Cervical assessment at the routine 23-weeks' scan: problems with transabdominal sonography.

OBJECTIVES: To compare transabdominal and transvaginal sonographic measurements of cervical length in pregnancy and examine the factors that may influence these measurements. METHODS: The study population consisted of 149 women with singleton pregnancies attending for routine ultrasound examination at 23 weeks of gestation. In all women the cervix was successfully visualized by transvaginal sonography and cervical length was measured after emptying of the bladder. This measurement was compared to that obtained by transabdominal sonography. In addition the ability to visualize the cervix transabdominally was examined in relation to body mass index (BMI), bladder volume and cervical length. RESULTS: The percentage of cases in which the cervix could be seen transabdominally increased from 42% for bladder volume of < 50 ml to 73% for volumes > 150 ml, and 13% for cervical length < 20 mm to 51% for lengths > 40 mm. The ability to visualize the cervix was unrelated to BMI. Although there was a significant association between measurements taken transabdominally with those made transvaginally, measurements taken with a full bladder were significantly longer than those with an empty bladder. CONCLUSION: The aim of cervical assessment in pregnancy is to identify women with a short cervix because they are at high risk of preterm delivery. This aim can not be fulfilled by transabdominal sonography. Such a scan fails to visualize the cervix in a high proportion of cases and in particular those with a short cervix. Furthermore, successful visualization requires a full bladder which falsely increases cervical length.     

Transvaginal and transabdominal ultrasonography of the uterine cervix during pregnancy.

Transvaginal and transabdominal ultrasound evaluation of the uterine cervix were compared in a study of 186 pregnant women. An empty bladder made transabdominal ultrasound measurement of the cervix more difficult, while bladder filling resulted in significant lengthening of the transabdominal cervical measurement. In contrast, transvaginal ultrasound cervical measurement was possible in all but 1 patient. Normal transvaginal ultrasound cervical measurements were significantly shorter on average than transabdominal cervical measurements, but compared closely with prior transabdominal ultrasound studies in which bladder filling was carefully controlled. Significant cervical shortening was not noted in most patients with a clinical diagnosis of incompetent cervix.     

宫颈腺癌的超声声像图特征研究

目的：探讨经阴道超声检查在宫颈腺癌诊断中的应用价值。方法：回顾性分析首都医科大学附属北京妇产医院 2012年2月—2017 年4月经病理证实宫颈腺癌的病例60例,结合病理结果及分期,对其术前超声声像图特点进行分析。结果：60例宫颈腺癌超声图像中,29例呈现正常宫颈声像图或仅宫颈前后径增大,31例呈现异常宫颈声像图,以宫颈实性低回声肿块、宫颈内膜线回声中断为主要表现。结论：中晚期宫颈腺癌经经阴道超声检查具有宫颈实性低回声肿块,宫颈内膜线回声中断等声像特点。经阴道超声对中、晚期宫颈腺癌有较高的诊断价值, 但对于早期宫颈腺癌有一定的局限性。     

经阴道三维彩色多普勒诊断早期宫颈癌

目的：探讨经阴道三维彩超检查诊断早期宫颈癌（Ⅰb期~Ⅱa期）的应用价值。方法：对96例早期宫颈癌患者和其他150例患者作经阴道三维彩超检查,并与手术、病理结果对照分析。结果：在96例早期宫颈癌患者中,Ⅰb1期67例,Ⅰb2期18例,Ⅱa期11例,其中鳞癌73例,腺癌19例,腺鳞癌4例。肿块大小：5mm×6mm×9mm~32mm×35mm×46mm。在150例对照组中,子宫颈正常组50例,宫颈肌瘤23例,宫颈粘膜下子宫肌瘤16例,颈管息肉11例,宫颈子宫内膜异位囊肿23例,宫颈纳氏囊肿27例。经阴道三维彩超显示宫颈癌宫颈肿块处血管形态分布可分成4型。早期宫颈癌三维阴道彩超诊断符合率为86.5%。结论：经阴道三维彩超能显示宫颈及宫旁组织的立体图像,宫颈处显示的4种血管形态分布对鉴别宫颈肿瘤的良恶性质有较高价值。     

