Title: The biomechanical effects of levator ani muscle laceration injuries after vaginal delivery Objectives: The aim of this thesis is to sum up current knowledge about the normal structure and function of levator ani muscle and findings about dysfunctions of a pelvic floor. By means of biomechanical instruments to analyse how the lower part of levator ani muscle closes (puborectalis muscle) during unilateral avulsion lesion. On the basis of computer simulation of biomechanical properties of the pelvic floor during avulsion lesion to describe the theoretical solutions for the therapy of the main types of dysfunctions of the pelvic floor. Methods: Biomechanical analysis was used with a help of computer model of muscular pelvic floor with a help of the ABAQUS model. This model with matched properties of muscular tissue was influenced by the standard pressure which influences the pelvic floor for a person of 80 kilos standing at rest. This model simulated unilateral avulsion lesion and biomechanical variables were observed during compensatory activation of uninjured parts of levator with the activity 100%, 50% and 10%. The map of the muscular tone and the rate of movement of the muscles of the pelvic floor were evaluated. Results: Only minimal movement is observed in the intact pelvic floor during...

Pelvic floor disorder is an emerging research area and is highlighted in many pelvic floor studies. Assessment methods for this type of injury are lacking and new methods for prevention and diagnosis are needed. Pelvic floor disorders are common among women and can lead to suffering for the patient. Levator ani muscle injuries are the main cause for pelvic floor disorders. This muscle group is an anisotropic skeletal muscle that helps support the pelvic viscera. Assessment of this muscle is difficult due to its complex geometry and location. Therefore, two muscle phantoms were constructed to mimic different properties of the levator ani muscle. The muscle phantoms provided more availability and a more controlled setting. The muscle phantoms were examined using ultrasound-based shear wave elastography which is an elastography method that can help determine the elasticity of tissue. A PVA-graphite phantom and a water-based gelatine-graphite phantom, both with fishing lines network as fibers for anisotropy, were constructed in this project. Shear wave elastography results of the PVA phantom indicated no anisotropy but visually resembled a muscle. Although not achieving anisotropy, the shear modulus of the PVA did match the shear modulus of skeletal muscle tissue. Shear wave elastography results of the gelatine phantom indicated anisotropy but visually did not resemble a muscle due to the low shear modulus of the gelatine. A 3D model of the female bony pelvis, that was provided for this project, was measured, and compared with reference value of previous study for future construction and 3D printing of the model. Results of measurements showed similarities between the 3D model and the female pelvis except for the sagittal outlet which had a deviant value. For future work, the muscle phantom can be developed by applying the complex geometry of the levator ani muscle, assembly of the muscle phantom, and the 3D rendering of the pelvis. The combination of these two parts provides a more complete phantom where shear wave elastography can be applied in the same way as in female patients. / Bäckenbottenbesvär är ett framväxande forskningsområde och lyfts fram i många bäckenbottenstudier. Bedömningsmetoder för denna typ av skador saknas och det behövs nya metoder för förebyggande och diagnostik. Bäckenbottenbesvär är vanliga bland kvinnor och kan leda till lidande för patienten. Levator ani muskelskador är den främsta orsaken till bäckenbottensjukdomar. Denna muskelgrupp är en anisotrop skelettmuskel som hjälper till att stödja inälvorna i bäckenet. Bedömning av denna muskel är svår på grund av dess komplexa geometri och läge. Därför konstruerades två muskelfantomer för att efterlikna olika egenskaper hos levator ani-muskeln. Muskelfantomerna gav mer tillgänglighet och en mer kontrollerad inställning. Muskelfantomerna undersöktes med hjälp av ultraljudsbaserad skjuvvågselastografi som är en metod som kan hjälpa till att bestämma vävnadens elasticitet. En PVA-grafitfantom och en vattenbaserad gelatin-grafitfantom, båda med fiskelinsnätverk som fibrer för anisotropi, konstruerades i detta projekt. Resultat från skjuvvågselastografi på PVA-fantomen indikerade ingen anisotropi, men liknade visuellt en muskel. Även då anisotropi inte uppnåddes, så matchade skjuvmodulen för PVA skjuvmodulen för skelettmuskelvävnad. Resultat från skjuvvågselastografi på gelatinfantomen indikerade anisotropi dock visade resultatet ingen visuell liknelse av en skelettmuskel på grund av gelatinets låga skjuvmodul. En 3D modell av bäckenbenet, som förseddes det här projektet, mättes och jämfördes med referensvärde av tidigare studie för framtid 3D friformsframställning av modellen. Resultat av mätningar visade på liknelser mellan 3D modellen och det kvinnliga bäckenbenet förutom sagittal outlet som hade ett avvikande värde. Inför fortsättning av det här projektet kan en utveckling av muskel fantomen ske genom applicering av den komplexa geometrin hos levator ani muskeln samt sammansättning av muskel fantomen och 3D framställningen av bäckenbenet. Sammansättningen av dessa två delar ger en mer komplett fantom där skjuvvågselastografi kan appliceras på samma sätt som hos kvinnliga patienter. / Ja

