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Editorial
. 2024;77(2):203-205.
doi: 10.5173/ceju.2023.272. Epub 2024 Apr 4.

Hiatal expansion and pelvic organ prolapse - the association is not causation

Peter Petros  1
Affiliations
Editorial

Hiatal expansion and pelvic organ prolapse - the association is not causation

Peter Petros. Cent European J Urol. 2024.
No abstract available

Keywords: POP; collateral collagen damage; hiatal expansion; levator avulsion.

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Conflict of interest statement

The author declare no conflict of interest.

Figures

Figure 1
Figure 1
Descent of the fetal head down the birth canal may damage collagenous and muscle structures in all 3 levels of organ support. At the upper end of the birth canal, figure1, overstretching by the head may cause uterine prolapse (circles ‘3’) and cystocele (circle ‘2’); further down the head may stretch the collagen/elastin fibrils lining LH (Shafik’s ‘hiatal ‘ligament’) to cause LH distension[3] ; further down, the perineal body may be damaged (circle ‘4’); finally, as the head exits, it may damage the collagenous insertion of pubococcygeus muscle (PCM) to the symphysis (circle ‘1’), and the pubourethral ligament ‘PUL’, (circle ‘1’) to cause SUI.
Figure 2
Figure 2
Pathogenesis of transverse defect cystocele. The cardinal ligaments (CL) reflect onto the anterior part of cervix. The fascial layer of vagina ‘PCF’ (pubocervical fascia) inserts onto CL. If CLs are ruptured (‘r’) by the head as it descends down the birth canal, the PCF attachment is also ruptured, and the anterior vaginal wall it prolapses downwards like a trapdoor, as a cystocele.
See this image and copyright information in PMC

References

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    1. Zacharin RF. Pelvic floor anatomy and the surgery of pulsion enterocoele: Chapter: Human anatomy. New York:Springer-Verlag Wien;1985. pp.18-64 and pp pp134-155.
    1. Rechberger T, Uldbjerg N & Oxlund H. Connective tissue changes in the cervix during normal pregnancy and pregnancy complicated by a cervical incompetence Obstets & Gynecol. 1988, 71: 563-567 - PubMed

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