子宫颈微偏腺癌9例临床病理分析

目的探讨子宫颈微偏腺癌(MDAC)的临床病理特征、诊断和鉴别诊断。方法收集9例子宫颈MDAC的临床病理资料,采用HE染色和免疫组化进行观察。结果患者年龄31~56岁(平均47岁),临床上大多表现为多功能性子宫出血、阴道分泌物增多、绝经后阴道流血、腹胀。子宫颈较正常增大、质硬、脆。组织学特点为腺体扭曲、外形不规则,浸润宫颈壁全层,以及纤维组织增生性的间质反应,腺上皮呈CEA阳性。术后随访至2006年10月,5例死于肿瘤复发和广泛转移;3例分别在术后15个月、46个月和8年复发,放疗后至随访期末尚存活;仅1例术后2年未见复发。结论子宫颈MDAC少见,呈侵袭性生物学行为,预后较差,临床和病理上均易误诊为宫颈其他多种良好肿瘤及瘤样病变。     

High frequency transvaginal ultrasonography in preoperative assessment of myometrial invasion in endometrial cancer.

The aim of the study was to assess the depth of myometrial invasion by endometrial cancer using preoperative 5-9 MHz, high frequency transvaginal ultrasonography as compared with postoperative assessment using histopathologic examination. The study included 120 patients with histologically proven cancers of the endometrium. All patients underwent transvaginal sonography before surgery. The depth of myometrial invasion was classified as none, inner half of uterine wall, and outer half of uterine wall. Of 106 (88.3%) patients with proven myometrial invasion, 98 cases (92.5%) were revealed by sonography. In 109 cases (90.8%) invasion was believed to be present on transvaginal sonography. Histologically proven invasion that correlated with sonography was shown in 88 patients (73.3%). In 32 patients (26.7%) ultrasonography could not correctly predict the depth of myometrial invasion. The depth of invasion was underestimated in 10 (8.3%) cases and overestimated in 22 (18.3%) cases. Preoperative assessment of invasion of the uterine wall by transvaginal ultrasonography had an accuracy of 73% if correlated with the definitive histopathologic examination. The role of high frequency transvaginal ultrasonography in preoperative assessment of the depth of myometrial invasion in patients with endometrial cancer is limited.     

宫颈癌血管生成与癌细胞增殖及浸润转移的关系

目的　探讨早期宫颈癌血管生成与癌细胞增殖及浸润转移的关系。方法　采用免疫组织化学 SP法检测75例早期宫颈癌、18例宫颈上皮内瘤样病变 (CIN)和 15例癌旁正常宫颈上皮中微血管密度 (MVD,CD34 标记 )及 Ki- 6 7抗原的表达情况 ,探讨宫颈癌血管生成与癌细胞增殖及浸润转移的关系。结果　 CD34 主要表达于宫颈癌巢间质血管内皮细胞 ,而 Ki- 6 7主要表达于宫颈癌细胞核。从正常宫颈上皮→ CIN→宫颈浸润癌 ,MVD和 Ki- 6 7表达均显著升高 (P<0 .0 5 )。宫颈癌 MVD与盆腔淋巴结转移、脉管浸润、间质浸润和 Ki- 6 7表达有关 (P<0 .0 5 ) ;而与年龄、FIGO分期、组织学分级和组织学类型无关 (P>0 .0 5 )。有盆腔淋巴结转移、脉管浸润、≥深层间质浸润及 Ki- 6 7呈高度表达者 ,其 MVD分别显著高于无盆腔淋巴结转移、无脉管浸润、<深层间质浸润及 Ki- 6 7<高度表达者 (P<0 .0 5 )。结论　肿瘤血管生成可能在宫颈癌发生发展、癌细胞增殖和浸润转移中起重要作用。宫颈癌伴 MVD显著升高者 ,其癌细胞增殖活跃 ,易发生浸润转移 ,但并非唯一决定因素。检测宫颈癌 MVD对进一步了解宫颈癌生物学行为具有一定的临床应用价值。     

Evaluation of the upper uterine cervix by the location of the vesicocervical fold of the urinary bladder to rule out cervical shortening during pregnancy with and without premature contractions.