Purpose: Intravaginal probes used for recording electromyography (EMG) from the pelvic floor muscles (PFMs) likely record activity from nearby muscles (crosstalk), and move during functional tasks, causing motion artifact data contamination, threatening the validity of results obtained. This study investigated the test-retest reliability and validity of surface EMG recordings from the PFMs using a novel, theoretically superior electrode in comparison to a commercially available intravaginal probe, the FemiscanTM. Methods: Healthy subjects (n=20) performed tasks with each vaginal electrode in situ: i) PFM maximal voluntary contractions (MVC), ii) coughs, iii) unilateral hip adductor/external rotator contractions at 25%MVC, 50%MVC, and MVC while keeping the PFMs relaxed or maximally contracted, and iv) transversus abdominis contractions (TrA; recorded using fine-wires) at 25%MVC, 50%MVC, MVC. Analyses: i) Intraclass correlation coefficients (ICC), ii) t-tests of proportions (α=0.05), iii) repeated measures ANOVAs and Tukey’s post-hoc testing (α=0.05) and iv) cross-correlation functions between peaks of transversus abdominis and PFM activity were used to determine the between-trial and between-day reliability of each vaginal electrode, a difference in prevalence of motion artifact contamination between electrodes, and the presence of crosstalk from the hip and TrA, respectively. Results: Between-trial reliability of both vaginal electrodes was excellent (ICC(3,1)=0.943-0.974). Between-day reliability was less consistent (ICC(3,1)=0.788-0.924 and 0.648-0.715 for the FemiscanTM and novel electrode, respectively). No significant difference in the proportion of files contaminated with motion artifact using each electrode existed. At submaximal intensities of hip muscle contractions, the FemiscanTM recorded significantly higher EMG amplitudes compared to what it recorded when the hip was relaxed, whereas the novel electrode did not, indicating that the FemiscanTM recorded crosstalk from the hip musculature. Low cross-correlation coefficients (<0.90) and large time delays (≥ 0.5 milliseconds) between peaks of PFM and TrA activity indicated that neither vaginal electrode recorded crosstalk from the TrA. Conclusion: The novel electrode is a promising tool to record EMG from the PFMs, as it records less crosstalk from the hip musculature than current technology while maintaining a high degree of reliability when comparing results collected within the same session; however, this electrode should not be used to compare one’s muscle activity between days. / Thesis (Master, Rehabilitation Science) -- Queen's University, 2011-02-07 14:46:30.811

The sexual differentiation of the spinal nucleus of bulbocavernosus (SNB) and the bulbocavernosus (BC) and levator ani (LA) muscles that the SNB innervates, are masculinized by androgens acting on the BC/LA. The site of androgen receptors (AR) responsible for the masculinization of the neuromuscular system is not known. A potential site of action is satellite cells: proliferation of these cells is androgen-dependent and satellite cells seem to contribute to the size of the LA. Fluorescent immunohistochemistry and confocal microscopy were used to co-localize satellite cells and AR within the LA of postnatal day one and three male and female rats. Results indicate that satellite cells express AR and reveal a difference in proportion of satellite cells expressing AR between the LA and control muscle. Interpretations of these findings, including whether the relatively small proportion of AR accounted for by satellite cells is enough to masculinize the SNB system, are discussed.

