ABOG Urogynecology and Reconstructive Pelvic Surgery key terms

The medial portion of levator ani arising from the pubic bone and inserting on the perineal body, external anal sphincter, and coccyx; it forms the urogenital hiatus and provides the primary voluntary support to the urethra, vagina, and rectum.

The U-shaped opening in the pelvic floor bounded by the pubovisceral muscle through which the urethra, vagina, and rectum pass; enlargement of this aperture is associated with prolapse and incontinence.

The clinical measurement, in centimeters, of the distance from the external urethral meatus to the posterior margin of the hymenal ring; a widened hiatus reflects perineal and levator injury and predicts prolapse recurrence after surgery.

A fibromuscular mass between the vagina and anus where the bulbospongiosus, superficial and deep transverse perineal muscles, external anal sphincter, and pubovisceral muscle converge; it stabilizes the distal vagina and anal canal.

A fibrous band along the obturator internus fascia running from the pubic bone to the ischial spine; it anchors the anterior vaginal wall's paravaginal attachments, and its detachment produces lateral anterior compartment prolapse.

The connective tissue layer between the anterior vaginal wall and bladder (also called the anterior endopelvic fascia) that, with its lateral attachments, supports the bladder base and proximal urethra; its defects underlie cystocele formation.

Detachment of the lateral anterior vaginal wall from the arcus tendineus fasciae pelvis, producing a lateral cystocele and often stress incontinence; it can be repaired vaginally or retropubically by reattaching the fascia to the arcus.

Tear of the pubovisceral muscle from its pubic origin, usually during vaginal delivery, visible on MRI or ultrasound as loss of muscle attachment; it reduces pelvic floor strength and raises risk of prolapse and recurrence.

A validated, standardized examination system that records nine anatomic points (Aa, Ba, C, D, Bp, Ap, gh, pb, tvl) relative to the hymen, yielding a stage from 0 to IV based on the most distal segment.

Protrusion of the bladder and anterior vaginal wall into or beyond the vaginal introitus, graded by POP-Q point Ba; it may cause a vaginal bulge, incomplete emptying, or occult stress incontinence when reduced.

Herniation of the small bowel through the posterior cul-de-sac between the uterosacral ligaments, presenting as a posterior or apical vaginal bulge; it is distinguished from rectocele by imaging or examination with Valsalva.

Descent of the uterus or vaginal apex (cervix or post-hysterectomy vault) toward or through the introitus, measured as POP-Q point C; failure to support the apex is a common cause of recurrent anterior or posterior prolapse.

Abdominal or laparoscopic suspension of the vaginal apex to the anterior longitudinal ligament of the sacrum using synthetic mesh or graft; it has high durable success for apical prolapse but carries mesh erosion and bowel injury risks.

A vaginal native-tissue apical repair in which sutures placed through the uterosacral ligaments are used to suspend the vaginal vault; ureteral patency must be confirmed because kinking or ligation can occur.

A transvaginal apical suspension that obliterates the posterior cul-de-sac by placing sutures through the uterosacral ligaments and posterior vaginal wall, often incorporating the peritoneum, to prevent enterocele and support the vault.

Leakage of urine with Valsalva that appears only after a prolapse is reduced, because the prolapse had obstructed the urethra; it is unmasked by reduction testing and may warrant a concurrent continence procedure.

The urodynamic finding of involuntary urine loss during filling cystometry with increased abdominal pressure in the absence of detrusor contraction; it confirms the diagnosis of stress incontinence objectively.

Involuntary detrusor contractions during the filling phase of cystometry, which may be spontaneous or provoked; it is the urodynamic hallmark associated with overactive bladder symptoms but may occur without symptoms.

The intravesical pressure at which urine leakage occurs during a graded Valsalva maneuver with a stable detrusor; low values suggest intrinsic sphincter deficiency and predict poorer outcomes with some continence procedures.

A weak urethral closure mechanism, often defined by low Valsalva leak point pressure or low maximal urethral closure pressure, causing stress incontinence even with minimal exertion; it may require a compressive or bulking procedure.