OBJECTIVES: To measure the length of the upper and lower cervix, as demarcated anatomically by the lowermost edge of the urinary bladder, in second- and third-trimester pregnancies with and without premature contractions. We hypothesized that patients with active premature contractions have a shorter upper cervix, placing them at greater risk of preterm delivery. METHODS: The lengths of the total cervix and of the upper and lower cervix, separately, and funnelling of the internal os, were assessed by endovaginal ultrasonography. In 120 women with normal pregnancy (43 of which with premature contractions), cervical dilatation and effacement were determined by digital examination. The correlation of cervical variables with the course of pregnancy was analyzed by the Wilcoxon test. RESULTS: The mean lengths of the upper and lower cervix were 15.9 +/- 1.7 mm (median 16.0 mm) and 26.4 +/- 3.7 mm (median 27.0 mm), respectively, in patients without premature contractions and 6.9 +/- 3.7 mm (median 6.0 mm) and 24.7 +/- 4.7 mm (median 25.0 mm), respectively, in patients with premature contractions. In the latter subgroup, the upper cervix was significantly shorter (p = 0.0001) but the lower cervix remained almost unchanged. Digital palpation was less accurate than transvaginal sonography for evaluating total cervical length. CONCLUSIONS: Transvaginal sonography is the method of choice for assessing cervical changes during pregnancy. In this prospective study, upper cervical length was the best predictor of preterm labor of all cervical parameters studied. Its length could be accurately determined by the location of the lowermost edge of the urinary bladder (vesicocervical fold of the bladder).     

宫颈绒毛腺管状腺癌的临床病理

  目的  探讨宫颈绒毛腺管状腺癌的临床病理特征、诊断标准及预后。  方法  分析北京协和医院10例宫颈绒毛腺管状腺癌的临床病理表现, 临床资料包括年龄、症状、术前检查、国际妇产科联盟(International Federation of Gynecology Obstetrics, FIGO)分期、治疗方式及随访结果, 病理表现包括大体表现、颈管浸润程度、有无淋巴结转移及淋巴脉管内瘤栓、组织学分型、核异型性、核分裂及伴随病变。  结果  10例患者平均发病年龄为39岁; 8例FIGO分期Ib1, 1例IIa, 1例Ia1;手术方式为全子宫切除+盆腔淋巴结清扫术+双附件切除术/卵巢活检术; 术后平均随访29个月, 8例健康生存, 1例复发, 1例失访。大体观察, 5例呈息肉样或菜花状外生性肿物, 直径5~25 mm; 4例呈乳头状或细绒毛样粗糙区, 面积25 mm×14 mm至35 mm×20 mm; 1例术后转移病例表现为溃疡型肿物, 直径25 mm。镜下肿瘤浸润深度2~12 mm, 浸润宽度5~26 mm, 1例累及阴道后穹窿; 9例有轻-中度核异型性, 术后转移1例病例呈中-重度核异型性; 核分裂平均48个/10高倍视野(HPF); 9例伴有宫颈上皮内瘤变Ⅲ级(cervical intraepithelial neoplasia Ⅲ, CIN Ⅲ)和/或原位腺癌(adenocarcinoma in situ, ACIS), 2例同时伴有高分化黏液腺癌; 1例观察到宫颈壁内个别淋巴脉管内瘤栓。10例均未发现子宫体受累、盆腔淋巴结或卵巢转移。  结论  宫颈绒毛腺管状腺癌的预后整体较好。提示预后不良的病理指标除了宫颈管壁深层浸润、累及宫体、血管浸润、淋巴结转移外, 还包括肿瘤细胞重度异型性和/或合并其他恶性程度更高的肿瘤成分。     

Three-dimensional power Doppler imaging of early-stage cervical cancer.

OBJECTIVES: To characterize intratumoral vascularization in early-stage cervical cancer by three-dimensional (3D) power Doppler ultrasound. METHODS: One hundred and forty-one patients with carcinoma of the uterine cervix and 30 normal controls were studied by transvaginal 3D power Doppler ultrasound. The tumor volume of the cervical cancer was determined. The blood flow within the tumor or normal cervix was measured and expressed as the vascularization index (VI), flow index (FI) and vascularization flow index (VFI). RESULTS: Of the 141 patients with cervical cancer, 44 patients had undergone prior cervical conization. Eighty-seven patients had measurable cervical tumors, of whom five had had prior conization. Abundant intratumoral power Doppler signals could be detected, and the VI, FI and VFI were significantly elevated in cervical cancer patients compared with women with a normal cervix and patients in whom no cervical tumor could be detected (P < 0.05, one-way ANOVA). We observed four types of intratumoral vascularity patterns, which did not significantly differ in VI, FI and VFI: localized, peripheral, scattered and single-vessel types. Cervical tumor volume was positively correlated with FI (linear regression, r = 0.373, P = 0.001), but not with VI or VFI. CONCLUSIONS: 3D power Doppler ultrasound provides a useful tool to investigate intratumoral vascularization and volume of cervical cancer.     

