscle in the rat. The experiments were divided into four main groups. Group I - the levator ani [LA] was excised and replaced in its own bed. Group II - the extensor digitorum longus, a fast muscle (with or without predenervation), and Group III - the soleus, a slow twitch muscle, were substituted for the LA. In group IV, the gracilis anterior muscle was either freely grafted in place of the LA or transposed a) with intact innervation, b) with its vascular supply intact or c) with preserved neuro-vascular supply. The optimum results of twitch and tetanic tension, and the amplitude of stimulation EMG responses was found in the case of LA resutured into its own bed and in the case transposition of the gracilis anterior muscle had been performed with its neuro-vascular supply intact in place of the LA. On the basis of these functional findings and morphological and anatomical observations (Grim et al. 1982), a surgical procedure is suggested for patients with anal incontinence (Grim et al. 1981, Dittertová-Vlasáková et al. 1982).

Anal Canal↗
PubMed1982

Levator ani transposition for anal incompetence secondary to sphincter damage.

An operative procedure is described in which the levator ani muscles are used to correct anal incompetence secondary to sphincter damage. The relevant pelvic anatomy and operative procedure are described in detail. Four patients in whom sphincter damage occurred during surgery for posterior vulvar carcinoma underwent the procedure; in 3, good sphincter function was attained. Morbidity was minimal. The transposition of the levator ani muscle to replace partially obliterated anal sphincter muscles is a suitable procedure for patients who have insufficient sphincter tissue for simpler repairs.

Adult↗
PubMed1994

[Prune belly syndrome with atresia ani and urethral stricture: a case report].

A case of prune belly syndrome associated with urethral stricture and atresia ani is reported. Cystostomy and colostomy were performed on his birthday. Cutaneous vesicostomy, bilateral ureterocystoneoplasty and proctoplasty were performed when the patient was one year old, and urethrotomy was performed when he was four years old. He was closely followed for six years and six months, and had developed without any serious episodes. We collected 128 cases of prune belly syndrome from the Japanese literature including this, and made a brief discussion of this syndrome with urethral stricture and atresia ani.

Anal Canal↗
PubMed1993

Kegel dyspareunia: levator ani myalgia caused by overexertion.

BACKGROUND: The onset of unexplained dyspareunia with a normal pelvic examination requires a careful evaluation to search for an etiology. CASES: The initiation of Kegel exercises led to dyspareunia in several patients whose pain could be localized to the levator ani muscles. Elimination of the muscular overexertion led to resolution of the dyspareunia in all cases. CONCLUSION: Dyspareunia associated with the initiation of Kegel exercises may be due to levator ani myalgia. Once recognized as a potential source of dyspareunia, levator myalgia is easy to diagnose and treat.

Adult↗
PubMed1993

Levator ani muscle morphology and recurrent genuine stress incontinence.

OBJECTIVE: To assess the impact of levator ani muscle morphology on the outcome of patients with genuine stress incontinence undergoing reconstructive surgery of the pelvic floor. METHODS: A follow-up investigation was performed on 30 patients from a previous study, who had undergone hysterectomy with combined anteroposterior vaginal repair for pelvic floor relaxation and genuine stress incontinence. Biopsy specimens of the pubococcygeal muscle had been obtained during posterior colporrhaphy and subsequently evaluated for evidence of striated muscle tissue. Eleven patients had striated muscle tissue in the biopsy specimens (group A), whereas 19 subjects did not (group B). Before operation and at 41 months (range 37-44) after operation, the patients underwent urodynamics, perineal sonography, and perineometry. RESULTS: At follow-up, all patients in group A were continent, whereas ten of 19 patients (53%) in group B showed recurrent genuine stress incontinence (P < .01). Compared with group B (48.5 +/- 21.9%), group A patients (71.8 +/- 16.5%) had a significantly higher abdominal pressure transmission ratio at follow-up (P = .02). At postoperative perineal sonography, group A patients (107.7 +/- 14.0 degrees) showed a significantly smaller retrovesical angle during straining than did group B patients (134.6 +/- 25.9 degrees) (P < .01). CONCLUSION: The levator ani muscle morphology has prognostic importance for the outcome of patients with genuine stress incontinence undergoing anteroposterior vaginal repair.

Female↗
PubMed1993

PERINAL--a new no-touch spray to relieve the symptoms of pruritus ani.

A new no-touch aqueous spray has been developed for the topical treatment of pruritus ani. It contains 0.2% hydrocortisone and 1.0% lignocaine hydrochloride, and has been shown in studies involving 83 patients to constitute a most convenient and clinically effective preparation for alleviating the symptoms of this distressing chronic condition.

Aerosols↗