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Finding the proportion of levator and fascial trauma of the pelvic floor in the development of symptoms pelvic organ prolapse - the effect of vaginal birth
Horčička, Lukáš ; Krofta, Ladislav (advisor) ; Halaška, Michael (referee) ; Chmel, Roman (referee)
Determination of the proportion of levator and fascial trauma of the pelvic floor in the development of symptoms of the descent of pelvic organs - the influence of vaginal birth Abstract Injury of levator ani muscle (LAM) is a significant pelvic organ prolapse (POP) risk factor. The puborectalis (PRM) and pubvisceral (PVM) subdivisions are at Level III vaginal support structures. Null hypothesis - there were no significant differences in muscle injuries patterns among LAM subdivisions. This retrospective magnetic resonance imaging (MRI) study included: 64 nulligravidae controls without pelvic floor dysfunction (PFD) and 526 POP symptomatic women of different parity. Primary outcome was PVM and PRM morphology on axial planes 1/ the place of the attachment to the pubic bone, 2/ visible separation/border between PVM and PRM. The attachment was scored as "normal" or "abnormal". The "abnormal" was divided in two types: a) "Type I" - loss of the muscle substance, but maintenance of the overall muscle architecture, b) "Type II" - muscle detachment from the pubic bone. The puboanalis (PAM) subdivision was evaluated as representative part of PVM. PAM and PRM attachments and separation were distinguished in all control cases. PAM and PRM attachments did not significantly differ. POP group characteristics were:...
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Influence of body position on pelvic floor muscle contraction strength
Zahořová, Markéta ; Křivánková, Markéta (advisor) ; Hráský, Pavel (referee)
Title: Methods of secondary prevention of the pelvic floor after childbirth Objectives: This is a theoretical work with a descriptive-analytical part. It includes an analysis of the literature from available sources, an analysis of active approaches in the secondary prevention of the pelvic floor and the creation exercise unit for further research. Methods: Literature analysis including processing of information from available sources. Results: Handbook of pelvic floor training with methodical descriptions. Keywords: Pelvic girdle, pregnancy, gynecological weaknesses after childbirth, incontinence, pelvic organ prolapse, sexual dysfunction, pelvic floor examination, Arnold Kegel method, Ludmila Mojžíšová method, Alexander method, Feldenkrais method, Cantienica, exercise unit
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To determine the indication for the use of synthetic materials in pelvic floor reconstructive surgery.
El Haddad, Rachid ; Švabík, Kamil (advisor) ; Huser, Martin (referee) ; Kališ, Vladimír (referee)
Introduction: Pelvic organ prolapse is a major health problem affecting 50% of parous women over the age of 50. The lifetime risk for pelvic floor surgery for prolapse is likely to be between 10 and 20% and a large number of patients require repeat surgery for recurrence. Cochrane review showed that mesh use at the time of anterior repair reduce the risk of recurrence. In our first study we prospectively evaluate the impact of mesh insertion during anterior repair on sexual function and quality of life. Mesh insertion may be associated with significant and in some cases serious adverse events. To justify its use, it seems necessary to identify women at high risk of prolapse recurrence. There is evidence indicating that levator ani avulsion injury is closely associated with prolapse recurrence. The aim of our second and main study was to demonstrate in a prospective randomized way that levator avulsion may be used to identify patients at high risk for failed native tissue prolapse surgery. Methods: The first study prospectively evaluated with validated questionnaires the impact of mesh insertion on quality of life and sexual function. The second study is a single-center, prospective, randomized interventional trial of two standard surgical procedures for post-hysterectomy vaginal vault prolapse in...
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