A new parameter for staging bladder carcinoma: ultrasonographic contact length and height-to-length ratio.

OBJECTIVE: The purpose of this study was to investigate the value of tumor-bladder wall contact length (CL), tumor height (H), and height-to-length ratio (H/CL) for preoperative staging of bladder carcinoma. METHODS: Fifty-seven patients with bladder tumors underwent suprapubic ultrasonography preoperatively, and the CL of the tumor with the bladder wall and H in the bladder lumen were measured. The CL, H, and H/CL values were correlated with the wall invasion determined by histopathologic analysis of the cystectomy material. Invasion was staged according to the TNM classification system. RESULTS: Statistically significant differences were found for CL (P < .001) and H/CL (P = .001) between the superficial and invasive tumor groups. These parameters were also effective for differentiating superficial or deep muscle invasion. A CL of greater than 41.5 mm and an H/CL of less than 0.605 were calculated as cutoff values for differentiating superficial and invasive tumors. Height had no value for determining invasion. CONCLUSIONS: The ultrasonographic measurements of CL of the tumor with the bladder wall and H/CL may be useful for staging bladder carcinoma by verification of these findings in larger groups of patients.     

PPAR-γ在子宫颈癌组织中的表达及意义

目的探讨子宫颈癌组织中过氧物酶体增殖体激活受体-γ（PPAR-γ）蛋白质的表达及其意义。方法应用PPAIR-γ多克隆抗体以免疫组化SABC法检测25例子宫颈癌组织、20例子宫颈上皮内瘤样病变及11例正常宫颈组织石腊切片PPAR-γ蛋白质的表达,并结合有无淋巴结转移和临床分期探讨其意义。结果正常宫颈组织、子宫颈上皮内瘤样病变和子宫颈癌组织中PPAR-γ的表达明显逐渐升高（P〈0．05）,在有无淋巴结转移及不同临床分期的子宫颈癌组织中PPAR-γ的表达无明显差异（P〉0．05）。结论提示PPAR-γ可能与子宫颈癌的发生及进展有关,可能做为治疗子宫颈癌的分子靶点。     

血清中CYFRA21-1和SCCAg水平对宫颈癌放疗患者预后的评价作用

目的探讨宫颈癌患者血清中细胞角蛋白19片段抗原(CYFRA21-1)和鳞状上皮细胞癌抗原(SCCAg)水平对宫颈癌放疗患者肿瘤预后的影响。方法选取2008年10月至2011年10月间在该院经病理检查确诊宫颈癌的患者100例。采用放射免疫检测法检测患者血清中CYFRA21-1和SCCAg水平,采用Pearson和Spearman相关性探讨血清中CYFRA21-1和SCCAg水平与宫颈癌患者临床特征的关系,采用COX回归模型探讨CYFRA21-1和SCCAg水平与子宫颈癌患者死亡或转移复发的关系。结果 100例宫颈癌患者,出现终点事件者21例,淋巴结转移率(LNR)4期患者出现终点事件的风险较高,约45.5%,CYFRA21-1和SCCAg水平均与宫颈癌患者癌胚抗原125(CA125)、肿瘤N分期、肿瘤浸润深度呈正相关,与患者年龄无明显相关。肿瘤分化程度(P=0.013)、血清CYFRA21-1水平(P=0.02)、血清SCCAg水平(P=0.03)、肿瘤浸润深度(P=0.04)是宫颈癌患者出现终点事件的独立危险因素。结论 CYFRA21-1和SCCAg水平与宫颈癌放疗患者预后密切相关。     

Color Doppler velocimetry and three-dimensional color power angiography of cervical carcinoma.

