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Overview of the Middle Compartment
Rania Farouk El Sayed, MD, PhD
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Terminology

  • Definitions

    • Middle compartment includes vagina, uterus, and their supporting structures
      • Weakness of support structures results in pelvic organ prolapse (POP)
        • True prolapse is complete organ eversion; however, term is commonly used to generically describe any degree of pelvic organ descent
      • Anterior vaginal wall (AVW) prolapse
        • Cystocele
        • Apical or uterine prolapse
      • Posterior vaginal wall (PVW) prolapse
        • Enterocele
        • Rectocele
        • Perineal descent without rectal prolapse
      • Vaginal vault prolapse (VVP)

Normal Support System

  • Uterocervical Support

    • Vaginal Support

      • AVW Support

        • PVW Support

          Structural Defects leading to POP

          • AVW Prolapse

            • PVW Prolapse

              • Vaginal Vault Prolapse (VVP)

                Pathophysiology of POP

                • Factors Contributing to POP

                  • Pathogenesis of POP

                    Clinical Evaluation

                    • Symptoms Related to POP

                      • Clinical Findings Related to POP

                        • Pelvic Organ Prolapse Quantitation (POPQ)

                          Treatment

                          • Conservative Management

                            • Surgical Management

                              Selected References

                              1. Farouk El Sayed R: The urogynecological side of pelvic floor MRI: the clinician's needs and the radiologist's role. Abdom Imaging. 38(5):912-29, 2013
                              2. Hale DS et al: Functional anatomy of the pelvic floor. In Bartram C et al: Imaging Pelvic Floor Disorders. 1st ed. Berlin, Heidelberg, New York: Springer. 27-38, 2003
                              3. Hale DS et al: Urogenital dysfunction. In Bartram C et al: Imaging Pelvic Floor Disorders. 1st ed. Berlin, Heidelberg, New York: Springer. 107-24, 2003
                              4. Lienemann A et al: Functional imaging of the pelvic floor. Eur J Radiol. 47(2):117-22, 2003
                              5. Delancey JO et al: Size of the urogenital hiatus in the levator ani muscles in normal women and women with pelvic organ prolapse. Obstet Gynecol. 91(3):364-8, 1998
                              6. Gill EJ et al: Pathophysiology of pelvic organ prolapse. Obstet Gynecol Clin North Am. 25(4):757-69, 1998
                              7. Theofrastous JP et al: The clinical evaluation of pelvic floor dysfunction. Obstet Gynecol Clin North Am. 25(4):783-804, 1998
                              8. Bump RC et al: The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol. 175(1):10-7, 1996
                              9. Huddleston HT et al: Magnetic resonance imaging of defects in DeLancey's vaginal support levels I, II, and III. Am J Obstet Gynecol. 172(6):1778-82; discussion 1782-4, 1995
                              10. Norton PA et al: Genitourinary prolapse and joint hypermobility in women. Obstet Gynecol. 85(2):225-8, 1995
                              11. DeLancey JO: Anatomy and biomechanics of genital prolapse. Clin Obstet Gynecol. 36(4):897-909, 1993
                              12. Helwig JT et al: Does midline episiotomy increase the risk of third- and fourth-degree lacerations in operative vaginal deliveries? Obstet Gynecol. 82(2):276-9, 1993
                              13. Benson JT et al: Female pelvic floor disorders. Investigation and Management. New York: Norton, 1992
                              14. DeLancey JO: Anatomic aspects of vaginal eversion after hysterectomy. Am J Obstet Gynecol. 166(6 Pt 1):1717-24; discussion 1724-8, 1992
                              15. Norton P et al: Abnormal collagen ratios in women with genitourinary prolapse. Neurourol Urodyn 11:2, 1992
                              Related Anatomy
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                              Related Differential Diagnoses
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                              References
                              Tables

                              Tables

                              Terminology

                              • Definitions

                                • Middle compartment includes vagina, uterus, and their supporting structures
                                  • Weakness of support structures results in pelvic organ prolapse (POP)
                                    • True prolapse is complete organ eversion; however, term is commonly used to generically describe any degree of pelvic organ descent
                                  • Anterior vaginal wall (AVW) prolapse
                                    • Cystocele
                                    • Apical or uterine prolapse
                                  • Posterior vaginal wall (PVW) prolapse
                                    • Enterocele
                                    • Rectocele
                                    • Perineal descent without rectal prolapse
                                  • Vaginal vault prolapse (VVP)

                              Normal Support System

                              • Uterocervical Support

                                • Vaginal Support

                                  • AVW Support

                                    • PVW Support

                                      Structural Defects leading to POP

                                      • AVW Prolapse

                                        • PVW Prolapse

                                          • Vaginal Vault Prolapse (VVP)

                                            Pathophysiology of POP

                                            • Factors Contributing to POP

                                              • Pathogenesis of POP

                                                Clinical Evaluation

                                                • Symptoms Related to POP

                                                  • Clinical Findings Related to POP

                                                    • Pelvic Organ Prolapse Quantitation (POPQ)

                                                      Treatment

                                                      • Conservative Management

                                                        • Surgical Management

                                                          Selected References

                                                          1. Farouk El Sayed R: The urogynecological side of pelvic floor MRI: the clinician's needs and the radiologist's role. Abdom Imaging. 38(5):912-29, 2013
                                                          2. Hale DS et al: Functional anatomy of the pelvic floor. In Bartram C et al: Imaging Pelvic Floor Disorders. 1st ed. Berlin, Heidelberg, New York: Springer. 27-38, 2003
                                                          3. Hale DS et al: Urogenital dysfunction. In Bartram C et al: Imaging Pelvic Floor Disorders. 1st ed. Berlin, Heidelberg, New York: Springer. 107-24, 2003
                                                          4. Lienemann A et al: Functional imaging of the pelvic floor. Eur J Radiol. 47(2):117-22, 2003
                                                          5. Delancey JO et al: Size of the urogenital hiatus in the levator ani muscles in normal women and women with pelvic organ prolapse. Obstet Gynecol. 91(3):364-8, 1998
                                                          6. Gill EJ et al: Pathophysiology of pelvic organ prolapse. Obstet Gynecol Clin North Am. 25(4):757-69, 1998
                                                          7. Theofrastous JP et al: The clinical evaluation of pelvic floor dysfunction. Obstet Gynecol Clin North Am. 25(4):783-804, 1998
                                                          8. Bump RC et al: The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol. 175(1):10-7, 1996
                                                          9. Huddleston HT et al: Magnetic resonance imaging of defects in DeLancey's vaginal support levels I, II, and III. Am J Obstet Gynecol. 172(6):1778-82; discussion 1782-4, 1995
                                                          10. Norton PA et al: Genitourinary prolapse and joint hypermobility in women. Obstet Gynecol. 85(2):225-8, 1995
                                                          11. DeLancey JO: Anatomy and biomechanics of genital prolapse. Clin Obstet Gynecol. 36(4):897-909, 1993
                                                          12. Helwig JT et al: Does midline episiotomy increase the risk of third- and fourth-degree lacerations in operative vaginal deliveries? Obstet Gynecol. 82(2):276-9, 1993
                                                          13. Benson JT et al: Female pelvic floor disorders. Investigation and Management. New York: Norton, 1992
                                                          14. DeLancey JO: Anatomic aspects of vaginal eversion after hysterectomy. Am J Obstet Gynecol. 166(6 Pt 1):1717-24; discussion 1724-8, 1992
                                                          15. Norton P et al: Abnormal collagen ratios in women with genitourinary prolapse. Neurourol Urodyn 11:2, 1992