Ureteral injury can be avoided by extending the bladder flap laterally to the level of the round ligament and mobilizing the vesicouterine peritoneum inferiorly, with the suture placed directly on endopelvic fascia
. If necessary, the utero-ovarian ligament can be ligated in a second step, just below the uterine-tubal junction.
Vaginal prolapse is a clinical condition characterized by bulging of the top of the vagina into the lower vagina or outside the opening of the vagina due to disruption in the functionality and strength of the levetar ani muscles, endopelvic fascia
and ligaments or the uterosacral-cardinal ligament complex1,2.
However, RF therapy requires multiple needles inserted into endopelvic fascia
and is more invasive than desired.
Mechanically, the pelvic organ support system is of two types: supporting system of the levator ani (LA) muscle and the suspension system of the endopelvic fascia
It is also claimed to cause endopelvic fascia
and connective tissue injuries due to forcing or stretching during delivery.
Unlike the MUS, a short (8-10 cm) graft of rectus fascia (or fascia lata) is positioned at the bladder neck, with the ends of the graft incorporating into the endopelvic fascia
and eventually becoming fixed by fibrosis in the retropubic space.
(25) found the continence rates in the 3rd and 12th months to be 90% and 95.2%, respectively, in their 2,625 patients in whom lateral prostatic fascia and endopelvic fascia
were preserved during RALP.
was not incised as part of the SMART technique (Samadi Modified Advanced Robotic Technique) in order to decrease risk of injury to neurovascular bundles on the lateral portion of the prostate and preserve erectile function in the patient.
Upon entry into the space of Retzius, the endopelvic fascia
was not incised to maximize nerve-sparing technique as part of Samadi Modified Advanced Robotic Technique (SMART) .
After the endopelvic fascia
had been opened, the division of the puboprostatic ligaments was avoided.
DISCUSSION: Uterine prolapse occurs most commonly in multiparous and post-menopausal women because of injury to the endopelvic fascia
and levator ani muscles.
Radzinsky (2006) noted that endopelvic fascia
is continually responding to mechanical stress, metabolism, hormonal and neurological activities.