The sexual differentiation of the spinal nucleus of bulbocavernosus (SNB) and the bulbocavernosus (BC) and levator ani (LA) muscles that the SNB innervates, are masculinized by androgens acting on the BC/LA. The site of androgen receptors (AR) responsible for the masculinization of the neuromuscular system is not known. A potential site of action is satellite cells: proliferation of these cells is androgen-dependent and satellite cells seem to contribute to the size of the LA. Fluorescent immunohistochemistry and confocal microscopy were used to co-localize satellite cells and AR within the LA of postnatal day one and three male and female rats. Results indicate that satellite cells express AR and reveal a difference in proportion of satellite cells expressing AR between the LA and control muscle. Interpretations of these findings, including whether the relatively small proportion of AR accounted for by satellite cells is enough to masculinize the SNB system, are discussed.

No description available.

Résumé : Introduction : Parmi les structures anatomiques impliqués dans la statique pelvienne, la continence urinaire et anale, le muscle élévateur de l’anus (MEA), le sphincter urétral (SU) et son innervation ont un rôle déterminant. Au cours de la grossesse, de l’accouchement par voie vaginale, de la chirurgie radicale pelvienne, des lésions des muscles du plancher pelvien ou de son innervation peuvent survenir. Ces lésions sont à l’origine de dysfonctions du plancher pelvien telle que le prolapsus uro-génital ou l’incontinence urinaire. Une meilleure connaissance de l’anatomie musculaire et nerveuse pelvi-périnéale est nécessaire pour diminuer la survenue et traiter ces troubles fonctionnels. Classiquement les muscles du plancher pelvien sont décrits comme entièrement striés sous contrôle somatique (nerf du MEA et/ou nerf pudendal (NP)). La dissection Anatomique Assisté par Ordinateur (DAAO) en utilisant des marqueurs nerveux et musculaires spécifiques peut aujourd’hui compléter les données établies par la dissection conventionnelle classique de sujets anatomiques.Objectif : L’objectif était de décrire l’innervation (origine, topographie, trajet, rapports, fonction) et la structure musculaire du MEA, de décrire l’innervation (origine, topographie, trajet, rapports, fonction) du sphincter urétral pour mettre en perspective les implications potentielles dans les dysfonctions du plancher pelvien.Méthodes : Nous avons étudié 9 fœtus humains (6 féminins et 3 masculins). Des coupes histologiques sériées de 5 µm d’épaisseur ont été effectuées dans les régions pelviennes de 7 fœtus âgés de 18 à 40 semaines de gestation. Pour chaque niveau de coupe, des lames ont été colorées puis traitées en immunohistochimie pour détecter : l’ensemble des fibres nerveuses (anticorps anti-protéine S100), les fibres autonomes cholinergiques (anti-VAChT), les fibres autonomes adrénergiques (anti-TH), les fibres autonomes nitrergiques (anti-nNOS), les fibres somatiques (anti-PMP 22), les fibres sensorielles (anti-CGRP), les fibres musculaires lisses (anti-SMA) et les fibres musculaires striées (anti-MYOG). Les coupes ont ensuite été numérisées par un scanner de haute résolution optique et les images ont été reconstruites en 3D avec le logiciel Winsurf®. Un fœtus additionnel a été entièrement destiné à réaliser de la microscopie électronique afin de confirmer nos résultats au niveau architectural musculaire.Résultats : Nous avons observé une innervation à la fois autonome (plexus hypogastrique inférieur (PHI)) et somatique (nerf du MEA et NP) du MEA. Nous avons individualisé des zones de cellules musculaires lisses au sein du plancher pelvien notamment de la partie médiane sous contrôle autonome (PHI) que nous nommons « compartiment médian musculaire lisse ».Nous avons systématisé le plancher pelvien musculaire en une zone médiale lisse sous contrôle nerveux autonome réalisant une interface entre les viscères pelviens, et une zone musculaire striée latérale sous contrôle nerveux somatique.Enfin, nous avons mis en évidence une double innervation à la fois somatique et autonome du sphincter urétral.Conclusion : La DAAO a permis de mettre en évidence une innervation pelvi-périnéale complexe avec l’intrication du système