Incontinence and Prolapse—An Integrated View John Bidmead  European Urology Supplements  Volume 1, Issue 10, Pages 33-37 (December 2002) DOI: 10.1016/S1569-9056(02)00153-7

Fig. 1 Level I support: The uterus is removed and the cervix is supported by the utero-sacral and cardinal ligament complex and the upper fibres of the paracolpium. European Urology Supplements 2002 1, 33-37DOI: (10.1016/S1569-9056(02)00153-7)

Fig. 2 Level II support: Condensation of the paravaginal fascia is shown, running laterally from the arcus tendineus fascia pelvis over the front and the back of the vagina, which attaches it securely in place. European Urology Supplements 2002 1, 33-37DOI: (10.1016/S1569-9056(02)00153-7)

Fig. 3 Level III support: This is a transverse scan of the vagina showing the normal position of the urethra (anterior), pubic synthesis at the front and the pubic rami. The probe is in the vagina and the lateral fornices of the vagina can be seen and are supported laterally towards the levator fascia. European Urology Supplements 2002 1, 33-37DOI: (10.1016/S1569-9056(02)00153-7)

Fig. 4 This slide shows the same view as Fig. 3 but on an MRI scan. The pubic synthesis can be seen at the front, the urethra in the middle, and the vagina appears as egg-shaped or butterfly-wing shaped. The lateral fornices of the vagina are supported laterally by the fascial attachments of the paravaginal fascia to the arcus tendineus fascia pelvis on the levator fascia. European Urology Supplements 2002 1, 33-37DOI: (10.1016/S1569-9056(02)00153-7)

Fig. 5 Burch colposuspension showing the anterior vagina attached to Cooper’s ligament. This changes the vaginal axis, bringing it to the anterior position, and therefore increases the risk of uterine prolapse or development of an enterocoele. European Urology Supplements 2002 1, 33-37DOI: (10.1016/S1569-9056(02)00153-7)