The volume of urine remaining in the bladder after voiding, measured by catheterization or ultrasound; elevated values suggest incomplete emptying from obstruction, detrusor underactivity, or prolapse and guide management.

A noninvasive test that records urine flow rate over time, yielding peak and average flow rates and a flow pattern; a low, prolonged, or intermittent curve suggests bladder outlet obstruction or weak detrusor contraction.

A symptom syndrome of urinary urgency, usually with frequency and nocturia, with or without urgency incontinence, in the absence of infection or other obvious pathology; it is a clinical diagnosis, not a urodynamic one.

Involuntary loss of urine associated with a sudden, compelling desire to void that is difficult to defer; it is the leakage subtype of overactive bladder and is managed with behavioral therapy, medications, and neuromodulation.

A therapy using an implanted electrode at the sacral nerve roots (typically S3) to modulate bladder and bowel reflexes; it is used for refractory urgency, frequency, urgency incontinence, and nonobstructive retention after test stimulation.

A minimally invasive neuromodulation technique in which a needle electrode at the posterior tibial nerve is stimulated in weekly office sessions to treat overactive bladder and fecal urgency; it is an alternative to implanted sacral neuromodulation.

A synthetic mesh tape placed under the midurethra to provide dynamic support and restore continence during stress; retropubic and transobturator routes are common, with risks of bladder injury, retention, and mesh complications.

A substance injected periurethrally or transurethrally to coapt the urethral mucosa and improve closure; it is a low-morbidity option for stress incontinence, especially in intrinsic sphincter deficiency or frail patients, with modest durability.

Migration or exposure of implanted synthetic mesh through the vaginal epithelium, bladder, or rectum, causing discharge, pain, or bleeding; it is managed by excision of exposed mesh and repair, and is more common with concomitant hysterectomy or poor tissue quality.

An immune-mediated or inflammatory response to implanted biologic or synthetic graft material that leads to poor incorporation, fibrosis, or exposure; biologic grafts remodel rather than being rejected in the classic transplant sense.

A macroporous monofilament synthetic material used in prolapse and incontinence surgery; its large pores permit tissue ingrowth and immune cell passage, reducing infection risk compared with microporous materials.

Surgical correction of prolapse using the patient's own fascia and ligaments without implanted mesh or graft; it avoids mesh-related complications but has higher recurrence rates than augmented apical suspension in some populations.

Tearing of the external or internal anal sphincter during vaginal delivery, classified as third- or fourth-degree lacerations; it is a leading cause of fecal incontinence and requires prompt recognition and repair.

Involuntary loss of liquid or solid stool or flatus that causes social or hygienic problems; causes include sphincter injury, pudendal neuropathy, diarrhea, and rectal urgency, and it is assessed with endoanal ultrasound and manometry.

An imaging study using an intrarectal probe to visualize the internal and external anal sphincters and identify defects, thinning, or scarring; it guides sphincter repair planning in fecal incontinence.

A test measuring anal sphincter resting and squeeze pressures, rectal sensation, compliance, and the rectoanal inhibitory reflex; it characterizes sphincter weakness, dyssynergic defecation, and Hirschsprung disease.

A defecatory disorder in which paradoxical contraction or failure of relaxation of the pelvic floor and anal sphincter impedes evacuation; it is diagnosed by manometry, balloon expulsion, or defecography and treated with biofeedback.

A bedside or laboratory test in which a filled balloon in the rectum is expelled to assess the ability to evacuate; failure to expel it within a set time supports a diagnosis of dyssynergic defecation.

A structured program of muscle training, biofeedback, manual therapy, and behavioral instruction to improve strength, coordination, and relaxation of the pelvic floor; it is first-line for stress incontinence, overactive bladder, and defecatory disorders.

A behavioral program using scheduled voiding, gradual interval extension, and urge suppression to increase functional bladder capacity and reduce urgency; it is a first-line treatment for overactive bladder.