Читать книгу Ambulatory Urology and Urogynaecology - Группа авторов - Страница 48

The lower one‐third of the vagina is fused with the surrounding structures through the endopelvic fascia anteriorly to the distal urethra, posteriorly to the perineal body, and laterally to the pubovaginalis muscle and perineal membrane. Together they support and maintain the normal position of the distal one‐third of the vagina and introitus. The perineal body is critical for support of the lower part of the vagina and proper function of the anal canal.

Perineal descent can occur due to separation of the anchored perineal membrane from the perineal body and can contribute to defecatory dysfunction. Therefore, level III disruption anteriorly can result in SUI from urethral hypermobility, and posterior disruption can result in distal rectocele or perineal descent.

The endopelvic fascia becomes the primary mechanism of support in circumstances when neuropathic injury or mechanical damage leads to pelvic floor muscle weakness. This may lead to loss of normal anatomic position if the ongoing stress overcomes the strength of the endopelvic fascial attachments. The resultant altered vector forces may lead to POP and/or visceral dysfunction. The goal of reconstructive pelvic surgery should be to recreate these supportive connections and restore the anatomical position of the pelvic organs while maintaining adequate vaginal length to maintain the vaginal apex in a natural position.