nerveux somatique et autonome. La fonction du contingent musculaire lisse pelvien reste à préciser. / Abstract : Levator ani muscle (LAM), urethral sphincter (US), and their innervation play a major role in pelvic status, urinary continence and anal continence. During pregnancy, vaginal delivery, pelvic radical surgery, damage of pelvic floor muscles or of their innervation may occur. These lesions are responsible for pelvic floor dysfunction such as urogenital prolapse or urinary incontinence. Better knowledge of pelvi-perineal muscle and nerve anatomy is needed to reduce the occurrence and treat these pelvic floor dysfunctions. Classically pelvic floor muscles are described as entirely striated under somatic control (levator ani nerve (LAN) and /or pudendal nerve (PN)). Computer Assisted Anatomical Dissection (CAAD) using specific nerve and muscle markers can nowadays complete data established by conventional dissection of anatomical subjects.The objective was to describe the innervation and the muscular structure of the levator ani muscle, to describe nerve supply of the urethral sphincter in order to better understand pelvic floor dysfunction.Methods : We studied nine human fetuses (6 female and 3 male). Serial histological sections of 5 μm of thickness were performed in the lumbar and pelvic regions of seven human fetuses aged 18 to 40 weeks of gestation. For each level, slides were stained and then treated in immunohistochemistry to detect: general nerve fibers (anti-protein S100), autonomic cholinergic fibers (anti-VAChT), autonomic adrenergic fibers (anti-tyrosine hydroxylase), autonomic nitrergic fibers (anti-nNOS), somatic nerve fibers (anti-peripheral myelin protein 22), sensory fibers (anti-CGRP), smooth muscle fibers (anti-SMA) and striated muscle fibers (anti-MYOG). The slides were then digitized by a high-resolution optical scanner and the images were reconstructed in 3D using the Winsurf® software. One fetus was entirely reserved for electronic microscopy in order to confirm our results.Results: We observed that LAM innervation is supplied by both autonomic (inferior hypogastric plexus (IHP)) and somatic (LAN and PN). We have individualized areas of smooth muscle cells in the pelvic floor, particularly the median part controlled by the autonomic system that we named “smooth muscle medial compartment”.We systematized within the pelvic floor muscle a smooth medial part under an autonomic nervous control as interface between the pelvic viscera and a lateral striated muscle part under somatic nervous control.Finally, we have demonstrated a dual innervation both somatic and autonomic sphincter urethral.Conclusion : CAAD has demonstrated complex pelvic-perineal innervation with the interaction of the somatic and autonomic nervous system. The function of the pelvic smooth muscle contingent remains to be clarified.

9 Abstract Title: Influence of Power Plate machine vibrations on m. levator ani contraction. Objectives: In my thesis I would like to follow up on my bachelor`s thesis in which I was analyzing the importance of exercise on the Power Plate machine from a theoretical point of view. I set the objective of my thesis, in co-operation with professionals in this area, to find out whether Power Plate machines have any impact on the pelvic floor contractions, especially on the m. levator ani. Methods: Theoretical part of my thesis was conducted using the research (exploration of facts) method. For theoretical input I mainly used my bachelor`s thesis which was being followed up with. Majority of studies regarding WBVT (whole body vibration training) influence on human body is available from foreign sources. The practical part of my research was conducted via the quantitative quasiexperimental method. The works was further performed with use of the explanation (empirical and generally theoretical) methods and interpretation methods. For the data analysis were used the basic descriptive statistics, analysis of variance with repetition with Geisser-Greenhouse adjustment and paired t-test. Interpretation method was used to generalize the research outcomes, to confront them with existing knowledge, and to debate their...

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...