OBJECTIVES: To investigate the blood flow within invasive cervical carcinoma by transvaginal two-dimensional (2D) color spectral Doppler and three-dimensional (3D) color power angiography and to correlate these parameters with the clinicopathological characteristics. METHODS: Seventy-four patients with invasive cervical carcinoma were enrolled for the analysis. Squamous cell carcinoma serum antigen levels (SCC) were obtained for all the patients. Sections of all malignant tissues were analyzed for tumor expression of cyclooxygenase-2 (COX-2). All patients underwent color and spectral Doppler examination and 44 patients had 3D color power angiography. Color spectral Doppler parameters (color score, lowest resistance index (RI), highest peak systolic velocity (PSV)) and 3D color power angiography indices (relative color, average color, flow measure) of FIGO I/II cervical cancers were compared with those obtained in a control group of 24 patients with a normal uterine cervix. Pulsed Doppler parameters and the 3D vascular indices were compared with clinicopathological parameters, SCC serum antigen levels and tumor COX-2 expression. RESULTS: At color Doppler analysis 72 patients (97%) showed intralesional detectable vessels. Color spectral Doppler and 3D-derived parameters were significantly different in FIGO I/II cervical cancers compared with those in women with a normal cervix. A significantly higher color score (P = 0.0008), lower RI (P = 0.032) and higher PSV (P = 0.004) were associated with a tumor diameter > or =4 cm compared with smaller tumors. The highest PSV was significantly higher in patients with FIGO stage III/IV compared with FIGO stage I/II (P = 0.0069). There was a direct correlation between PSV and SCC (r = +0.44, P = 0.003). The median relative color was significantly higher in patients with a higher color score (P = 0.0006). No statistically significant correlations were found between 3D color power angiography parameters and the clinicopathological characteristics or between the 3D vascular parameters and biological factors. CONCLUSIONS: Alterations of 3D ultrasound-derived vascular indices were found in patients with cervical cancer compared with those with a normal cervix. Moreover, some vascular indices proved to be associated with tumor size. The assessment of a possible clinical role of 2D and 3D ultrasound-derived vascular indices in cervical cancer deserves further investigation.     

阴道镜在早期宫颈癌及癌前病变诊断中的价值

目的探讨阴道镜检查在早期宫颈癌及癌前病变诊断中的价值。方法回顾性分析江西省妇幼保健院阴道镜下活检患者470例临床资料,以病理检查为金标准,其中阴道镜下宫颈活检证实为早期宫颈癌及癌前期病变的患者120例;非宫颈癌及癌前病变患者350例。采用诊断试验四格表法分析阴道镜检查的各项评价指标。结果阴道镜对宫颈癌及癌前病变诊断灵敏度为80．83％,特异度为91．43％;随病变程度的增加阴道镜诊断的阳性率增加。结论电子阴道镜检查对早期宫颈癌及癌前期病变有很高的诊断价值,可考虑用于宫颈癌的筛查。     

血管内皮生长因子C在宫颈癌中的表达及其与淋巴转移的关系

目的分析正常宫颈，宫颈上皮内瘤样病变，无淋巴结转移，有淋巴结转移组的宫颈鳞癌组织中VEGF-C的表达。方法收集84例正常宫颈组织，宫颈上皮内瘤样病变和宫颈鳞癌组织（按有无淋巴转移、分化及临床分期分组）。进行SP免疫组化染色，测定VEGF-C蛋白的表达。结果VEGF-C表达主要位于肿瘤细胞胞浆及胞膜内。它在正常宫颈、CIN及宫颈鳞癌组织中的表达依次增高，有淋巴结转移组较无淋巴结转移组中VEGF-C的表达显著增高。VEGF-C的表达与患者的临床分期无关（P〉0．05），与富颈癌的病理分级呈负相关。结论提示VEGF-C有促进宫颈癌发展、促进淋巴管生成、抑制癌细胞分化的作用。由于VEGF-C与淋巴道转移的密切关系，故可在临床工作中通过检测宫颈癌活检组织中VEGF-C的表达估计其预后，为宫颈癌的治疗提供新策略。     

A prospective comparative study of transvaginal ultrasonography and digital examination for cervical assessment in the third trimester of pregnancy.

Digital examination of the cervix has traditionally been the "gold standard" for cervical assessment. However, it can be subject to inter- as well as intra-observer variation. The usefulness of transvaginal ultrasonography for cervical assessment is examined in this study. Although differences between measurements of transvaginal ultrasonography and digital examinations were observed, transvaginal ultrasonography appears to be a potentially useful and reproducible technique for assessing cervical changes in pregnancy and for prediction of onset of labor.     

