GLUP_Gardone_Il pavimento pelvico come unità morfo-funzionale – M. Meschia

1. Il pavimento pelvico come unità morfo-funzionale Michele Meschia U.O. Ostetricia e Ginecologia Magenta In God we trust All others must use data!!

5. La fascia endopelvica

6. Le connessioni muscolo-fasciali

7. I muscoli del pavimento pelvico

8. The Urogenital Diaphragm

10. A = rest B = increases abdominal pressure Relationship between pelvic viscera and levator ani muscle

12. Il muscolo pubo-rettale

14. Il supporto pelvico

17. Major Levator Ani Defects : Case-Control Study of Pelvic Organ Prolapse Prolapse N=151 Normal N=134 Levator Ani Defects OR 7.3 DeLancey, et al. 2002, 2007

18. Effect of Levator ani relaxation

19. Levels of support DeLancey 1988 Endopelvic fascia

23. Defects in the anterior compartment (level III) The vaginal hammock

24. Anatomical relationship between anterior vaginal and apical supports Cervix Arcus Tendineus -Fascia Pelvis -Levator Ani Apical Supports Vaginal Wall

25. DeLancey JO. Am J Obstet Gynecol. 2002;187:93-8 Association between cystocele and apical prolapse

26. Bladder Descent Cervical (Apical) Descent Bladder Prolapse versus Uterine Prolapse Summers et al, Obstet Gynecol 2006 60% of bladder descent explained by apical descent

29. CL AVW Rectum ATFP US LA 3 D model

30. Findings of Simulations

33. Childbirth

36. Genetics familiar transmission Pifarotti, IUGA 2008 Controls 90 Cases 124 P OR (CI) Mothers with POP (n/%) 12 (13%) 31 (25%) 0.039 2.2 (1.0-4.5) Sisters with POP (n/%) 3 (3%) 21 (17%) 0.002 5.9(1.7-20.5) All relatives with POP (n/%) 14 (16%) 43 (35%) 0.002 2.9 (1.5-5.7)

39. Conclusion Pelvic floor dysfunction, is a multifactorial and extremely common disorder in which genetic, endocrine and environmental factors may predispose to different clinical conditions including urinary incontinence, anal incontinence and pelvic organ prolapse.