子宫内膜癌经阴道超声表现与肌层浸润深度的相关性研究

目的探讨子宫内膜癌经阴道超声表现与病理诊断肌层浸润深度的相关性。方法46例子宫内膜癌术前均经阴道超声观测子宫三径之和、宫内膜厚度、彩色血流分布特点及血流阻力指数。根据病理检查肌层浸润深度分为Ⅰa期9例,Ib期22例,IC期15例。结果子宫三径之和为12．9～27．4cm,宫内膜厚度为4．7～65．0mm,在Ⅰa期、Ⅰb期、Ⅰc期的子宫三径之和、宫内膜厚度逐渐增大,差异有统计学意义（P〈0．05）。37例探及血流信号,血流显示率80．4％;Ⅰa、Ⅰb期、Ⅰc期血流显示率逐渐增大,差异有统计学意义（P〈0．05）。肌层浸润越深,阻力指数越低,各期比较无统计学差异（P〉0．05）。结论子宫内膜癌经阴道超声表现与病理诊断肌层浸润深度相关,经阴道超声检查可作为子宫内膜癌的术前检查方法。     

Does transvaginal sonographic measurement of cervical length before 14 weeks predict preterm delivery in high-risk pregnancies?

OBJECTIVE: To determine whether high-risk patients manifest cervical length < 25 mm on transvaginal ultrasound before 14 weeks of gestation, and if this finding is predictive of preterm delivery. METHODS: Asymptomatic pregnancies at high risk for preterm birth were followed prospectively from 10 + 0 weeks to 13 + 6 weeks with transvaginal sonographic measurement of the cervix. A cervical length < 25 mm was considered a short cervix at this gestational age and at the follow-up ultrasound examinations, performed between 14 and 24 weeks. The primary outcome was preterm birth at < 35 weeks of gestation. RESULTS: One hundred and eighty-three pregnancies met the study criteria and were included in the analysis. Only 10 (5%) patients had a cervix < 25 mm before 14 weeks. The sensitivity, specificity and positive and negative predictive values of a short cervix were 14%, 97%, 50%, and 82%, respectively (relative risk, 2.8; 95% confidence interval, 1.4-5.6). The mean transvaginal sonographic cervical length before 14 weeks of gestation was 33.7 +/- 6.9 mm in pregnancies which delivered preterm (n = 36), and 35.0 +/- 6.8 mm in those delivering at term (n = 147) (P = 0.3). Follow-up transvaginal ultrasound examination of the cervix to 24 weeks revealed that the average gestational age at which a short cervix was detected was 18.7 +/- 2.9 weeks. CONCLUSION: A cervical length < 25 mm on transvaginal sonographic assessment rarely occurs before 14 weeks even in high-risk patients destined to deliver preterm; in these patients cervical changes predictive of preterm birth develop mostly after this gestational age.     

Pathogenesis of urethral funneling in women with stress urinary incontinence assessed by introital ultrasound.

OBJECTIVE: The incidence of urethral funneling (UF) seen in women with stress urinary incontinence (SUI) during straining is reported to range from 18.6% to 97.4%. Its morphologic basis is unknown. The aim of the present study was to determine whether SUI patients with and without UF differ in terms of history, urodynamic results and magnetic resonance imaging (MRI) findings. PATIENTS AND METHODS: Fifty-four women (mean age 52 +/- 11 years) with a history of SUI confirmed by clinical and urodynamic findings were included in the study. UF was demonstrated by introital ultrasound performed at a bladder filling volume of 300 mL during maximal straining. MRI for assessment of the urethra, levator ani muscle and endopelvic fascia was performed using axial proton-density-weighted sequences. RESULTS: UF was demonstrated by introital ultrasound in 59% of the patients with SUI (Group 1) and was absent in 41% (Group 2). There were no differences between the two groups in mean age (P = 0.208), the incidence of mild prolapse of the anterior vaginal wall (Aa, Ba; stage I; P = 0.741), and urodynamic parameters (urethral closure pressure at rest; P = 0.507). The percentages of nulliparous and parous women were 22% and 78% in Group 1 and 54% and 46% in Group 2 (P = 0.013). The two groups did not differ in the MRI demonstration of morphologic defects of the urethra, levator ani muscle and endopelvic fascia or of combined defects. CONCLUSIONS: The results of the present study did not elucidate the pathogenesis of UF. The demonstration of UF crucially depends on the examination technique employed.